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COMMENT

'Regrets of the dying should influence end of life care'

Maybe you are already familiar with the online article: “Top five regrets of the dying”. Written by Australian palliative care worker Bronnie Ware, it documents the most commonly expressed regrets of the dying.

It’s simple but powerful message, like all great writing, has captivated some, irritated others but either way spread worldwide ripples of reflection and debate.

The article summarises many conversations Bronnie Ware has had with dying patients into five common areas of regret, namely:       

  • “I wish I’d had the courage to live a life true to myself, not the life others expected of me.”
  • “I wish I hadn’t worked so hard.”
  • “I wish I’d had the courage to express my feelings.”
  • “I wish I had stayed in touch with my friends.”
  • “I wish that I had let myself be happier.”

Ostensibly the article could be viewed as a rather sad piece about death and regret. But there is a subtext that is inspiring and potentially life changing. As Bronnie summarises:

“Life is a choice. It is your life. Choose consciously, choose wisely, and choose honestly. Choose to be happy.”   

Certainly it made me think twice. It reminded me that, contrary to popular wisdom, time is, in fact, not money but rather a rather precious and finite resource. It also prompted me to remember that health is not to be taken for granted for without it we lose our freedom.

But that’s just my take on it. Have a look at the article for yourself - you’ll find an enormous amount of comment and discussion surrounding it.  Curiously, considering its source, there is not much from a nursing point of view. This has led me to reflect that perhaps more attention to the regrets of the dying could affect our approach to palliative care.

Compassion is often cited as the prime motivating force behind people’s decision to pursue a career in nursing. It’s also considered as one of its basic tenets. Despite recent publicity, my experience is that nurses do care. Not in a doe eyed, angelic sister of mercy caricature, but by providing practical solutions to suffering, in an organised efficient and professional way.

But compassion has an ugly sister - its name: “pity”.The particular circumstances and dire needs of palliative patients can turn compassion into pity - not a helpful approach.

At its heart, compassion involves respect for another human being. It views every person as an equal. But pity, however well meaning is an emotion lacking respect and it demeans its recipient. The loss of dignity associated with receiving it only adds to the burden of the patient’s emotional load.

Learning from the wisdom imparted by the dying alters that dynamic: the nurse-patient relationship becomes more equal. There is give and take on both sides and pity can be banished.  

We need to understand that growth doesn’t stop at puberty. Life can begin at 40, 50 or whenever you decide. A final emotional growth spurt happens when people are faced with their own mortality. By attending to the words that often accompany this concluding chapter in a patient’s life, nurses can learn lessons for our own lives, as well as honouring the wisdom of those we care for.  

Stephen Riddell is a district nurse working in Dumfries and Galloway

Readers' comments (6)

  • Very interesting article! I shall think about it in the course of my practice.

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  • I enjoyed this article very much.
    As a hospice chaplain I'm constantly struck by how much good spiritual care nurses routinely offer -even if they are sometimes nervous about using that word. This is a good example of how well placed nurses are to engage in spiritual care - and dealing with regrets is part of spiritual care.
    I'm also very pleased that the writer was so clear about the mutual benefits of all of this - the wisdom of the dying as well as helping us to live our lives better, gives their regrets dignity and purpose.

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  • It is so important to provide as much emotional care and comfort for those facing their last hours. I believe there should be more support for people to fill in their personal death plans so that medical staff and close family know the wishes of the dying person and give them the comfort they have requested. There is a very good Death Plan template in the end of life website My Last Song.

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  • I think there is one possible problem here. Although Ms. Ware's piece strikes a chord, one has to ask a couple of questions: is it true and is it verifiable? Note that the beginning of the comment says: 'palliative care worker Bronnie Ware' - well, she might have been, but she certainly isn't now - website http://bronnieware.com/ If you visit her blog, there's not that much evidence to support her care work. At best, this is just a series of anecdotal observations made by someone who, in her own words, 'a very fine story teller'. Now ask yourself - if you were caring for the dying, would you question them about regrets? Is that ethical?

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  • definitions from the COED 11th Ed

    isn't empathy the more appropriate for the nursing profession in the provision of dignified therapeutic care

    compassion
    n noun sympathetic pity and concern for the sufferings or misfortunes of others.

    ORIGIN
    Middle English: via Old French from ecclesiastical Latin compassio(n-), from compati 'suffer with'.



    empathy
    n noun the ability to understand and share the feelings of another.

    DERIVATIVES
    empathetic adjective
    empathetically adverb
    empathic adjective
    empathically adverb

    ORIGIN
    early 20th cent.: from Greek empatheia (from em- 'in' + pathos 'feeling') translating German Einfühlung.

    USAGE
    People often confuse the words empathy and sympathy. Empathy means 'the ability to understand and share the feelings of another' (as in both authors have the skill to make you feel empathy with their heroines), whereas sympathy means 'feelings of pity and sorrow for someone else's misfortune' (as in they had
    great sympathy for the flood victims)

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  • michael stone

    I must be missing something, here - these are comments from the dying, about their past life. You cannot go back, and alter that, surely ?
    Isn't it rather more important, to listen to a person's wishes about how they want their death to take place ! As in the guy on casualty yesterday, who was firm in his wish to die at home, and not in hospital !
    Isn't it the hypothetical comments which the person, after death, could 'somehow have made about the way you interacted with him as he 'died'', which are relevant for this stage of a person's care !!!!

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