Reducing the Fear of Death

Sonal Jagasia, MD MPH (Psychiatrist) & Vishal Bhakta, MD (Hospitalist)

Reducing the fear of death may:

Reduce chaos, anger, and uncertainty among patients and their families.
Promote resilience, relief, and peace for all those involved.
Reduce burnout among healthcare professionals when confronted with large numbers of people facing mortality.

The most essential element in healing from a traumatic event is support: medical, emotional, cognitive, and spiritual/philosophical/religious.

Medical:

Treatment should be more than defying death.
Focus on the treatment of suffering: pain, anxiety, dyspnea, nausea, etc.
End of life experiences are not only about life’s final transition. The experiences should address life in its entirety.
During the final stages of dying, the pull to sleep is typically strong, deep, and soothing. Therefore, eliminating unnecessary disruptions is critical.

Emotional:

Accept death as a possibility.
What you say should be comforting and nurturing.
Avoid saying, “There is nothing left that we can do.” Patients and families will feel abandoned by this statement. Consider, “While we don’t know how to cure the coronavirus, there are many things I can do for you. No matter what happens, I want you to know you are not alone and we are here to help.”

Cognitive:

Fear may be triggered by uncertainty, and validating this sentiment is important.
It may seem paradoxical but contemplating the reality of death may relieve the fear of death. You can ask, “Are you willing to talk about those fears with me?”
Turning inwards with meditation, amidst chaos, can help reduce fear. Sample 3-minute meditation.

Spiritual/Philosophical/Religious:

Dying patients seek a deeper understanding of their end of life experiences; encourage patients to speak about these experiences openly.
People are often spiritually/emotionally enlightened during the end of life, despite physical deterioration.
Try to honor these themes in conversation: love, nurture, connection, remembrance, and forgiveness.
The human connection will be equally important for you and the patient. It is ok to share personal emotions and experiences with patients during this time.

Practical considerations:

There may not be time to provide the support that patients need, so involve others as much as possible—palliative care, pastoral care, phone calls to family members, and nursing staff.
Using gentle humor or sharing personal stories with colleagues can reduce stress.
Simple gestures can provide incredible comfort and ease. For example, find out if it’s possible to arrange delivery of patients’ favorite foods, meals, books, etc.
Be brave, be open to emotional challenges, be kind to yourselves, and forgive yourselves as you approach the medical trenches. Know that you are not alone and we are here to support each other unconditionally.

References:

Death is But a Dream: Finding Hope and Meaning at Life’s End; Christopher Kerr, MD PhD