Interpersonal Aspects in the Care of Terminally Ill Patients

Terminal illness usually refers to an illness where the point of death is imminent. To many, the word terminal means “there is no hope” or “nothing can or should be done.” Yet, in reality, those who work with patients who have terminal illnesses continually find that the period of a person's time for dying is filled with creative possibilities. However, a conceptual framework, a mythology, might serve to transform the anxiety of death creatively. Research done by Kubler-Ross¹ and Nighswonger² has helped to provide that framework. They describe a series of “stages” (Kubler-Ross) or “dramas” (Nighswonger) by which we are able to have some understanding of the process of dying. These stages provide a needed, simple, useful outline of the normal moves made by people who are dying and are similar in their usefulness to Freud's stages of infantile development; their main interest is focused upon the interior (intrapsychic) moves that occur within the person undergoing the anxiety of the process of dying. What follows is the addition of an interpersonal dimension to our understanding of the process of dying.

Any definition of terminal illness will tend to make terminal illness a static condition, a state determined by the moment of death. Such a definition will encourage us to ignore the process of dying and, more important, to ignore the life which precedes the moment of death. I propose an understanding of terminal illness that does not imply a single point in time, but rather a period of time between two points. The word terminal may represent either the beginning or ending of a journey. The period of terminal illness begins when a person's physical condition can be expected to result in death within a predictable range of time. This range of time may be known either to the patient or therapist or to both, or it may not be known to either. The end point, obviously, is the moment of death.

We might describe the time of a terminal illness as that time in which one is aware