Dying can be a healthy process. This might seem curious since one definition of health is the absence of disease, and death could be seen as the ultimate failure. A healthy death demonstrates the value of the bio-psycho-social-spiritual model. Bio – physical ease of symptoms. Psycho – emotional well-being and happiness. Social – trusted relationships. And a spiritual dimension too – a sense of positive connection with ‘other’ – friends, families, communities, music, environments, that we often call love. A healthy death includes practical things like getting affairs in order and reconciling past misunderstandings. It also enables people to contribute in positive ways, paving the way for long-term healing, despite short-term pain. John Donne (‘Ask not for whom the bell tolls; it tolls for you’) famously pointed out that individuals are not as individual as we may think. When someone dies, a bit of me dies too, and the more I identify with that person, the more of me dies with them.
Between 1986 and 1988, I learned how to orchestrate a healthy death as the GP of a brave and talented young woman (Sheila). Her friends worked ceaselessly to overcome bio-psycho-social challenges to make that period full of fun and playful reminiscence. It resulted in a positive story of her life and her death. Those around her became more spiritually healthy – better able to interact positively with other. Then we moved on, stronger and wiser because of the experience.
One question for healthcare practitioners is – what understanding of Health helps to do this?
In 1986, David Seedhouse argued the limitations of contemporary definitions of health – ‘ideal state’, ‘normal species functioning’, ‘a commodity’, ‘physical, metaphysical or intellectual strength’. He then argued that the goal of all approaches is to work towards achieving chosen potentials. Health, he claimed, is ‘Foundations for achievement’.
I often refer to Seedhouse’ work because it helps to see the practical and contextual nature of health – health means different things to different people at different times to achieve different things. On the other hand, I often wish for a definition that explains that health is more than an individual phenomenon. What do I make of Donne’s bell – that spiritual dimension of positive connection with ‘other’? Positive connections bind people together. Negative connections dis-integrate. Health means co-creating positive connections, even when we are hurting from losing someone we love.
Antonowski’s idea that health means rising above adversity and McIntyre’s idea that we define ourselves as a coherent story can help. Health is a ‘positive narrative unity’ – I am the lead actor in the feature-film that is my life story and co-actor in the life stories of many others. A healthy death means individually and collectively reviewing the connections in our life stories, making them positive by forgiving past and present injustices and celebrating past and present triumphs.
Could we use this approach in general practice? Perhaps we could invite patients at their annual care plan review to resolve past misunderstandings and plan for positive, healthy futures?
Author: Paul Thomas
About the author: Paul is a GP who has developed theory and practice of community-oriented integrated care, including shared care for diabetes, mental health and end of life.
Tweet for this blog 269 characters (Tweet maximum went up from 140 to 280 characters in 2017): A healthy death requires positive narrative unity – individuals and communities review the connections in their life stories to forgive past and present injustices and celebrate past and present triumphs. Can primary care do this for patients with long-term conditions?
Connected publication: Thomas P (2009) Sheila, London Journal of Primary Care, 2:2, 184-185.https://www.tandfonline.com/doi/abs/10.1080/17571472.2009.11493284