The debate has gone on for decades that whether an individual should be informed about fatal illness or not. Some argue that it is an unnecessary burden and others maintaining that people have a basic right to know as much of the truth as they wish in order to prepare themselves emotionally, as well as to take care of family responsibilities and settle practical arrangements. The initial disclosure of the fatal prognosis and the final accommodation, which must be reached in order to meet death with dignity, are the two phenomenons, which delimit the terminal process.
When an individual becomes aware that he is dying, he realizes that a force over which he has no control will determine certain fundamental aspects of his life. He feels helpless as he faces the curtailment of his future, the necessary parting from cherished family and friends, and multiple threats to his self-esteem such as loss of productivity, increasing dependence, and physical deterioration.
How do people react to these threats to their security and self-esteem? Normal reactions include feelings of anger at ‘cruel fate’, sadness for what must be given up, inadequacy, helplessness, and anxiety. Some are overwhelmed by all this and live out their last days in unreachable depression or isolation, but many do manage to come to terms with the situation.
The fundamental coping tasks for the dying person include the management of anxiety, the maintenance of self-esteem and dealing with the mourning of the people and the objects he is losing. The mobilization of hope is one of the most significant coping mechanisms for the terminally ill. Even patients who have understood and accepted their prognosis can usually find some basis for hope, and doctors should be careful not to go so absolute as to eliminate this possibility. A great source of anxiety is the patient’s fear that because of changes in body appearance or function, the physical and economic burdens of his care or simply his new status as a dying person, family, friends, and physician may reject or abandon him. Warm and open communication with loved ones and trusting relationships with medical personnel provide invaluable emotional support. Patients who cannot acknowledge the prognosis or the related anxieties and rely heavily in denial and those, from whom the truth has been deliberately withheld, find themselves isolated and unable to share their concerns
Maintenance of self-esteem and working through the loss of beloved people and things are the remaining tasks for the patient. Despite the dependent and helpless position in which they may find themselves, the terminally ill can still maintain their dignity, their value, and their individual identity. It is possible by making decisions about their day-to-day lives and by setting realistic and realizable goals, which can provide a sense of achievement when the usual work and family functions have been relinquished.
Experts focus in two crucial elements involved in a person’s coming to terms with approaching death: his need for permission from significant people in his life and his voluntary relinquishment of everyone and everything of value to him. Only when other people signify their readiness to accept his death, his feelings of guilt, inadequacy and helplessness are relieved. Family members may cope by denying, displacing, and isolating their distressing emotions or consciously controlling their mood. Seeking information about the disease helps the patient to face the troubles and pains with maturity. Keeping busy, finding some meaning or purpose in the approaching death and relying on emotional support from clergy, medical personnel, and other family and friends may also prove beneficial. Terminal illness is a frightening thing because it forces one to face death and come to terms with it but it also offers an opportunity for personal growth and development.