The fragility of those approaching death reveals the deepest meaning of human dignity. Dr. Marie-Sylvie Richard, a Xaverian sister and director of a palliative care center, draws on her experience accompanying the dying. With each person, she insists, we must find a way to make genuine contact.
Relationship with another human being gives life its flavor and meaning. Yet when someone is dying, real contact becomes difficult. You face a person in suffering. Only by listening to that suffering can relationship become possible.
The Loss of Self-Worth
As the end of life approaches, the sick, disabled, or elderly person is forced to surrender capacities one by one. This dependence makes the bonds with those nearby increasingly painful. The body changes. The mind dims. Self-doubt sets in. I am not who I was. I don't know if I can still be loved. People will tire of me.
When this loss of self-worth deepens, it can drive dying people toward despair so complete they wish for death: I don't know if they recognize and love me as I am now; better to die than live like this. We must consent to this psychological dying: Yes, I understand.
The dying person lives in uncertainty. Everything becomes threatening. What will happen to me? How will the illness progress? How will death come? Will I be alone? Fear of solitude, of losing one's mind, of losing all control, of being unable to speak for oneself, of lying helpless in the hands of others—these pile up. And beneath them can come a deeper trial: doubt about everything, even one's own beliefs. Yet through this suffering, through total stripping away, something deeper can take root.
When everything seems to collapse, the dying have the hardest time reaching out to others. And yet those are precisely the moments when they most want someone to listen—truly listen—to what they feel. To be reassured. To know that they still matter to someone.
The Helplessness of Those Who Love Them
Families and friends suffer from watching suffering. It can be unbearable to sit with someone in unrelenting physical pain. The sense of helplessness is overwhelming. For those who know the patient well—a spouse, adult children—it is agony not to be able to step into their place, not to understand what they live through as moral and spiritual torment. The intensity of our love cannot ease their suffering or prevent their death. Each person finds themselves alone. Those with faith can entrust their loved one to God. And yet we all, regardless, live this helplessness of reaching the other in their pain.
I find myself confronting my own limits—never easy, especially when I want to do so much and time is running out.
The Difficulty of Speaking
Another source of suffering for those near a dying patient is the difficulty of speaking truly to one another. This becomes harder still in grave illness, in advanced age, as death approaches.
It is crucial to tell the patient about their illness and what lies ahead. They are the first person who needs to know. Yet how many lies, half-truths, and evasions we tell—not from cruelty, but to soften a reality that seems too brutal for them and for those around them. Don't tell them; they mustn't know. Information must come in small pieces, at the pace of their questions, in an atmosphere of truth and trust. Not to hide something from them, but so they can truly hear and understand it.
Families need guidance and support in learning how to do this.
When a patient asks, Am I dying?—that question frightens everyone. In fact, it is almost never asked directly. Usually the patient themselves signals that they sense death drawing near. They might say: Do you think I will die soon? With those words—die soon—they have already told us something. They are showing us what they feel. Rather than freeze in fear of the question, we can learn to ask it back simply: You say you will die soon. Why do you say that? What do you feel? This way they give us the elements we need to answer. Practice this small technique in an atmosphere of trust, and we lose our dread of words that might wound. Then we can even permit ourselves to stumble: You know, your words move me. I don't know what to say.
Discovering Reciprocity Again
Sometimes verbal communication is no longer possible. The illness touches the brain or the organs of speech. The patient drifts in and out of consciousness, or has no strength left to whisper a syllable. We must all learn to speak without words: with eyes, with a hand, with a smile. We must read every small gesture, every shift of body, as if it were language. It is hard to stay beside someone without feeling any return—any sense that something passes between you. Yet those who have known people with severe disabilities know how we can be transformed by their presence even when there is no apparent reciprocity in communication.
We must believe in this reciprocity even when we cannot feel it. The philosopher Paul Ricoeur asked: When you sit with someone at the end of life, someone with whom you cannot speak, do you leave that room as you entered it? No.
Something has happened inside us. Something has touched us, transformed us, is transforming us.
The other, in their terrible vulnerability—unable to speak to us, to reach toward us—simply through our courage in staying present, in attentive presence, this other person shakes us and changes us at the deepest level.
Dr. Marie-Sylvie Richard, 2004