Lorna E. Segall
As advancements in medical technology have afforded humans the opportunity to benefit from life extending interventions, dying has often become synonymous with failure. Because physicians are focused on extending life, they can easily lose touch with the skills necessary to care for their dying patients.
It is essential that not only physicians, but all members of the healthcare community have the skills needed to care for patients in their final phase of life (EPEC, 1999). If caregivers, patients, and family members feel confident in the care patients are receiving, the process can be a positive experience and can allow both patient and family members an opportunity to create meaningful memories.
Considered one of the pioneers in hospice care and the dying process, Elizabeth Kübler Ross, a Swiss-trained physician, became famous for her death and dying seminars at The University of Colorado’s School of Medicine. Kübler Ross would invite her patients to attend these seminars and share their dying experiences with her students. Her insights would change how society thinks about death (Webb, 1997).
Initiated by Elisabeth Kübler Ross and her impact on the hospice movement, America began to reshape its focus on caring for the dying. When patients are able to remain relatively free of pain and suffering, they are able to focus on the psychological, spiritual, social and emotional aspects of the final phases of their lives (Webb, 1997). Organizations like hospice provide the medical, spiritual and psychological support that dying patients need to have a meaningful death.
There is no uniform dying process and people approach their own death in a unique way. Like birth, death is unpredictable and unique to the individual who is experiencing it.
There are some events, however, that can be expected with dying patients just as there are with births. Those who are experiencing the final phase of life begin to eat less and sleep more, become sensitive to light and communicate less and may appear confused or disoriented.
As persons acknowledge that they are dying, they begin to withdraw from the world and people around them. This withdrawal phase may begin by patients not watching television or reading the newspaper, and end with their withdrawal from neighbors, family members and loved ones.
On the outside it may appear that nothing is going on; however, on the inside, the sorting out of one’s self and life is occurring. This process is usually done with eyes closed. Even though individuals may appear to be asleep, much important work is happening within. They speak less and rely on other forms of communication (Karnes, 2005).
In many cases, as patients make the transition from one world to the next, they become difficult to arouse, may appear comatose and do not respond to verbal or environmental stimuli. This inability to react to environmental stimuli is called nonresponsiveness.
Non-responsiveness is a characteristic that can be found not only in patients experiencing the end-of-life process, but also in patients experiencing different stages of Alzheimer’s Disease, comas, and low-awareness states. Although we have no way of knowing what non-responsive patients hear, experience indicates that their level of awareness may be greater than their ability to respond; therefore, it is wise to presume that the unconscious, or non-responsive patient, is hearing everything (EPEC, 1999).
Individuals who are experiencing the end stages of life are usually able to process aurally, and, therefore, may benefit from music therapy.
Music therapy is an evidenced-based intervention method that has been utilized with individuals and families at all phases of the dying process. The goals of hospice music therapy are: to reduce stress, depression and anxiety, to increase relaxation and reality orientation, to provide a means of communication and self-expression, to offer procedural support, and to address issues of anticipatory grief (Starr, 1999).
Additionally, music therapy in the hospice setting can help patients and their families cope with issues of grief, loss, pain, and feelings of hopelessness (Hilliard, 2001). When persons are faced with impending death, it can be difficult for them to communicate, to express feelings and their final thoughts. Music therapy can facilitate such communication between patients and their families while also offering a reassuring, non-threatening presence (Hilliard, 2003).
Music therapy sessions may include activities such as instrument playing, song writing, singing, and life review. Ultimately, music therapy serves to assist patients and their families in maintaining the highest quality of life possible throughout the dying process, even when their loved one is in a nonresponsive state.
Music therapy interventions have been utilized with persons who are in nonresponsive states. It is music’s independence from language that makes it a useful modality in which to work with patients who are unable to communicate with words for psychological, physiological or emotional reasons (Magee, 2005).
Because it is widely agreed that the music center of the brain is often the last to deteriorate (Starr, 1999), this finding further validates the use of music therapy as an appropriate method of care for non-responsive patients. Music has the ability to elicit strong emotions and memories by offering a means of communication and by promoting mental awareness and physical activity.