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© Danielle Robertson Pty Ltd t/as DR Care Solutions
Reflecting on National Carers Week, one of the biggest stressors on carers is tensions within the family or with formerly close family friends.
On this subject, let me introduce Margaret Rice, the Sydney-based journalist and author of “A Good Death – a compassionate and practical guide to prepare for the end of life”[1] and founder of the Good Grief! website.[2]
Having met at a recent virtual forum, I sought out Margaret’s book. It shares the wisdom of palliative care nurses, everyday Australians, and Margaret’s own experiences of companionship to dying loved ones.
A warm embrace
In our “death denying culture”[3], reading this book is like a warm embrace and conversation with a close friend. It intimately details what actual happens when someone is dying and what you can do to make that experience for them as triumphant as possible.
What I found particularly insightful was the discussion on managing conflict, something I do experience in assisting families with care palliative care support.
Managing tensions
As Margaret puts it, the journey of impending death invariably involves tensions.
"Barriers can continue at death, despite romantic notions that somehow an impending death will make people behave in a more heavenly way."[4]
An end of life plan resolves bedside conflict
One straightforward way of managing conflict is to encourage the person, on being diagnosed with a terminal illness, to finalise an end of life plan[5]. This legal document sets out what medical support and interventions the person desires when they no longer have the capacity to communicate their wishes.
Having these wishes clearly set out will avoid any highly-charged conflict between family members over end of life care. Arguments between siblings as to whether their parent would have wanted to be resuscitated or not, often endure far beyond the deathbed.
Make amends with the dying as soon as possible
Someone’s imminent death can precipitate the very human need to make amends.
If you personally have an outstanding conflict with a person having terminal illness and you want a personal connection with them before they die, resolve the conflict as soon as possible, before their condition worsens and certainly before they are placed in a hospital or hospice ward.
Margaret advises this course of action for several reasons. It will be better managed when the person is relatively well. It removes the risk that you may be seen as thinking only of yourself, with you seeking your own absolution.
Further, once in hospital, the dying person may have in place a list of people they do not want to see or the family may have done so. Either way, if you are on the list your access to the person dying will be denied. All of this is more common than you think.
By the bedside
Care professionals accept that conflict amongst family members at a dying person’s bedside is common. Long standing sibling rivalries can come out in force and tensions over time given to care giving over the years can certainly overflow.
Palliative care specialists will usually intervene and call on a social worker to shield the patient from family conflict, even when the patient is unconscious. Conflict destroys the sense of peace and comfort they seek for their patient.
The social worker's primary concern is to develop a rapport with the patient and establish what is of benefit to the patient. Social workers will only organise family meetings to resolve conflict at the invitation of the patient, their consent is not enough.
Remember, when a person is dying, a professional palliative care team will always put that person first. It is important that we all follow their lead and do the same.
What's next?
To continue the conversation, read Margaret’s book[1]. It received a five-star rating on Amazon, and has taken hold beyond our shores with a strong US readership and now US publisher, and an edition translated for Chinese audiences is soon to be released.
If you need support and guidance as a carer, please feel free to contact me, Danielle Robertson at DR Care Solutions, for an initial discussion on how to set up the right care, support and assistance at the right time and in the right place.
Resources
[1] Rice M, A Good Death – a compassionate and practical guide to prepare for the end of life, Murdoch Books, Sydney, 2019
[2] GoodGrief! website
[3] Ibid, p. 8
[4] Ibid, p. 37
[5] DR Care Solutions' End of Life Planning Checklist
