'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
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