End of Life Experiences

Michelle Choi MD Journal

Perhaps Dying and Death is not what we think it is. I found my conversation with Dr. Christopher Kerr, MD PhD, this week so interesting- the fact that the majority of people who are dying are having end of life experiences which could be life-affirming, self-healing, comforting, insightful, and therapeutic.⁠⁠

Perhaps we as physicians don’t know, because we don’t ask, and perhaps we aren’t listening. Dr. Kerr in his book Death is but a Dream, states that “the prejudices of present-day medical training have caused an inability to see dying as anything but a failure, and they compromise the self-soothing power of a patient’s end-of-life experiences.” And in my own career, I’ve started to wonder- how much treating is there and how much actual healing is occurring? If we continue to treat at any cost- are we making the end of our lives more painful, and will dying be more painful for us? At that point- are we prolonging our lives, or are we prolonging our death? ⁠⁠

Think about it, you could have already seen this. For that rare person who dies at home under hospice, how many doctors have you seen? When a person is dying in the hospital or in a nursing home, and comfort care has been chosen where the primary goal is just to make the patient as comfortable as possible, the frequency of the doctors visiting will decrease. I understand that dying and death is a difficult topic, we make it a painful topic. But I can’t help but think that this way of thinking needs to change. If we don’t respect the sacredness of the dying process, the beauty that this process could be and this phenomenon that occurs in most people- where they have end of life experiences that help the dying to transition from distress to acceptance, to have these experiences which could be life-affirming, to feel that tranquility and to feel whole before dying- are we cutting ourselves short? And while it would be great for more doctors to incorporate this awareness into their practice, the truth is most doctors are not in private practice, we work for managed healthcare. The healthcare systems need to change and accept our humanity. We have lost our way with dying and with death.⁠

Michelle Choi MD