As most everyone around the world is aware, Nelson Mandela is dying. This statement elicits deep feelings of melancholy, sadness and grief. Why? It's in the language.
The immediacy of the present progressive'is dying' connotes a very different emotional response than the remoteness of 'is going to die'. Mandela is a great man who has earned global respect. As his family strives to maintain some degree of privacy, the final chapter of his complex life is displayed for the world to see.
The family's respectful refusal earlier last week to allow President Barack Obama an audience with Mandela himself as he nears death is an example of how deeply they guard the privacy of these final moments. Mandela's eldest daughter, Maca Zvi, reportedly blamed the foreign press's death watch vigil to be in "bad taste."
Countless people experience the private and personal struggle of an elderly family member dying in myriad ways everyday. Cultural norms, religious rituals, family relationships, financial constraints and medical uncertainty influence the course of dying. Resolution and reconciliation can only come by first acknowledging that someoneis dying.
We all hope for some degree of peace, grace and comfort at the time of death. Despite research that finds that most Americans prefer to die in their own homes, for those over 65 years of age, only 25 percent of deaths occur in the home, while 35 percent occur in hospitals and 28 percent in nursing homes.While many of these situations are unavoidable, many more are by default- because simply stating that one wants to die at home does not constitute an actual plan. At a minimum, making a plan requires determining a healthcare power of attorney and providing guidance to that person about acceptable medical intervention. To be sure, that intervention may be to take full advantage of all that technology has to offer or to maintain consciousness to allow for contemplation as cited in the 15th century Latin text Ars Moriendi, "The Art of Dying." The only bad plan in end of life care is no plan at all.
Nelson Mandela is often described as "the father of the nation"; he has been awarded the Nobel Peace Prize and the U.S. Presidential Medal of Freedom. At nearly 95 years old, it is highly unlikely that he will be able to recover from this pulmonary illness to his former functioning self. While it is obvious that he is'going to die' the truth is that he 'is dying'. He is being kept alive on life support, and his family is involved in a legal dispute over his place of burial. Whether his death will come despite medical technology or as a result of discontinuing life sustaining therapy is uncertain. What is certain is his death. Regardless of the politics, awards and protests, this family is struggling with a misfortune known all to often to families everywhere.
Families can be loving, complex and messy. As a world-reknowned leader, his life in the public spotlight is even more complicated. But for every person on the planet, advance directives for end of life care can empower the elderly to die in the manner in which they lived and remove the burden of guessing from their loved ones. It is the onus of both the physician and one's family to acknowledge that someoneis dying so that the remaining precious time can be spent rejoicing in their life.