Knowing one's death: philosophical considerations

Abstract

Coming to know and accept one's impending death allows terminally ill persons to face their mortality without deception. While life as such is a constant race towards death, terminal illness brings one's own death closer to experience. Being in the face of death in this manner can be transformed into an ontologically rewarding experience. Research on medical practices of truth telling in cases of terminal illness tends to show that there is healthy acceptance of impending death in western contexts, whereas in other contexts patients are more likely to do well when poor prognosis is concealed from them. This paper considers the case of knowing one's death in terminal illness, and explores responses to truth-telling and allied issues in non-western contexts like India from a philosophical/reflective rather than prescriptively ethical or empirically evidenced perspective. It argues that culturally contextualised, sensitive ways of helping patients know that they are terminally ill can lead to a more spontaneous and freer acceptance of death in nonwestern contexts.

“End-of-life care is more than wound care”: Health-care providers' perceptions of psychological and interpersonal needs of patients with terminal cancer

“…[21] More recently, though there is a recognition that patients in India, particularly those who are younger and more educated, would want to be informed about the closeness and inevitability of their death. [22] This can help them reconcile their “unfinished business,” express their needs and preferences, and experience what they construe as a “good death.”[2324] George[25] highlighted that how sensitively the disclosure is made is perhaps more important than what is said. In addition, the issue of when is also critical; there must be time for the person to make some choices in a situation of powerlessness and uncertainty.…”

“…The participants’ responses revealed that patients had divergent interpersonal needs; strong wishes for support, time, and deeper connections with their families as well as active avoidance or detachment from relational bonds. George[25] argues that in collectivistic cultures like India, the presence of family and friends can help the person feel less alone in the experience of dying. Patients’ request to go home or the wish to be with family and die at home may reflect strongly held cultural beliefs and practices about death.…”