The obligation of “perjury” in relation to incurable and dying patients was a deontological (from the Greek deоn - duty, logos - word, teaching) norm of Soviet medicine. The doctor’s right to “perjury” in the name of ensuring the right of a terminally ill person to ignorance was considered as a feature of professional medical ethics in comparison with universal morality.
The basis for this feature is quite serious arguments. One of them is the role of the psycho-emotional factor of faith in the possibility of recovery, maintaining the struggle for life, and preventing severe mental despair. Since the fear of death was believed to hasten death by weakening the body in its fight against disease, reporting the true diagnosis of a disease was considered tantamount to a death sentence. However, there are cases where lying has done more harm than good. Objective doubts about the well-being of the outcome of the disease cause the patient anxiety and mistrust of the doctor. The attitude and reaction to the disease in patients is different; they depend on the emotional and psychological makeup and on the value and worldview culture of the person.
Is it possible to reveal the diagnosis to the patient or relatives? Maybe we should keep it a secret? Or is it advisable to inform the patient of a less traumatic diagnosis? What should be the measure of truth? These questions will inevitably arise as long as there is healing and death.
Currently Russian specialists Numerous are available foreign research psychology of terminal patients (terminus - end, limit). The conclusions and recommendations of scientists, as a rule, do not coincide with the principles of Soviet deontology. Studying the psychological state of terminally ill patients who learned about their terminal illness, Dr. E. Kübler-Ross and her colleagues came to the creation of the concept of “death as a stage of growth.” This concept is schematically represented by five stages through which a dying person (usually an unbeliever) passes. The first stage is the “stage of denial” (“no, not me,” “it’s not cancer”); the second stage is “protest” (“why me?”); the third stage is “request for a delay” (“not yet”, “a little more”), the fourth stage is “depression” (“yes, I’m dying”), and the last stage is “acceptance” (“let it be”) .
The “acceptance” stage is noteworthy. According to experts, the emotional and psychological state of the patient at this stage changes fundamentally. The characteristics of this stage include the following typical statements of once prosperous people: “In the last three months I have lived more and better than in my entire life.” Surgeon Robert Mack, a patient with inoperable lung cancer, describing his experiences - fear, confusion, despair, ultimately states: “I am happier than I have ever been before. These days are now actually the most good days of my life". One Protestant minister, describing his terminal illness, calls it " happiest time of my life". As a result, Dr. E. Kübler-Ross writes that she “wished that the cause of her death was cancer; she does not want to miss out on the period of personal growth that terminal illness brings with it.” This position is the result of awareness of the drama of human existence: only in the face of death is the meaning of life and death revealed to a person.
The results of scientific medical and psychological research coincide with the Christian attitude towards a dying person. Orthodoxy does not accept false testimony at the bedside of a hopelessly ill, dying person. “Concealing information about a serious condition from a patient under the pretext of preserving it mental comfort often deprives the dying person of the opportunity to consciously prepare for death and spiritual consolation gained through participation in the sacraments of the Church, and also clouds his relationships with relatives and doctors with mistrust.”
Within the framework of the Christian worldview, death is the door to the space of eternity. Deadly disease is extremely significant event in life, this is preparation for death and reconciliation with death, this is an opportunity to repent, pray to God for the forgiveness of sins, this is deepening into oneself, intense spiritual and prayer work, this is the exit of the soul into a certain new qualitative state. Therefore, it is unlikely that an Orthodox person will be surprised by the prayers to God of Elder Porfiry from the monastery in Milesi about the sending down of cancer to him and about his joy in the disease, given to him at his request.
On this occasion, Abbot Nikon (Vorobiev, † 1963), one of the spiritual elders of our century, once wrote that cancer, from his point of view, is God’s mercy to man. A person doomed to death refuses vain and sinful pleasures, his mind is occupied with one thing: he knows that death is already close, already inevitable, and only cares about preparing for it - reconciliation with everyone, correction of himself, and most importantly - sincere repentance before God. Revealing the content and meaning of the Christian understanding of the harmfulness of false witness, the meaning of illness and death becomes the basis for many domestic doctors to revise the deontological norms of Soviet medical deontology. Metropolitan Anthony of Sourozh, himself a former doctor, believes that we need to pay attention modern doctors that during the illness ( we're talking about about incurable diseases) a person must be prepared for death. At the same time, Bishop Anthony says: “Prepare the dying not for death, but for eternal life» .
Arguing that a doctor’s attitude towards incurable and dying patients cannot be simply scientific, that this attitude always includes compassion, pity, respect for a person, readiness to alleviate his suffering, readiness to prolong his life, Metropolitan Anthony of Sourozh draws attention to one “unscientific “approach - on skill and “readiness to let a person die.”
In 1992, the Council of Bishops of the Russian Orthodox Church canonized Grand Duchess Elizaveta Feodorovna (widow of Grand Duke Sergei Alexandrovich, son of Emperor Alexander II, killed by a terrorist in 1905). In 1909, she created the Martha and Mary Convent of Mercy in Moscow, where she was not just an abbess, but participated in all its affairs as an ordinary sister of mercy - she assisted during operations, made bandages, consoled the sick, believing at the same time: “It is immoral to console the dying with false hope for recovery, it is better to help them move into eternity in a Christian way.”
Kalinovsky P. Transition. // The last illness, death and after. Ekaterinburg, 1994. P. 125.
Basics social concept Russian Orthodox Church. // Information bulletin of the DECR of the Moscow Patriarchate. 2000. No. 8. P. 82.
Monk Agapius. The divine flame kindled in my heart by Elder Porfiry. M.: Publishing house Sretensky Monastery, 2000. P. 56.
Metropolitan Anthony of Sourozh. Healing the body and saving the soul. // Human. 1995. No. 5. P. 113.
Death loved one- one of the most difficult and serious tests that can only happen in life. If you had to face this misfortune, then it is stupid to advise you to “pull yourself together.” At first it will not be easy to accept the loss, but you have the opportunity not to plunge deeper into your condition and try to cope with stress. As practice shows, it is impossible to fully prepare for death dear person, even if he was sick, and such an outcome had already been determined by doctors. Such a loss usually results in serious emotional distress and depression. After this, the grieving person himself may, as it were, “fall out of life” for a long period of time. Unfortunately, there is no fast way to get out of the depressed state provoked by the death of a loved one, however, it is necessary to take measures to ensure that this misfortune does not result in a severe form of depression for you. Typically after death close relative or a friend, people begin to feel guilty, feeling that they did not do all the good for the deceased that he deserved. Many thoughts related to the deceased person scroll through the head, which causes general depression.
4 stages of grief
1. Shock and shock. For some, this stage may last a few minutes, while others plunge into a similar state for many days. A person cannot fully comprehend what has happened; it is as if he is in a “frozen” state. From the outside it may even seem that the tragic incident did not have much impact on him, but in fact he is simply in the deepest shock. 2. Rejection and complete denial, depression. The person does not want to accept what happened and think about what will happen next. The realization that life will never be the same again seems terrible to him, and he tries in every possible way to forget himself, just not to think about what happened. From the outside it may seem that the person is numb. He either avoids or does not support all conversations about loss. However, there is another extreme - increased fussiness. In the second case, the mourner actively begins to engage in some kind of business - sorting through the things of the deceased, finding out all the circumstances of the tragedy, organizing a funeral, and so on. As a result, sooner or later the understanding comes that life has changed dramatically, which leads to stress, and then to depression. 3. Awareness of loss. The full realization of what happened comes. It can happen completely suddenly. For example, a person involuntarily reaches for the phone to call a relative or friend, and suddenly understands why this is no longer possible. Also, awareness can come gradually. Having passed the stage of denial, a person begins to replay in his head many events related to the deceased. This stage may be accompanied by outbursts of anger and resentment. What is happening seems unfair and nightmarish, and the awareness of the irreparable situation angers and worries. Many options are being considered in which the outcome could have been different. The person begins to get angry with himself, believing that it was in his power to prevent the misfortune. He also pushes other people away, becoming irritable and depressed. 4. Acceptance and mourning. This stage usually occurs within a few months. In particularly difficult cases, the situation may drag on. Having gone through the most acute stages of grief, a person begins to come to terms with what happened. His life has been flowing in a different direction for some time, and he is beginning to get used to it, gradually “rebuilding.” Memories of the deceased make him sad, and periodically he mourns a dear person.
2. Take care and take care of yourself Many people experiencing the pain of loss give up on their appearance and in general – for any kind of self-care. And yet, this is the one minimum required, which you should not forget about - washing your hair, bathing, brushing your teeth, washing things. The same applies to eating. It’s clear that you don’t need any of this right now, and all your thoughts are occupied with other things, but still don’t ignore your needs. 3. Write a letter to the person who has passed away Surely, you believe that you didn’t have time to tell your loved one a lot, you didn’t confess a lot. Spit out all the unsaid things on paper. Write how much you miss this person, what you would do if he were around, what you regret, and so on. 4. Don't suppress emotions Perhaps it seems to you that if you suppress the external manifestations of grief in every possible way, then in this way you will quickly cope with the misfortune that has fallen upon you. However, you simply “lock” your emotions and experiences and do not allow them to break free. It’s better to cry out your grief - it will be easier for you. 5. Try to distract yourself Of course, right now there is nothing more important to you than your loss, but do not forget that your life goes on, as do the lives of those who are dear to you. Undoubtedly, many of them also experience better times and need your support. Communicate with your loved ones, together it will be easier for you to survive this pain. 6. Help from a psychologist Some find it very difficult to come to terms with their new situation on their own. If you realize that the situation is getting worse and your depression has dragged on, make an appointment with a psychologist - he will advise you on how to cope with the bitterness of loss.
How to accept the departure of a relative to another world
- Don't bottle up your emotions and let your emotions out as often as you need. This is a natural human reaction to the loss of communication with a dear being. Share your experiences with loved ones - they will probably want to hold you. This big test for all family members - perhaps one of them needs your support. Many owners feel guilty after the death of a pet, if it occurred prematurely. Don’t blame yourself or a loved one for what happened. Tell people you care about about your experiences. Surely, they will want to support you, and this will make it easier for you to bear the loss. Help other suffering animals. Undoubtedly, there is more than one shelter in your city, and in general there are many animals on the streets that need protection. It is possible that you will eventually become attached to one of them and want to bring it into your home. Undoubtedly, he will never replace your loved one. four-legged friend, however, you can save the animal from adversity and find another comrade among “our little brothers.”
American psychologist Elizabeth Kübler-Ross, in the process of working and observing patients dying from serious illnesses, identified 5 stages of accepting death. By the way, they were voiced more than once in Doctor House:
Stage 1 – Denial
Stage 2 – Anger
Stage 3 – Bargaining
Stage 4 – Depression
Stage 5 – Acceptance
That is, we can conclude that everything will happen by itself, having first gone through the previous 4 stages.
We need to think about this. Do not hush up the topic of death, not only when communicating with other people, but also when communicating with yourself.
And don't forget about it.
Acceptance comes gradually.
I can tell you the following about my experience.
This topic, as well as what happens after death, has interested me since childhood. My biggest fear was losing my mother. Perhaps the interest was caused precisely by this, since I could not, in principle, imagine our separation “forever”. And so I tried to understand what and how.
A year ago this happened and I faced the inevitable.
I continued to be interested in the topic of life after death, all taboos were removed from discussions of death and now I talk about it freely. But there is really no one to talk to except my sister - people avoid this. I also REALLY listen to my feelings. And often what comes to me is actually almost impossible to describe in human language.
From what is possible: death is really not the end and not oblivion, but we, in our earthly form and level, are not able to realize this. There is a lot more, a great variety of everything besides us. I do not support any religion or esoteric practices, etc. And I’m not trying to prove anything to anyone, because I have another goal - to get answers.
Oh, here's another thing about fear.
I stopped being afraid of my death, but I really began to be afraid either early death(because life is very amazing and interesting and I want to learn as much as possible here), or on my deathbed I bitterly regret that I lived my life meaninglessly and stupidly.
And only recently, having smoked herbs for the second time in my life and having experienced the onset of panic due to a very rapid heartbeat, I felt the fear of dying right here, now.
From which I subsequently concluded that in a (pseudo) critical situation a person turns on a certain defense mechanism, an instinct of self-preservation, probably, which, through fear, forces the owner to act to his own salvation.
My point is that in a conscious state before death, we are more likely to experience fear in any case. It's ingrained in us.
Another very important thing is not to live with this fear and not to ignore this aspect of our existence.
Now I understand that this is a philosophy of life: a person is born - a person must die. Between these two points is life. Whether you like it or not, no matter what, it will be so.
My father died five years ago lung cancer with metastases. I knew the diagnosis, saw the history, took him to chemotherapy. I knew what the ending would be. He was already weak. And then, three days before his death, he suddenly felt better, even began to walk, tried to do push-ups on the floor - he was a strong little man. My mother calls me: “Oh, listen, dad got better, I gave him herbs, so he started walking...”. And I was like: “Mom, why are you fantasizing?.. He will die anyway.” I said this about my father to my mother. She burst into tears and hung up. Then I came to my senses - damn, I’m a pathologist, but she’s not.
Dealing with death is never easy, and no matter how much you prepare, it is always a very emotional and sad time. To help you prepare for loss, here are some tips.
Steps
Part 1
Talk to other people- Do not tell your child that a loved one has left/is just sleeping. This white lie may cause the child/children to fear sleep, or they may think that the person has gone for a walk/vacation when this is not the case. If you hide the reality, it may cause your child to resent you and mistrust you.
- Be honest with your child/children, but use age-appropriate answers. For example, your child is very young and asks, “How did grandpa die?” You can tell that grandpa had a problem in his head, he was very ill, his condition did not improve, his body stopped working, he died and is resting in a very special place. When your child grows up, you can tell him that the thing in his head is a brain tumor, what is the name of the place where he rests (you can tell your child/children where the grave is), and that grandpa loved you very much.
- This is normal for a child - they are naturally curious. Answer with facts, not emotions (the worst thing is to blame your child for being nasty). If a child asks what happens when a person dies, be honest and say that the buried body goes through a stage of decomposition, the body rots and then becomes just a skeleton. If he asks what cremation is, tell him that the body is burned in a special way at very high temperatures. high temperature so that it becomes ashes.
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Inform distant relatives about the health of your loved one. Communicate via email, phone or social networks.
Part 2
Spending time together-
Sit down and talk to your loved one as much as possible. If you regret something or need to tell him/her something you've kept secret for years, use this to talk to them. However, remember that if it's something serious (you cheated on him for 15 years), then it might be better to abstain. You don't want to put him/her under more stress.
Talk to your loved one about death. Ask if he/she is scared. You may feel better when he's gone if you know he wasn't afraid to leave. And if your loved one is scared, help him or her cope with their fears.
Tell your loved one that you will miss them and say "I love you" often. There is nothing more important than these three words.
Tell your loved one if you are scared, confused, or upset. He can tell you things that will put you at ease and help you with the process.
Take parting words from your loved one. Some will want to talk about death, funeral plans, etc., while others will not. Don't assume you know what he wants or needs. Now is not the time to play guessing games!
- If your loved one is pretending that they are not dying and everything will be okay, understand that this is a defense mechanism and is replacing hope. While it is important to be sensitive to your loved one's approach to death, do not let this fantasy cause tension and problems for you and other family members. This may be exactly the case when it is important not to beat around the bush, but to show in the kindest and most caring way that your loved one has fatal disease, and that it affects other people too. Nothing will be good and you will waste a lot of time if you pretend, when you should be spending it making memories, fulfilling your loved one's wishes and spending quality time together.
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Gather your family members in a room and talk about old times. Everyone will have a memory of how your loved one smiled and was happy or heard while remembering all these moments. It will also be a pleasant memory: he or she was surrounded by family who loved this person very much, and what could be better than being close to family when you need their support most?
Make sure you say everything you want to say. When this person is gone, you will not be able to get anything back.
Part 3
Practical aspects of the situationPart 4
Preparation-
Be prepared for many emotions that will overwhelm you. Some emotions may arise once, while others may return again and again. Typical thoughts and emotions include: anger, fear, anxiety, feelings of injustice, resentment, exhaustion, hope, joy in moments together, wishful thinking, relief, sadness, despair, and many others. There are no right or wrong feelings or thoughts, and you may find that some emotions interfere with your ability to think clearly.
Allow yourself to experience grief. Crying is normal, and it is better to let it all out rather than suppress your emotions. When tears come to your eyes, don’t hold them back.
- Cry with your child/children and talk about the dead person. This will show your child/children that you never forget about this person and that it is okay to cry, show anger and express feelings and grief. Remember that people grieve in different ways.
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- If you feel that other people are insisting that you fill your loved ones with rituals, attitudes, and specific behaviors that do not align with how you want to remember your loved one, thank them for their suggestions, but remind them that everyone has their own way of remembering others and that you will use your own way.
- You may feel better if you put everything out of sight immediately after your loved one's death. A pair of flip-flops, a tie, even his/her favorite pen... Put them back when you feel you can handle it, the memory of them will always be there.
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Spend time outside now and then. You will need your energy and focus to stay afloat. Sometimes this means running away from what seems too real and what is happening. Take short breaks to take a break from the emotional depth that comes with the dying process.
- Voice your worries, sadness and feelings to your pet or close friend.
- Go to the park or dinner or just hang out with a couple of friends and family and relax for a while.
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Start seeing a therapist during your care process. Attending counseling before your loved one dies will help prepare you. It is also an important bridge between that person's presence and absence in your life. Continue to see a therapist after the person dies. Speaking freely and openly will help you open up your feelings; he won't judge you because his job is to help you.
- Respect the wishes of the younger ones as well as everyone else. It is the child/children's choice whether to attend the funeral/grave or not. Don't be offended, discourage or force them to do it if they refuse and/or don't feel comfortable doing it. Everyone has the right to choose. Your reaction matters and can leave deep positive or negative memories for your child.
- Respect the grief others are experiencing. Other people who were also close are going through the same thing as you. Take time to spend with friends and family and listen to their stories. Listen to others when they express their problems to you. You have the right to vent; especially during such an emotional crisis as the process of death.
- You can create a book of memories about your loved one. This can be especially helpful for young children who will not remember this person when they grow up. In this book, keep things like photographs, journal entries, mementos, phrases that the person always repeated, special recipes, etc. Such a document will forever preserve the memory of them, even after several generations have passed.
- Know that this is not your fault.
- Sit down with your loved one and make a scrapbook of memories to remember them by. Use his favorite color, a poem you received from your spouse, etc., all the little things you enjoyed with your loved one.
- If you plan to plant a garden or tree in your yard as a memorial to your loved one, say so before he or she dies.
Warnings
- Don't try to make death a trifle; Don't try to make people laugh by making fun of them. However, remember that you will often hear dark humor used as a defense mechanism, so don't be shy or berate others if this happens from time to time. Look at it for what it is - it's a way to cope with grief so that you can return to a polite attitude.
- Don't talk too much. Try to listen to the needs of those around you. Sometimes the dying person will not want to talk or even listen to others talk, so encourage them with silence. It can be a very spiritual pastime.
- Do not criticize crying, mourning for loved ones or those who are sick; it's disrespectful. Losing a loved one is a sacred moment. Show respect. And even if you feel impatience or relief, do not take it out on others at the time of death; such emotions cause embarrassment and convey disrespect.
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Make sure everyone in the family knows that this loved one will die soon. This will allow all family members and close friends to say goodbye to him.
Allow children to visit a loved one. Explain to them what is about to happen. Speak clearly to children and respect their dignity. There is a tendency to hide the reality of the situation, although children are able to understand and accept more than adults think. In fact, it is the child who often has thoughts that calm or console the adult. Here's what to remember:
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