What Dying People Want.

Book Review.

Kuhl, David.  M.D.  What Dying People Want.  Practical wisdom for the end of life.  Public Affairs.  2002.

D.K.- Ai the time writing (2002) David had had a career in palliative care for fifteen years.  He has developed a palliative care program for people with terminal cancer and AIDS at St. Paul Hospital in Vancouver.  He lives in Vancouver.

Comment. Henry.

Here is a resource that will be helpful for health providers who deal with those who have terminal illnesses and for those who have relationships with people who are terminally ill.  David approaches the topic of “dying people” with compassion and genuine care.  This book is the result of an in-depth series of interviews by a physician who specializes in palliative care.

This book seeks to answer the question, “What is the lived experience of knowing you have a terminal illness?” (Intro.)  Listening to people who are dying provided answers to that question.  “People who are dying are still living.” (Intro.)

The revelation of the diagnosis of a terminal disease usually comes with the experience of extreme emotions.  A response of ambivalence is normal.  Dying produces an anxiety that is “perhaps the anxiety at the core of all anxieties”. (18)  When the dread can be translated to fear “it can be met with courage”. (21)  The option of suicide focuses more on killing the pain than killing yourself.  An interesting exercise is suggested to “get a sense of chronis and kairos”. (29) 

 “To speak to anyone about terminal illness without adding to their suffering is an art that requires communication skills and self-knowledge”. (51)   Skilful communication is difficult and must include compassion.  There must be an effort made to avoid “iatrogenic suffering” (55) for the patient.

Pain management is an important factor for patients with a terminal illness.  “Through touch- both touching and being touched- a healing process begins.”  Touching is a very strong non-verbal message.  A “life review” (137) is common in the experience of dying. This process is made more difficult by unresolved issues.  Emotions will be ‘all over the map’.  “Speaking the truth” (166) is very important and essential in experiencing forgiveness as part of a relevant life review. Thirteen specific steps are presented on how to break this silence and facilitate speaking the truth.

The “longing to belong” (199) is a part of every phase of life but it is heightened in the presence of a terminal illness.  “Self-realization” (223) and the answer to the question “Who am I?” (223) need to be faced with genuine reality and honesty. 

The end of life experience (death) is describes as “transcendence- a human spirit stripped to the literal substance of itself before God”. (254)  Alcoholics Anonymous has coined the slogan, “Let go and let God”.  It is a concept of spirituality, a relationship with God, “or some higher power”. (261)  It is in this experience that resolution is experienced and it is personal.

David includes a very practical ‘appendix’ (293) in which he explains how a doctor might talk to patients that are terminally ill.

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