Dr. Saul Ebema
When a member of the family is dying, unique problems arise. These problems usually begin at the time of diagnosis. Communications often becomes difficult as family members experience different stages of grief.
Expectations of the family are often altered since a member of the family will not be able to function normally due to terminal illness and will soon die. The family’s needs grow and change as their loved one’s illness progresses.
Early in terminal illness, there are the emotional burdens of learning of the illness and coming to accept a terminal diagnosis, of giving up hope of cure and choosing comfort measures. “In addition to grieving for the potential loss of the loved one, there is also the grief for the death of the family unit as it has existed before.
Although the family will continue after the death, it will forever be changed by the death.” Because of the painful predicament the families of a terminally ill patient are placed in, pastoral counseling can be helpful. This is because some family members can be at risk for depression, anxiety, social isolation and suicidal. Some questions for Identifying At-Risk Family Caregivers are;
- Do you feel overwhelmed as a caregiver?
- Do you feel isolated?
- Do you have other family helping you?
- Do you feel prepared for your loved-one’s death?
- Have you felt intensely sad or anxious recently?
Family caregivers need social, volunteer, and emotional support while caring for a dying family member at home so that their own physical and emotional health does not suffer. They also need a lot of encouragement to maintain hope and a positive attitude so that they can continue care-giving.
Emotional Responses of the Family as Death Nears
In addition to grieving the impending loss of a family member due to terminal illness, “The family member is also grieving for that part of him/herself that will be lost with the death of a loved one and for the family which will be forever changed. It is a strenuous time for the family as they struggle to cope with the impending death until it becomes reality and must face further crisis of bereavement.” The process of waiting for the death to happen calls upon the family to have some adaptational tasks and some of
these tasks include:
Remaining with the patient: This may involve making sure the patient is not lonely and involving the patient in family experiences.
The second adaptational task is to remaining separate from the patient. The family members must also begin the process of separation; this may involve exploring the possibilities of life without the dying family member. The family members have to begin preparing for life without the dying member. This can be a very difficult task if the family members where heavily dependent on the dying member of the family.
The third adaptational task is Role Adaptation. Each family member has to adjust to the needs of the dying member of the family.
The fourth task is dealing with grief. This involves dealing with all the emotions associated with impending death. Pastoral counselors can encourage family members to express their feelings and offer emotional support as needed. The fifth adaptational task involves, coming to terms with the death The family members have to begin anticipating life without the dying person. An increased awareness an acceptance of the death minimizes the grieving process after the patient has died.
After coming to terms with the death, the family can begin preparing for the funeral and other important legal documents. The six adaptational task is saying goodbye. This is an important task for both the patient and their loved ones. Sometimes the dying patient needs permission to die and to let go.
As these tasks are being completed, each family member hopefully will attempt to finish unfinished business with the patient. Expressing feelings, resolving past conflicts, tending to last wishes will create the closure that makes the final separation more peaceful and bearable for family and patient.
 Bernard Schoenberg Psychosocial Aspects of Terminal Care (New York: Columbia University Press. 1972)
 Therese A. Rando, Grief, Dying and Death: Clinical Interventions for Caregivers (Champaign, IL: Research Press. 1984), 171.
 Ibid., 330.