Death and Living: A Family Therapy Approach

For many years the issue of death with dignity has been explored in great depth by investigators of the dying process. Since Kubler-Ross first popularized the subject with the publication of her book, On Death and Dying,1 professionals and nonprofessionals alike have developed an awareness of the needs of the terminally ill patient. However, the desires of the patient to cope with pressing family issues so as to live out his life with greater acceptance has not enjoyed the same degree of understanding. Scientific medicine militates against the encouragement of exploring living issues of a psychosocial and existential nature which make for continuing emotional fulfillment and personal growth in the terminally ill.

Marmor, in discussing systems theory, has pointed out that from birth every person is enmeshed in a series of dynamic interactions with his environment and with other people, all of whose inner processes have been shaped and altered by their interactions with a wide variety of systems.2 In the treatment of the terminally ill, there is a tendency to minimize the profound effect that the family system exerts on the patient, the therapeutic milieu, and the ultimate success or failure of any program to preserve both life and dignity as long as is feasible. As part of my role as liaison-consultation psychiatrist to the terminally ill at the Boston Veterans Administration Hospital since 1972, I have been involved in analyzing the effects of the family system upon the patient, physician, and hospital milieu in the care of the terminally ill. Without a careful investigation of the stresses superimposed upon any treatment plan by the family system, there is no possibility to avoid frustration, anger, and eventual rejection of the patient by the helpers upon whom he is dependent.

Glaser has stated that if human illness creates a disturbance in identity, then constant physicians are a necessity.3 It seems clear that it is not only the patient who requires a constant phy