The founder of the Hospice movement, Dame Cicely Saunders, identified four important human tasks that people want to complete during the process of dying. They are:
• To say ‘goodbye’ – to people, animals and things that have been important to them
• To say ‘thank you’ – for a life together, for help and care provided, perhaps particularly in this last period when extra care has very often been needed.
• To say ‘sorry’ – perhaps for failings or slights or demands, or especially for being difficult to live with, in the last illness.
• To say ‘I love you’.
Many people focus on helping the dying person to complete these tasks, but it is a two-way communication. Both the dying person and their loved ones need to complete these tasks to their own satisfaction.
This can lead to problems, however, because one person may never be able to say ‘goodbye’ to their own satisfaction, to say ‘thank you’ enough, or ‘sorry’ with enough emphasis, or ‘I love you’ with intensity. The problem is that this can demand too much energy or reserves of support from the other person.
Either a dying person or their loved one may need help, therefore, in closing the communication. Perhaps it will be enough to say that you have heard: ‘Thank you for saying that.’ Or: ‘What you’re saying is really important to me’.
Sometimes more is required, because people need to know that, not only have you heard, but you accept what has been said. ‘Your love has always meant such a lot to me.’ Or: ‘I realise how important it is to clear up our disagreement’.
When an important communication takes place, the people involved may need an external recognition of how difficult the communication has been. This may be because either the dying person or their loved one does not have emotional or physical strength to care for the other person by recognising what the other has been communicating. Therefore, another family member or a carer or helper can assist by drawing attention to the profound exchange that has just taken place. In this way they support the communication. ‘It’s good you have been able to talk about such important feelings’.
You can also signal importance by some shared action: ‘Let’s drink to that’. ‘Let me give you a hug’. And a helper can encourage that: ‘Why don't we just sit quietly for a bit and remember the good times you have had?’
Dr Malcolm Payne is a leading educator and writer in social work and end-of-life care, emeritus, honorary or visiting professor at universities in the UK, Poland and Finland. He is the author of many books and professional and research publications in health and social work. Among his recent books are: The Creative Arts in Palliative Care (edited with Nigel Hartley) Philadelphia/London Jessica Kingsley; Humanistic Social Work: Core Principles in Practice Chicago: Lyceum/Basingstoke, UK: Palgrave Macmillan and Social Work in End-of-Life and Palliative Care (with Margaret Reith) Chicago: Lyceum/Bristol, UK: Policy Press.