Becoming better ‘dying’ healthcare workers
*Paul J Moon
Palliative Care, Alacare Home Health & Hospice Birmingham AL, United States
Paul J Moon
Palliative Care, Alacare Home Health & Hospice Birmingham AL
Published on: 2017-08-11
Introduction: Healthcare workers are not immune to death-anxiety and fear of mortality.
Such dynamics have been shown to hinder more transparent interactions between professional
caregivers and care-recipients.
Discussion: Practical means to becoming better ‘dying’ healthcare workers include
thinking deeply and regularly on one’s own mortality as well as courageously and openly
engaging in death-talks with others, including care-recipients. Approaches to cultivating
these aims are offered.
Conclusion: Healthcare workers are urged to be more intent on knowing own mortality
in order to better engage with care-recipients on necessary conversations of their mortal end.
A way to improve healthcare service to others will be rendered by becoming a healthcare
worker who is better self-aware, by practical methods, of one’s own, and others’, terminality.
Healthcare, Death, Mortality, Practice
It may be argued that the best, most credible and evidence-based healthcare practice in the modern world remains nothing more than an exercise in delaying the inevitable, unavoidable and intractable actuality of human demise and death. As one physician confessed of the “ultimate impotence of medicine as a cure for death,”  (1388) this innate human condition cannot be refuted. But, we nevertheless try. Even healthcare workers, who know better in light of education, training, and related personal and professional experiences, in effect, refute pending mortality by keeping mum on the subject or, worse yet, wielding euphemisms or code words (expired, passed, in a better place, etc.).  Setting aside self-defense mechanisms, it is asked: Is it a good act to withhold truth from another person? If so, then on what basis does anyone have such authority to withhold? And, if others withhold truth from you, then do you have any basis to complain?
Truth-telling is a vital component of healthcare practice [3,4] and, in the modern day, care-recipients have a right to be informed of the truth of their health status. [5,6] Although technological and knowledge innovations are commendable in healthcare fields, the critical element of honest communication can be imperiled by same kind of creativity. In fact, it has been proposed that the next “medical innovation”  (para. 5) needs to be healthcare workers explicitly accepting the fact that all mortals shall die. But why would this be an innovative turn? It would be so as the overarching social milieu in which healthcare is practiced in the western world is still characterized by dynamics of death-avoidance,  death-denial,  death-defiance, [9, 10] and death-management. 
The aim proposed here is for becoming better ‘dying’ healthcare workers. In other words, the news and verity of human mortality must become an unhindered, un-euphemized and unmitigated verbiage and diction that is part and parcel of routine speech and discourse in personal and professional affairs for healthcare workers as they intentionally labor to deepen the confession of their own mortal status. Reaching this objective will call for particular self-awareness, which has been indicated as a benefit for healthcare workers in coping with death occurrences.  Such demeanor will eventually serve healthcare workers’ public deportment when interfacing care-recipients who are to be informed of their health condition and prognosis. There is no magic wand or on-off switch for normalizing this mentality and discourse. Rather, it requires due introspection and conscientious practice.
Thinking deeply and regularly on one’s own mortality
Acts of deep and deliberate reflection is held to be a core aspect of adult learning.  As healthcare workers are to be lifelong learners,  exercising personal reflection is deemed a necessity as it can cultivate a clearer insight into own held beliefs, which is vital knowledge for effective careers. [15,16] Here, the more specific notion of reflecting on oneself is emphasized, along with the topical focus of such reflection, namely one’s own mortality.
Thinking intently on one’s own impending demise and death is one path to becoming a better dying healthcare worker. Although it has become trite to remark all human beings are constantly, incrementally dying, it is nevertheless true. It is undeniably true. As such, this ‘mortal’ truth lurks within and behind all conversations healthcare workers have with care-recipients concerning health status and projections.
However, why is intentional reflection on one’s own mortality important to be of good service to others? Kastenbaum averred that life cannot be adequately comprehended unless death is also carefully considered. Moreover, Herman Feifel, perhaps the father of death studies, asserted that existential maturity involves recognizing limitations and that knowing oneself (self-knowledge) requires acceptance of eventual personal death. In fact, Feifel stated that “our future mandate is to extend our grasp of how death can serve life.”(542) For healthcare workers, pondering deeply and regularly on one’s own mortality is to gradually become more informed that every transaction with care-recipients is fundamentally an engagement between two constantly, incrementally dying persons. From this stance, talking about death is (should be) as natural as talking about living.
In 2008, I published a piece on a discourse called death-talks.  In the article, practical strategies were described towards physicians (and other healthcare workers) becoming more self-informed and prepared in order to improve engagement with sick persons and family members on conversations regarding dismal news and terminal prognosis. Those strategies are writing subjectivity statements, maintaining a personal journal, and mentoring and group discussions (see Moon article for details). 
In addition, three more pragmatic recommendations are offered here for sake of becoming more conscientious of assured mortality, which can help with more genuinely conversing with others. First, healthcare workers can complete a personal loss history (see Worden, pp. 254-255, for sample outline of loss history).  Akin to a medical history, one can recount important death-losses by listing names of decedents, loss dates, and specific notations, such as key dynamics of postloss grief, what helped to ease the grief, how honesty from others impacted that experience, etc. Again, as one’s medical history can assist in grasping a better understanding of current status, completing a loss history may clarify one’s current status regarding views of mortality and attitude towards talking with others of pending death or terminal condition.
As healthcare workers, another useful tactic is to attend funerals more conscientiously. In addition to a salutary impact upon grieving family members by healthcare professionals being present at the funeral,  such practice can mean the exercising of greater awareness of one’s own internal states and thoughts during funeral proceedings as well as more keenly observing the unfolding dynamics when engaging with others in such settings. Giving of condolences, extending encouragements, allowing of silences, and perhaps weeping alongside others, are all good gestures that can aid healthcare workers to better recognize one’s responses to sorrowful circumstances and how meaningful survival can still be nurtured in the midst of death observations and bereavement.
Thirdly, healthcare workers can labor to get one’s house in order. Actually, processing personal advance directives, drafting an obituary, outlining one’s funeral agenda, and the like, can all come in handy for purpose of gradual conviction of the impending death-outcome of self,  as well as learning to be more open with others about unfavorable facts of the shared human condition. Active preparation for personal mortality can be an impactful object lesson for other-observers. Yet, at the core, healthcare workers attentively preparing for their own demise and eventual fatality will enable a more primed frame of reference during death-talks with care-recipients and others.
The notion of Ars moriendi is still relevant in modern culture. The preceding refers to the ‘art of dying’, which, in origin, was a tract of guidelines for a Christian manner of dying. Per logic, however, such artful practice of accepting mortality can only be more richly done after admitting tempus fugit, mors venit or time flies, death nears. Hence, this brief presentation was aimed at urging healthcare workers to be more intent on knowing own mortality in order to better engage with care-recipients on necessary conversations of their mortal end. As such, an improved service to others will be rendered by becoming a better (conscientiously) dying healthcare worker.
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