Helping Another Die Well: Is This a Task of Human Development?

A developmental task is conceived of as a universal expectation or achievement. The most commonly held developmental tasks have to do with the evolving abilities of infants and children in 4 domains: physical, emotional, cognitive, and social. Key tasks within the domains include making a primary attachment and learning to trust, having a sense of autonomy, demonstrating initiative, and developing an identity.1 Much less addressed but derived from convincing evidence are developmental tasks of adulthood, including intimacy and solidarity, career development and career decision making, and generativity.1-3 The latter includes caring for others as opposed to being self-absorbed. Achieving a developmental task at one point in life may well be linked with achieving a subsequent developmental task, so aiding a person to achieve one task could position him to attempt and accomplish a later task. Recent evidence suggests that in the face of their child's incurable cancer, parents seek to achieve their internal definition of "being a good parent" to their seriously ill child during the child's final weeks and days of life or until the child's "last breath." The work of a "good parent" involved meeting the child's basic needs, for example, clothing, food, and housing; ensuring healthcare and avoidance of harm through advocacy on the child's behalf; being a good life role model, including conveying empathy for others; being fully available; and being well-informed enough to make reasoned and unselfish decisions on behalf of their child. Of special importance to the parent was the certainty that the seriously ill child knew that he/she was well loved by the parent.4 This conscious, deliberative effort by parents seems to represent their developmental work at their child's end of life. Achieving their internal definition of being a good parent seems to be linked with their subsequent well-being as bereaved parents.5 Helping parents achieve their internal definition of being a good parent then becomes a priority concern for oncology clinicians who are involved in the care of the child and the family. Available literature on other informal caregivers (ie, spouses, offspring, and friends) implies that these caregivers of seriously ill adults with cancer also take quite seriously the role of being a "good caretaker." Achieving positive aspects of being a good caretaker is reported to be part of the caregiver's self-image. Combined, these data-based sources of evidence indicate that helping a loved one die well may be important developmental work.

If the opportunity to assist another to die well is a developmental task and, thus, a potential task for all of us, and if achieving this task aids us to move to another level of human functioning, what are the outcomes for the individual who attempts this task but does not feel successful? When a death is sudden and unexpected, such as from trauma, and not from a diagnosed disease, and there was no opportunity to do the developmental work of assisting with a good death, are the outcomes different for family and friends who otherwise would have been caregivers? Could an outcome for a caregiver of a sudden and unexpected death of a loved one be lingering regret, or perhaps the seeking to aid in the life transition of another ill person in order to achieve the developmental task? Do caregivers who complete their developmental work of assisting another to die well in ways that are consonant with their internal definitions experience a resulting kind of emotional, social, or cognitive advance? Certainly, such a developmental advancement would not replace the incredible sense of loss or the heavy weight of grief, but it might add to the meaning of the experience of human loss.

The idea of assisting with a good death may extend beyond the developmental work of an involved and caring individual to include the developmental work of a community or a nation to aid in the good death of its members. Professional associations representing disciplines or scientific and regulatory associations representing governments and world health are now producing policies, recommendations, position papers, and care guidelines related to providing the highest-quality palliative and end-of-life care. If these documents represent the developmental work of an entire society or nation, what are the group outcomes of achieving or not achieving that work?

Developmental tasks are not solitary actions. A developing child makes an attachment to and trusts another, separates from another, shows industry in comparison to others, and develops an identity in interaction with others; adults achieve intimacy with others and are generative for others. The work of each of these developmental milestones requires access to others. We as oncology nurses have the privilege of being accessible to assist caregivers (professional colleagues, family members, or friends of seriously ill patients) to do their developmental work at end of life. We need much more research on this aspect of cancer care at the level of the individual cancer patient and caregiver and at the level of entire nations, and we would welcome such research submissions to our journal.

My very best,

Pamela S. Hinds, PhD, RN, FAAN

Editor in Chief, Cancer Nursing(TM)

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