Mindful Living for Terminal Patients

Mindfulness, which involves focusing on the present moment with curiosity and acceptance, has been shown to help manage emotional distress. For instance, mindfulness can help cancer patients ease anxiety related to illness and death by focusing on the present and their bodily sensations. However, factors like the duration and environment of mindfulness interventions can influence their effectiveness.

The article "The Gift of Here and Now at the End of Life: Mindful Living and Dignified Dying Among Asian Terminally Ill Patients" by Singaporean researchers Ping Ying Choo et al. (2023) explores the impact of mindfulness on end-of-life care.

The authors highlight that one of the main goals in caring for terminal patients is to protect their dignity, as many patients express that life without dignity is not worth living. Canadian researcher Chochinov, through interviews with terminal patients in Canada in 2002, developed a dignity model. This model identifies three factors contributing to the loss of dignity at the end of life: illness, perspectives on dignity, and social interactions. One core practice within this model is mindfulness—focusing on the present without worrying about the future, taking life one day at a time (referred to as "mindful living"). Subsequent studies added cultural factors, showing that the concept of preserving dignity for terminal patients can vary across cultures. For example, in China, "mindful living" tends to be family-centered, with patients desiring to focus on the present moment with their loved ones in their final days.

Building on these early studies, the authors sought to explore in more detail what "mindful living" looks like for terminal patients and why it is effective. By analyzing 50 interview records, they investigated the life experiences and mechanisms of mindful living among terminal patients in Singapore. The participants were mostly male Chinese cancer patients over the age of 50 who were receiving palliative care.

The interviews and analysis revealed three key components of mindful living for terminal patients. These specific mindfulness practices brought the patients a unique sense of calm. In general, they viewed mindfulness in the face of death as a way to find comfort in every moment of life and to cherish the limited time shared with family during the final stage of life. These three themes—awareness, attention, and attitude—intertwined to create a cycle that brought about "re-perception," allowing patients to face their terminal illnesses and inevitable death with greater dignity, through meaning reconstruction and a perspective of gratitude.

(1) Purposeful Self-Awareness

Patients, through reflecting on their illness and impending death, seek strength, meaning, and support. This includes drawing strength from faith (awareness of life's resilience), finding balance between fighting the disease and accepting the natural process of dying (awareness of life's flexibility), maintaining connection with the community (awareness of the importance of community), and reconstructing their experience of terminal illness (awareness of reconciliation, liberation, and freedom). Below are some quotes from the interviewees:

"If treatment is possible, I will accept it and take it step by step. After all, life is precious. I don't treat death and funerals as taboos, but rather face them directly. Death is a part of life, and it's just a matter of time." (70-year-old mother, gynecological cancer)

"I tell myself not to feel depressed or lost just because I have a terminal illness. It's been over ten months since I was diagnosed, but I don’t define myself as just a cancer patient. During chemotherapy, I listen to music and watch TV... I am not restricted by my illness, and I still do what I want to do." (64-year-old husband, lung cancer)

"The social worker and home care team are here to help me. So, when I have pain, I must speak up... otherwise, no one will know the challenges I'm going through." (55-year-old father, lung cancer)

"This is a new stage of my life. I see it as a blessing... It has helped me reconsider my life and the people around me." (70-year-old husband, lung cancer)

"I used to worry a lot about leaving my children, but my faith made me reflect... Now, I see illness as a blessing... I love myself more, love the way I am now, because my perspective has changed, my focus has shifted... I have reconciled with myself." (53-year-old mother, lung cancer)

(2) Focusing on Family

Patients focus on family relationships and their legacy within the family, forming deeper connections with their loved ones as they approach the end of life. This includes passing on wisdom and hope to family members (life's legacy), acknowledging personal achievements in the family (humble celebration), expressing love and gratitude to family members (conscious gratitude), recognizing the support of family during the illness (gratitude and empathy), and resolving regrets and unfinished business (finding happiness through forgiveness).

"Soon, I will be gone. (After I die) I hope my family remains intact; the bonds between family members must remain." (55-year-old husband, lung cancer)

"I raised my children myself, and I feel fulfilled. They’ve all grown up, gotten married, and now have children of their own." (70-year-old mother, kidney cancer)

"I’m not very good at expressing gratitude, so I don’t know how to say it... I express it through actions." (56-year-old mother, breast cancer)

"I am grateful to you... I don’t think we’ve ever talked about gratitude (for each other), but I am deeply thankful inside." (80-year-old father, lung cancer)

"They gave me strength. That’s why I can keep going... My family’s support is so strong." (56-year-old mother, breast cancer)

"My illness has made me wake up and say, ‘You have an amazing wife! How did you not notice this sooner?’... I am really grateful for my wife’s support." (77-year-old husband, prostate cancer)

"I apologized to my children, and they accepted my apology... After I was diagnosed, I told them, ‘I’m sorry, I used to hit you for no reason. It was my fault.’" (58-year-old husband, colorectal cancer)

(3) Acceptance of Death

Patients adopt a non-judgmental attitude towards death and make necessary arrangements for their impending passing. Through these preparations, they achieve a sense of closure and inner peace, cherishing every moment spent with their family. This includes sharing beautiful moments with family (companionship beyond life and death), expressing final wishes and making posthumous arrangements (directly confronting impermanence), and passing on responsibilities to successors (transmitting roles).

"I want to spend the remaining time with my family. We can cook together, eat together, and just enjoy happy moments simply by being with each other." (62-year-old husband, nasopharyngeal cancer)

"This is my top priority: ensuring that they are all taken care of after my death, including my daughter, son-in-law, and grandchildren. When I must leave, I will feel at ease." (70-year-old husband, lung cancer)

"I hope my wife will continue to stay strong and be the pillar of our family, holding everything together... I also hope my daughter will help her do this." (51-year-old husband, liver, gallbladder, and pancreas cancer)

"I have already told my children, ‘When I am no longer here, you must take care of your mother. This is the most important thing to me: you must take care of your mother.’" (65-year-old husband, kidney cancer)

The article shared today comes from multicultural Singapore, which provides valuable insights relevant to terminally ill patients living in Asian cultures. It aims to offer perspectives on how mindfulness can help preserve the dignity of life in the end-of-life stage within an Asian cultural context.

In Western culture, mindful living at the end of life typically focuses on being present in the moment without worrying about the future. In contrast, in Asian culture, it is equally important to focus on the impermanence of approaching death while reflecting on one's role and participation within the family. The concept of "interdependent self-construction" in Asian cultures suggests that we often define and find meaning in our existence through important relationships, especially with our family.

If you are reading this research and are experiencing the final stages of life for yourself or a loved one, what kind of awareness, focus, and attitude are you experiencing? How do the 12 mindfulness principles in the three major themes resonate with you personally?

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