End of Life, Relationship Issues During

At the end of life, everything drops away except that which is most important: for most people, it is the relationships that have made up their lives. As death approaches, relationship issues that have developed throughout people's lifetimes may be magnified and examined more closely for reflection and consideration. What is important relationally at the end of life can often be identified by the messages conveyed during final conversations. The five primary themes that emerge in final conversations are love, identity, religion/spirituality, everyday activities, and difficult relationship issues. The purpose of this entry is to describe these five message types as they reflect what occurs in conversations at the end of life.

One thing to consider as these messages are reviewed is the encouraging and empowering nature of the conversations that occur while people face the reality of death and loss of someone with whom they are close. These interactions often arise in the midst of strong and frequently negative emotions that accompany death such as grief, fear, sadness, and anger. Impending death brings with it cognitive reactions that include a loss of control, denial, uncertainty, and even avoidance.

At the end of life, relationships also have to coexist with three pervasive challenges: The first challenge is the chronic physical pain that frequently accompanies death. To manage the pain, the dying often must take powerful medications that can leave them in psychologically altered states (i.e., hallucinations, mental confusion, or sleeping for longer periods). The second challenge is the chronic stress that is commonly experienced by both individuals in the close relationship. It is difficult to behave normally in the midst of constant worry and strain. The third challenge is the cultural expectations that have made death unnatural, morbid, and a taboo topic.

In addition to the challenges that surround relationships at the end of life, awareness that death is near also gives people in relationships many valuable and irreplaceable opportunities. An impending death gives people permission to say no to less important, although seemingly more demanding, parts of their lives. People (both those who are [Page 526]dying and their loved ones) tend to slow down their active lives and, for a brief time, focus intently on their relationships. Whereas unexpected sudden death limits many of the choices and opportunities for the resolution of issues in close relationships, foreknowledge of impending death gives the gift of time to communicate in ways that may have a profound impact on the relationship as well as on the individuals. Final conversations provide opportunities to create new memories, cherish old ones, and find closure where needed.