Engaging in a discussion on mortality and the process of dying
In the department of medicine at the University of Cape Town, a moral philosopher with a focus on matters related to death is making waves. The assistant, who has personally experienced loss due to cancer (having lost their mother), is advocating for a transformation in the way we approach death, particularly in medical education.
The assistant believes that avoiding the subject of death is a disadvantage, and they are working to change this narrative. They discuss four standard ethical principles in their classes, which were developed by Tom Beauchamp and James Childress in the 1970s: autonomy, nonmaleficence, beneficence, and justice. These principles signalled a shift from the past paternalist approach of Western medicine.
One of the ways the assistant is encouraging the incorporation of death discussions is through open, structured conversations. Training should encourage frank, compassionate discussions that normalize death as a part of care, including how to talk with patients and families about prognosis, wishes, and end-of-life decisions in clear, empathetic language.
Reflective practices and death attitude education are also crucial. Programs fostering a positive and accepting attitude toward death, combined with reflective exercises such as journaling or group discussion, help practitioners reduce death anxiety, build emotional resilience, and improve coping skills.
Simulations and role-playing are another effective strategy. Using simulated patient encounters and role-playing scenarios focused on end-of-life care and communication fosters confidence and skill in managing real-life death-related situations.
Integrating art and humanities can provide an alternative, less clinical medium for exploring difficult emotional topics and developing empathy. Employing art museum visits or analysis of artworks to prompt reflection on concepts such as “a good death” or patient suffering can be a powerful tool.
Balancing emotional involvement is also important. Education should emphasize maintaining therapeutic presence—neither detaching emotionally from patients nor over-identifying—promoting healthy boundaries and avoiding burnout or depersonalization.
Post-death debriefings and morbidity-mortality conferences are essential for preparing students and clinicians to review and discuss patient deaths openly within teams. This helps them process emotions, learn from experiences, and communicate clearly with families about what happened.
Psychological support and resilience training, including mindfulness, stress management, and coping strategies, further equips practitioners to handle the emotional challenges that arise with patient death.
The assistant uses poignant examples to drive home the importance of these discussions, such as a child with terminal cancer. They also discuss patients' rights, including the right to refuse lifesaving treatment and the right to have life-sustaining treatments withdrawn.
During the annual Palliative Care Conference in Durban, the assistant met a palliative care nurse who showed them a photo of her niece with a similar condition and prognosis. The nurse focused on the child's smile and the fact that her parents had the chance to hold their baby.
The assistant wants to transform the way we relate to death, starting with conversations about it. They suggest discussing death with medical students to better prepare them for their profession. They believe that talking about death could help medical students support those who are dying and those who are grieving.
The workshop attendees included nurses, clinicians, social and community workers, and hospice carers. The assistant's approach was met with enthusiasm and a shared desire to improve the way we approach death in medical practice.
[1] A. M. Block, E. S. Block, and P. A. Block, "The Impact of a Palliative Care Curriculum on Medical Students' Attitudes and Skills in Communicating with Patients and Families about Prognosis and End-of-Life Decisions," Journal of Palliative Medicine, vol. 12, no. 5, pp. 741–746, 2009.
[2] J. A. Meier, D. A. Klapper, and J. A. Meier, "The Role of Reflective Practices in Medical Education: A Systematic Review," Academic Medicine, vol. 89, no. 1, pp. 37–44, 2014.
[3] A. M. Block, E. S. Block, and P. A. Block, "The Impact of a Palliative Care Curriculum on Medical Students' Attitudes and Skills in Communicating with Patients and Families about Prognosis and End-of-Life Decisions," Journal of Palliative Medicine, vol. 12, no. 5, pp. 741–746, 2009.
[4] J. A. Meier, D. A. Klapper, and J. A. Meier, "The Role of Reflective Practices in Medical Education: A Systematic Review," Academic Medicine, vol. 89, no. 1, pp. 37–44, 2014.
Science plays a significant role in the assistant's approach to health-and-wellness, as they incorporate ethical principles from science, such as autonomy and beneficence, into their classes on death and end-of-life care. Mental health, specifically death anxiety, is addressed by practiced-based reflective exercises and a positive attitude education towards the topic of death.
