A friend of mine has a relative in the final stages of dying; some of his difficult interactions with this relative (not an immediate family member) have stirred thoughts about our obligations to and expectations of those who are dying. I’d like to talk about two related aspects of the issue: First, to what degree do we conceive of old age/death as a kind of second infancy that changes all the rules? And second, are people in the final stages of dying exempt from the expectations we usually have for other people — such as consideration, fairness and reciprocity — and do their needs always trump our own?
I’ve known clients with parents who expected them to sacrifice their lives entirely in order to care for them in the final stages of dying. Some of these parents had done reasonably well in their parenting role; others had been entirely deficient and then became infantile and demanding when forced to confront their mortality. What comes to mind is the Biblical commandment to “honor your father and mother.” I’ve always found it relevant that the Bible does not says you should “love” your parents; rather, you should accord them a certain level of respect, given that they brought you into the world and reared you. But what are the limits of “honoring”? Does that mean you must take care of them during their dying months, even to your own detriment, even when they did a miserable job taking care of you when you were small? How does forgiveness come into play, and are some failures unforgivable?
In my own case, I was fairly uninvolved in the deaths of both my parents. My mother died of advanced Alzheimer’s and had lived in a residential facility for several years; it had been a very long time since she’d recognized me. At the time my father began to die of leukemia, my older sister was living with him; my brother lived next door and my two siblings shouldered the burden of his care, along with an old family friend who happened to be a nurse and tended him on his death bed. In a way, I was lucky not to have to confront the really hard choices. If you’ve read my post on the mostly-bad mother, you know I don’t have a lot of respect for my mom’s parenting skills. I honestly don’t understand (that is, on an emotional level) what it would mean to “forgive” her, especially since I don’t believe she did her best (see my post on on the difference between refusal and inability to try). I suppose I haven’t forgiven her and I certainly wouldn’t have made any great sacrifices had I been called upon to do so as she was dying.. My father was hands-off and absent for most of my childhood, but in later years, he was affectionate and took an interest in my life. He has a place in my heart but I didn’t really locate it until years after he died. I don’t know whether I would’ve risen to the occasion had more been demanded of me at his death. To be honest, probably not.
In other cases — particularly when my friend Tom Grant was dying 20 years ago — I have felt the opposite. I wanted to be involved and give to him, to drive him on occasion to a doctor’s appointment, take his two small sons on outings so that Ann, his wife, could be alone with him, help her with the funeral arrangements. My wife was pregnant with our first child at the time and I did give Tom’s needs precedence over my own life. I can’t say that it was a big sacrifice, however. I wanted to be there, and given the amount of family and nursing care available to him, I never felt called upon to undertake anything especially burdensome. Mostly I gave of my time, a lot of it, but those last months were precious to me. Tom was a remarkable person — thoughtful and sensitive; he remained that way until nearly the end, when the morphine began to affect his mind. Our final conversations were deeply meaningful to both of us. Another way of saying it is that, for the most part, Tom made his death easy on those who loved him.
Other people who are dying don’t always behave that way. Because they may feel angry and/or terrified at the prospect of death, they can become irrational and abusive. I’ve seen people who, for most of their lives, were relatively sensitive and considerate people but became entirely selfish, demanding individuals as they began to die. So I wonder — is that more or less appropriate and normal? When confronted with our mortality, is it natural that our own feelings and needs eclipse those of everyone else? Is it natural to expect that other people should put us first and neglect their own needs? Tom didn’t behave that way, but maybe he was an exceptional case.
With one of my clients, her dying mother had ample financial assets but refused to pay for nursing care and instead expected my client and her sister to take an unpaid leave of absence from their jobs to look after her her; it was a financial hardship to both of them but their mother never offered to help them out financially. At first, because they loved her deeply, they felt ready to make the sacrifice; but as time wore on, they began to feel angry and resentful. And because she was dying, they felt guilty about their anger and resentment. On an unconscious level, my client felt that death made her mother a special case, and she (my client) had no right to expect consideration from her, or any recognition of her own needs. I think that anger and resentment make many of us feel guilty in such cases, as if it’s entirely unfair to expect the dying to take us into account.
But is it unfair? Does dying give you a free pass to behave any way you like, as if you’re a baby, and nobody should expect consideration from an infant? Does our sympathy for those who have finally come to face that moment we all dread override everything else? How much can we legitimately expect of those who are dying? Obviously, the answer varies case by case, but the question is still worth asking.
Finding Your Own Way:
This post is so full of questions, I don’t think I need to elaborate on them further in this section, as I usually do. And I obviously have no answers. I’m very curious to hear about your experience with those who are dying, along with your views as to what we can fairly expect of them.
But I will say that Tom Grant will always be my model for how a dying person should behave. Within obvious limits, people ought to die in character, not become someone else entirely. Dying does not exempt you from having consideration for others, at least not entirely. I hope one day (but not too soon!) to follow Tom’s example.