End-of-Life Assessment Within a Holistic Bio-Psycho-Social-Spiritual Framework.

Abstract

There is much about death and dying that has yet to be explained by science.- Walter (1996, p. 358) Death is certain, yet drastically underexamined. The notion of death is often intellectualized, but rarely internalized as part of a cognitive and affective perspective on life itself. We are aware of its reality-reminded daily in obituaries and media reports of the recently deceased. Yet the thought of dying and the realization of mortality may be deferred until the time it is closer at hand. Death comes in many forms, including sudden trauma and brief illness, which, unfortunately, may rob individuals of the opportunity to address the most important issues of life prior to one's final exit. Alternatively, disease or chronic health ailments can gradually erode health and strength, thereby prolonging the process of dying (see Emanuel & Emanuel, 1998). Indeed, modern advances in medicine may alter the very nature and progression of end-of-life "trajectories" (e.g., Lynn, 1997) with significant implications for the psychological, social, and emotional experience of the dying person (