Awareness of Dying by Barney G. Glaser

By Barney G. Glaser

Should still sufferers be informed they're loss of life? How do households react while one among their participants is dealing with demise? Who should still display that loss of life is coming near near? How does medical institution staff-doctors, nurses, and attendants-act towards the loss of life sufferer and his relations?

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When a patient is defined as certain to die within a few days, nurses tend to focus their conversation with him on. the immediate. present, discussing such matters as current doses of medication for pain relief or other topics relevant to his comfort. But if they do not antici­ 38 PART TWO: TYPES OP AWARENESS CONTEXTS pate death for some time, then they will extend the temporal range implied in their talk. ” Another told a patient that he would need another X ray in two weeks. Similarly, they talk about blood tests to be done next week, or about the family’s impending visit.

Many a hospital patient poses for the staff both questions simultaneously: Is this patient going to die here, and when? ” Even more specifically, let us say that certainty of death means the degree to which the defining person (physician, nurse, or even the patient himself) is convinced that the patient will die. Let us say that tim e of death means the expectation of either (a ) when the certain death will occur, or (b ) when the un­ certainty about death will be resolved. Time units can be from minutes to months, varying with the nature of the illness and the patienfs location in the hospital.

Of course a correct interpretation is offered when the staff member judges it will neither disclose nor arouse suspicions of terminality. A patient near death, for instance, may be moved to a special space or room, but is informed that this move is only to permit more intensive care. A patient may even be sent home to die on request of his family, but his discharge from the hos­ pital is explained in quite other terms. Occasionally the physician will give a patient an incorrect or incomplete diagnosis to explain his symptoms— as in one instance when a patient was discovered, through a diagnostic operation, to have incurable cancer of the pancreas but was sent home with a diagnosis of diabetes and given instructions in the use of insulin.

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