Dying is inevitable; there is no escape, no way out. Despite an ideal
vision of the end of life in which people die peacefully and comfortably at
home, surrounded by supportive family and friends, many individuals die in
hospitals, and many are in pain and alone.1
Increasingly, clinicians are recognizing the difficulties that arise when
caring for dying patients.2 Perceiving death
as a personal defeat or professional failure despite its being a natural event,3,4 clinicians caring for patients at the
close of life may feel lost in a foreign land without a map. Clinicians sometimes
fear that recognizing the imminence of death may remove a patient's hope.
They also may have little confidence in their ability to manage severe pain,
dyspnea, and other terminal symptoms. The intense emotions that patients and
their families display, and the equally strong emotions that clinicians experience,
can be uncomfortable and troublesome. Too frequently, clinicians feel out
of place negotiating the complexities of a family's dynamics at a time when
the integrity of the family is most at stake. When spiritual questions and
longings arise, clinicians may feel ill-equipped to help patients in their
search for meaningful answers. Even years of experience caring for dying patients
does not lessen the challenge of confronting the deaths of friends and family
or, ultimately, oneself.
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