Practitioner Perspective: Rethinking What it Means to Die Well

Amy Siple, APRN, FNP, GS-C wants integrative practitioners to start thinking about death. And not just their patients’ deaths, but their own death as well.

“If we're going to be empathetic with patients, it's important for us to consider our own mortality,” said Siple, at the 2023 Integrative Healthcare Symposium in New York City.

In her presentation, Siple, a nurse practitioner who serves residents in long-term care in Wichita, Kan., urged practitioners to consider what it means to die well. Too often, people shy away from the idea of death. In a world of uncertainty, one thing is for sure: everyone will die, Siple said. And if people acknowledge the inevitability of death, with the proper planning and care, they can live out their last days comfortably and peacefully.

However, according to Siple, the United States healthcare system regularly neglects to facilitate positive end-of-life experiences, laser-focused on prolonging the lives of the terminally ill with aggressive medical treatments instead. The integrative field challenges much of the conventional, unnatural treatments commonly used to prolong one’s life. With goals of disease prevention and longevity, integrative medicine isn’t always considered when people reach the end of their life. Yet, Siple explained, integrative medicine and end-of-life care share many of the same principles.

“Integrative practitioners are interested in a root cause analysis, discovering the etiology before the procedure. And then looking at the whole person,” Siple said in an interview. “That holistic perspective, dying well absolutely fits into that model.”

In turn, both fields can learn something from each other. Many of the same integrative practices that help patients live well, can also help them die well, which, in Siple’s opinion, can be just as important.

Weighing the Medical Goals of the Terminally Ill

When thinking about end-of-life care, three central goals should be considered: to prolong a patient’s life, to maintain their functioning, and to make sure they’re comfortable. Unfortunately, these goals often contradict one another. To weigh them means having open and honest conversations about how a patient envisions their ideal death, Siple said.

Just like with any other patient, those with terminal illnesses need to be asked to look toward the future and decide what they would like it to look like.

“We plan funerals, we plan weddings, and we even plan childbirth,” said Siple. “So, let me ask you to think about what your ideal death would look like? Are you inside or outside? Who is sitting by your bed? Who's holding your hand? Is there music playing?”

According to Siple, the only way to facilitate a comfortable end-of-life experience for patients is to have these discussions and ask difficult questions.

Engaging in Conversations around Death with Patients

It’s crucial that, instead of encouraging unrealistic hope and going through with aggressive treatments, providers are direct with patients about their chances of dying and the most likely timeline for it, said Siple.

After a patient is properly informed about their prognosis for life expectancy, Siple said it’s important to explain their options and ask questions about what goals they want to prioritize along with their fears surrounding death.

“Asking questions that help clients make informed decisions is absolutely essential,” said Siple. “The health care team must be willing to walk through the dying process with clients because dying well can be a reality.”

During these conversations, Siple suggested asking questions such as,

• What do you understand about your diagnosis?
• What concerns do you have about what lies ahead?
• How do you want to spend your time if your health worsens?
• Who do you want to make decisions for you?
• How much are you willing to go through to have a shot at being alive and what is tolerable to you?

“Different people will answer these questions differently, but we do need to give them the opportunity to answer,” said Siple.

Seeking Meaning in Illness

While most view death, and the process leading up to it, as an inevitably negative experience, in Siple’s opinion, with the right care, the end of one’s life can be beautiful and fulfilling. For that reason, Siple said she’s not a proponent of euthanasia.

“Terminal illness often forces one to reappraise the meaning and the purpose of life. If one allows space in life, for the process of finding meaning in illness to unfold, then one can move from the superficial to the profound,” she said. 

While conventional medicine uses aggressive means to delay death, integrative medicine can get caught up on the idea of longevity and preventing illness in the first place. Either way, death is left out of the conversation. But the fact is, death is a part of life, Siple explained.

“Death will come to us all; it's a matter of what that looks like,” she said. “And we can just try to fight till the end and stay in denial, and people will experience great pain and suffering as a result, or we can face reality, find out what people's goals are, and walk with them through the process, and death can be beautiful.”

LISTEN: How to Help Patients Die Well