By typical end-of-life definitions, Nelson Mandela is dying (he is in critical condition after a lengthy hospital stay, and has had multiple recent admissions). Those of us in the healthcare professions see this end-of-life equation all of the time: increasing severity of illness and frequency of hospitalizations plus advanced age almost always equals dying. Now, everyone likes to believe this equation may be altered by hopes, prayers, and modern medicine. But unfortunately, such yearnings usually fail to change the equation, no matter how powerful our offerings or how advanced our medicine.
President Mandela is a case in point. A case followed closely by the world, but also foreshadowing what may happen with each of us at the end of our own lives. We can all learn the following three lessons from his end-of-life experience.
1. Recognize the end-of-life equation. On June 9, 2013, South Africa’s best-selling weekly newspaper, The Sunday Times, reported that Mandela’s long-time friend Andrew Mlangeni publicly stated: “You (Mandela) have been coming to the hospital too many times. Quite clearly you are not well and there is a possibility you might not be well again.”
Mandela’s long-time comrade recognized and verbalized the end-of-life equation whether the rest of the world wants to hear it or not. I applaud him. Oftentimes, the only one who is willing to acknowledge what is really happening is the one who is approaching death himself. The rest of us: friends, family and even doctors, often choose to remain in a state of denial believing that more can be done to change the equation.
2. Understand decision motivations. Lots of people want to keep Nelson Mandela alive at all costs, even if it inadvertently causes unnecessary suffering for him. You may read this and ask, “Are these people selfish?” I would say, generally, they are not, we are not. We all love him and recognize his iconic peace-promoting power in South Africa and abroad. However, our perspectives are underpinned by “our” desires for him rather than perhaps asking what he would desire for himself. Virtually the whole world is praying for his return to health.
In contrast, Mr. Mlangeni, was also quoted in the Sunday Times article urging Mandela’s family to “release him” and “let him go.” This position is the most selfless and loving, but can also be the hardest to realize. Again, should we become involved in making end-of-life decisions for another, we must ask ourselves about the motivations for our choices. We should select care not based on what we desire or fear about our loved one, but should with great reflection select treatments which the dying would choose for themselves.
3. Give permission to die. In South African culture, it is customary for the family to give final permission to die, to emotionally and spiritually release the one who is approaching death. At some point Nelson Mandela will receive the words, “We release you, Father.” I have given this same permission to my very own dying grandmother, and I have frequently stood at the patient bedside as families gave permission to their own. Rarely, in living, do we create occasions to bid such sweet offerings to those we love, but surely in the face of dying, we should utter the words, “thank you,” “I love you,” and “good-bye … I release you.”
So, Nelson Mandela is dying (either shortly or in the not so distant future), yet he remains iconic, not only for South Africans, but for the rest of us as well. Take these three lessons from the end of his life and apply them to yourself and your own family. Then take his words and apply them to your life: “What counts in life is not the mere fact that we have lived. It is what difference we have made in the lives of others that will determine the significance of the life we lead.”
Monica Williams-Murphy is an emergency physician and author of It’s OK to Die.
