Bear Witness to the End:
When a patient can accept a measure of her own death, even to a small degree, what they ask about can be a big challenge.
Talking about dying is not what most clinicians outside of hospice expect to cover. But when you are the one your patient trusts, they will ask you—about hastening death, about what it’s like to die, and about saying goodbye. These conversations can be scary for clinicians who haven’t cultivated their skills—but paradoxically, deeply satisfying for clinicians who can create a safe space for patients, hold their own emotions in a way that serves themselves and their patients, and draw on experience of having seen this phase of living and dying firsthand.
We don’t have maps for most of these conversations: we let our patients lead. Yet there are two situations where we find a talking map to be a useful scaffold. The first situation is when a patient requests a hastened death—also called ‘aid-in-dying’ or ‘assisted suicide’ or ‘euthanasia.’ Only in a handful of US states is there legislation that enables patients to use medical means to hasten their death. The question, however, comes up everywhere, and our talking map is designed to enable clinicians regardless of whether a Death with Dignity law is available.
The second talking map is useful is designed for the moment when a clinician decides to say goodbye to a patient near the end of life whom they might not see again. Originally published in the Annals of Internal Medicine, this talking map frames goodbye as an appreciation. Tell your patient what you’ve enjoyed about working with them, remind them of what they taught you, leave them with a sense that you’ll be a better clinician because of them. And if they come back for another visit—they won’t mind if you tell them again.