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Ask the Rabbis: In counseling end-of-life care, what Jewish principles are most valuable?
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The answers show two different and coherent conceptualizations of death, according to whether the subjects believe or not in individual life after death. For NB death marks the end of the individual, while for B it marks the passage to a new dimension. Each of these assumptions determine two different models of 'good death'. B prefer to be unconscious when death comes. They do not fear the next world, but rather the passage, the crossing over the boundary: a mysterious but actual process, that take place in time and space. This attitude coexists with the hope of a miraculous delay of death itself, which seems to conflict with the conviction of reaching the true, best and perfectly happy life in the union with God.
What happens between the moment of death and the one of re-birth is obscure and, thus, generates anguish. The NB attitude seems, instead, to appeal to the epicurean sentence: "If I am, death is not; if death is, I am no longer: why, then, fear death? NB reveal also a different aesthetics concerning death and dying.
Principles of the World Beyond Death
Things, objects, the environment become almost gifts that the dying person leaves to the living, gifts precious because intrinsically beautiful, thus assuming an autonomous importance. B, on the other hand, underline "decorum" as appropriate style of both the dying person and the bystanders.
The NB interviewees, even if perfectly aware and proud of their own ethos , acutely felt the lack of a socially recognized and accepted secular way of dying. Secular rituals are lacking, and realizing scenes of death which contain and respect their conception of life is difficult when not totally impossible.
Nevertheless, the two models have several points in common about what is indispensable for making the moment of death more comfortable. These elements are substantially consistent to clinical and organizational praxis of palliative care, i. Despite B and NB agree on many elements presence of friends, relations, competent and continuous care, pleasant environment, attention to details, respect for choices, etc.
This concept of coincidence between the social dimension and the biological one is crucial [ 1 ]. Thus, death becomes 'bad' [ 11 ].
In fact the intentional prolonging of this condition the artificial prolongation of biological life at the end-of-life is seen as an unjustifiable violence. Assistance to the dying person has been understood, up to the present day, more as an act of charity rather than as a medical duty. It is not by chance that we will have to wait for the middle of the 20th Century before one speaks of palliative 'medicine' in hospices which had been created and mostly still managed as charities at a time when hospitals had long since been considered an expression of science and of the public health service.
The cultural model to which palliative care refers be it implicit or explicit makes reference to a style of good death which has its roots in the Christian tradition of caring. The Hospice can, in fact, be considered the belated fruit of the realization of that process of charitas , which a follower of St.
Jerome, a matron of the gens Fabia , started in Rome in the IV century [ 40 ]. Such a model of good death, if acknowledged uncritically and if shared only by health professionals, could be inadequate to the sensibility and expectations of a population made up more and more of cultural and moral strangers.
If this model were imposed on patients — even unwittingly — it could produce a gap between medicine and some patients, perhaps resulting in a sharpening of that solitude which palliative care sets out to soothe. This study highlighted the existence of some different constitutive features of "good death" focusing on the distinction between believer and non-believer in the maintenance of individuality after death, and we feel that this difference is a major one, at least in the Italian cultural context and deserves further research.
The awareness of these differences may help palliative care professionals meet the real needs and expectations of terminal patients. It would seem reasonable to conclude that today it is not possible, nor desirable, to assume a single specific model of good death, and that a plurality of models should be foreseen, accepting in this case, their practical and theoretical implications. National Center for Biotechnology Information , U.
Freud's Theories of Life and Death Instincts
Health Qual Life Outcomes. Published online Nov 7. Author information Article notes Copyright and License information Disclaimer. Corresponding author.
- The AL-EX Project (ALternative EXistence).
- The Real Problem of Inspiration;
Franco Toscani: ti. Received Jul 14; Accepted Nov 7. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL. This article has been cited by other articles in PMC. Abstract Background Different ideas of "good death" may influence the effectiveness of end-of-life care in patients with different ethos. Methods Semi structured-interview to 8 persons, 4 believers and 4 non-believers in individual life after death from the general Italian population. Results The analysis has shown a diverse and coherent conceptualization of death according to whether the subjects believe or not in individual life after death.
Conclusion There are aspects in common and aspects in contrast between believers and non-believers in individual life after death: while sharing many aspects of what a "good death" ought to be, they have opposite stands on being aware of dying. Keywords: good death, end of life, life after death, awareness. Introduction Death and culture Death is "good" when it fits with the role given, acknowledged and accepted by the dying person [ 1 ]. The "role of dying" and the belief in Everlasting Life In the past, the acceptance of the role of dying was probably easier [ 3 ].
Death and medicine In the Western world the process of individualization i. Aims of the study This study, in order to bring elements together for a more general debate on this subject, aims to: 1. Methods A qualitative study was carried out using the long interview method devised by Mc Cracken [ 17 ]. Table 1 Interviewees characteristics. Open in a separate window. Table 2 Categories which define a "good death" in medical palliative care literature.
Table 3 The interview. Free association of the term: "death". Images of life and images of death. What makes you think of life and death? The presence of death in your history: when, on what occasion, did it occur in your life? On these occasions what made you feel good and what made you feel bad? What positive or negative elements characterized those circumstances?
What do you understand by a good or bad death? Can you give real or hypothetical examples? What do you think a person who is dying needs? What would this person like in the form of a gesture of attention or respect from others? How would you like to live the last week of your life? Three things that you would like to happen to you in the last week of your life. Three things that you would like to avoid doing or happening to you. Are life and death two independent events?
Is there anything a person must never do in their life considering the existence of death?
Is it possible to do something in life which would assure a good death? Death: an event or a process? If it is a process, when does one begin dying? If so, when and why? When does one feel 'ready for dying' if this is possible? How do you think one feels 'inside'? What is the mood? What would be the attitudes towards the life one is leaving and towards what is eventually expected?
What would you like to leave and what would you like to take with you? Would it be a consolation knowing that the others are still around?
Freud's Theories of Life and Death Instincts
In an important relationship what is more acceptable: the suffering of seeing the other dying; or the suffering of dying knowing that the other is left alone? In your opinion, what is meant by death "occurring in a natural way"? Why do people have to die? Do you believe in fate? How would you imagine life to be if there was no death?
Would something change? Do you think there is anything after death? Does this shape the way you live and the way you die? Do death rituals have any meaning to you? What should we do with our corpse?
Related Principles of the World Beyond Death
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