Wednesday, November 21, 2007

a good death?

in my new job, I’m working on a project that has to do with end-of-life issues, and in particular, improving the quality of dying and death. this may sound strange – how can dying and death be improved? but put children in the mix and it becomes even stranger. the question we are trying to answer is: what would a “good death” look like for a child?

this question, on the surface, seems like an oxymoron. a good death for a child? it is never good that a child dies. it cannot be good. so how can there possibly be such a thing as a good death for a child?

as I start to research this issue, it appears that there can be a “good death” for an adult. it’s easy to imagine a person, at the end of a long, fulfilling life, surrounded by family and friends, proud of his or her accomplishments, spending his/her last few days, without pain, quietly reflecting, saying goodbye, and so forth. as deaths go, this could be a “good death.”

but for a child? again, it seems like an oxymoron. a child, by the mere fact of being a child, hasn’t had a long and fulfilling life. they may have friends and family, but they haven’t had time to accumulate the accomplishments of a lifetime. they haven’t been able to reproduce. they haven’t been able to marry. so the looking back that takes place, if it does at all, is over a much shorter span of time. and the child might not even have the capacity to look back over his/her life.

looking at the more clinical literature, features of a good death start to appear. some examples are, focus on the dying patient’s needs and respect for his/her preferences regarding treatment, etc., giving the dying patient as much control as possible over decision making, sharing information as openly as possible, and so forth.

so again, the question arises: what would a good death look like for a child?

many of these activities simply cannot be done with a child, for example, what is a child’s preference in terms of treatment? how would one give a child as much control as possible? how about sharing information? these goals can happen with a child, but more thought needs to be given as how to achieve these goals with a child, especially with a very young child.

because, when dealing with a young child, you are actually dealing much more with the family, the family as a unit becomes more central in the care. this is not just a child that is dying – it is a child and a family that is experiencing the dying. so what can be done to best support the family, as well as the child, at this time?

if there are choices, even simple ones to make about treatment, let the child have a say; give the child control over things he/she can control; be honest, since children know anyway and would rather know the truth than be told lies.

(this is something I wrote last February, just a month after I started my new position.)

2 comments:

Sarcastic Mom (aka Lotus) said...

Sorry, to put this here, but I'm in a hurry, and I figured it's a good place?

The meme's FINALLy up! ;-)

Tagged Like Gangbusters

Happy Thanksgiving!

nachtwache said...

Ah yes, happy Thanksgiving!
I'll work on my meme this weekend, promise. :)

If people have a faith were they believe in life after death, especially 'heaven', they can look forward to something better. That sure helps!
Does your faith help you in your job?