Silent
Silent provides the tools for seekers to recognize their path and enables self-reliance for spiritual and magickal growth.
Seekers gain insight from his work and find their inner calm from his ability to listen and help others reflect.
Stages of Care at the End of Life
Silent • June 30, 2024
Five Stages of Palliative Care
Navigating the Shadows:
Recently, a friend and colleague shared the end-of-life journey for his mother. She had been ill for some time. The family had reconciled itself that the end of days was nearing. However, the grief and frustration they experienced were magnified by the hospital staff's lack of communication regarding hospice care.
Death education for the dying and the circle of care around them is the most critical portion of end-of-life. Without understanding that their mother would not be returning, the support and comfort that hospice provides, the family was caught unawares, feeling abandoned in their darkest hours. A few days after entering hospice, their mother became an ancestor.
The unpreparedness deepened their sorrow. The absence of guidance and the stark reality of an impending loss without a plan intensified their anguish, reminding us all of the critical importance of compassionate and thorough end-of-life care discussions.
As a doula, providing education is equal to other parts of care.
Hospice vs. Palliative Care
While both hospice and palliative care share the goal of providing comfort and support, they differ in their approaches and timing:
Hospice Care: Hospice care is reserved for those in the final months of life, typically when curative treatments are no longer pursued, and the focus shifts entirely to comfort care. It involves a team-based approach to providing comprehensive support to patients and their families, ensuring a dignified and peaceful end-of-life experience. Hospice care is often provided in the patient's home but can also occur in hospice centers, hospitals, or nursing homes.
Palliative Care: Palliative care, on the other hand, is appropriate at any stage of a severe illness and can be provided alongside curative treatments. It focuses on relieving symptoms and improving quality of life from diagnosis onward. This broader scope allows for integrating palliative care in various healthcare settings, from hospitals to outpatient clinics.
Stages of Care at the End of Life
The journey through palliative care is a profound and transformative experience, both for the individual facing a life-limiting illness and for their loved ones. Palliative care is a holistic approach that seeks to improve the quality of life for patients and their families by addressing the physical, emotional, spiritual, and social needs associated with severe illness. Here, we delve into the five stages of palliative care, reflecting on the profound intersections of spirituality, life, and death.
Initial Assessment and Care Planning: The first stage involves a comprehensive assessment of the patient's physical symptoms, psychological state, social circumstances, and spiritual needs. A tailored care plan is developed when collaborating with the patient, their family, and the palliative care team. This plan addresses pain and symptom management, psychological support, social services, and spiritual care. This stage is critical in establishing trust and understanding the patient's values and goals.
Active Treatment and Symptom Management: At this stage, the focus is on managing pain and other distressing symptoms such as nausea, breathlessness, and fatigue. The palliative care team employs various medical and non-medical interventions to ensure the patient remains comfortable. This stage is not about curing the illness but enhancing the quality of life and maintaining dignity.
Psychological and Emotional Support: Palliative care acknowledges the profound emotional impact of life-limiting illness on patients and their families. This stage involves providing counseling, support groups, and therapy to help cope with anxiety, depression, and the existential distress that often accompanies serious illness. The emotional well-being of caregivers is also a priority, as is recognizing the burdens they carry.
Spiritual Care: Palliative care recognizes that spirituality is a core aspect of human existence. It addresses spiritual distress and facilitates spiritual well-being. This may involve connecting patients with chaplains and spiritual advisors or facilitating personal practices such as prayer, meditation, or rituals like kispum.
In the context of kispum, this could mean helping the patient and their family perform rituals that honor their ancestors, connect with their heritage, and find spiritual solace in their traditions.
End-of-Life and Bereavement Care: The final stage focuses on preparing for the end of life and supporting the family through grief. This includes managing symptoms during the active dying process, providing emotional and spiritual support, and helping families cope with grief after the death. Bereavement care continues for months after the death, ensuring that families have the resources and support they need to navigate their loss. This is the primary focus of my work as an end-of-life doula.
Kispum and Hospice
Incorporating the kispum practice into hospice enriches the experience of honoring and connecting with ancestors. The kispum ritual, traditionally performed to offer sustenance and maintain a bond with the departed, aligns with palliative care's holistic and compassionate nature. As patients and families engage in these rituals, they can find spiritual nourishment and a sense of continuity with their heritage.
This is a time of preparation and planning.
Kispum is an ancient Mesopotamian ritual of ancestor veneration involving offerings like water or libations to honor and connect with the deceased. This practice maintains a spiritual bond, providing comfort and continuity between the living and their ancestors.
For instance, a kispum ritual could be adapted to the hospice care setting. In this ritual, seekers pour libations or offer other symbolic gifts to their ancestors, fostering a deep sense of connection and peace.
This ritual bridges the physical and spiritual realms, providing comfort and meaning during the end-of-life journey. The spiritual guidance offered by palliative care professionals can help facilitate these rituals, ensuring they are meaningful and supportive.
Final Thoughts
The five stages of end-of-life care—initial assessment, active treatment, psychological support, spiritual care, and end-of-life bereavement—form a comprehensive approach to enhancing the quality of life for those facing serious illness. When intertwined with spiritual practices like kispum, palliative care addresses physical and emotional needs. It honors the spiritual journey, creating a holistic tapestry of care that respects and uplifts the human spirit.
ABOUT THE AUTHOR
The FDA is spending an afternoon on the future of psychedelic medicine — the harder question, what to do with what you saw, isn't on the agenda.
New research on AI companionship raises an old, unglamorous question about which voices deserve our trust. Back in early August, researchers at Stanford published something quietly damning. They studied more than a thousand adults who talk to AI companions on Character.AI, and, for a smaller group, actually read the conversations themselves — nearly half a million messages, donated for analysis. The people who leaned on the chatbot hardest, who disclosed the most, who called it a friend or a partner, were not the ones who felt better. They were the ones with the smallest circles of people in their actual lives, and the ones most likely to end up feeling worse. This week, a psychotherapist put the finding more bluntly than any journal abstract would allow, telling a reporter that human beings cannot have a genuine relationship with an AI. Not won't. Can't. I want to sit with that word "can't," because it is doing more theological work than its author probably intended. The Oldest Kind of Listening Every tradition I have spent real time inside — Pagan, Heathen, the Judaism I grew up in before I grew out of it — assumes that some voices deserve more trust than others, and that telling them apart is a skill, not a given. The Hávamál, that blunt old Norse book of household counsel, spends stanza after stanza warning against handing someone your whole mind before you have tested them: watch how a person behaves under some strain, it counsels, before you decide what their friendship is worth. That isn't cynicism. It's discernment — the discipline of asking what a voice actually is before you let it tell you who you are. An AI companion never fails that test, because it was never built to be tested. It has no bad day to reveal it. It does not get tired of you, contradict you out of its own need, or risk anything by staying. That isn't intimacy. It's a smooth surface with nothing underneath to discover — comfort without the friction that would ever prove it real. What the Study Actually Found, and Didn't To be fair to the research, it did not find that AI companionship is worthless, or that everyone who uses one is in trouble. It found something narrower and more useful: the people most likely to be harmed were already isolated, already leaning hardest, already treating the chatbot as a substitute rather than a supplement. The researchers themselves reached for a food metaphor — the comparison one summary used was "social junk food." It satisfies a real hunger, briefly, in a way that can make the deeper hunger harder to notice. That distinction matters, and it isn't mine to blur into something tidier. This is not a clinical finding about any one person's mental health, and if you're using an AI companion and wondering whether you're in trouble, that's a conversation for a therapist, not a blog post. What I can speak to is the older question sitting underneath the study — not whether the voice is helpful, but whether you have quietly stopped asking. The Uncomfortable Question So here is the question, and I am not going to answer it for you: what have you been listening to lately because it was easier than listening to something that might actually disagree with you? It doesn't have to be a chatbot. It can be a version of a friend you've stopped really talking to, a teacher whose books you've read but whose challenge you've never let land, a version of God who conveniently wants exactly what you already wanted. The AI companion is only the newest and most efficient shape this problem has ever taken. It is easier to notice in a machine because the machine is honest about what it's doing. The rest of us have gotten very good at hiding it. A Practice Pick one voice you've been trusting easily lately — a person, a habit, an app, a feed you check first thing. Ask it plainly: when was the last time you told me something I didn't want to hear? If you can't answer, sit with that. Don't rush to fix it tonight. Just notice, honestly, which of your voices have never once cost you anything to listen to. Hekate keeps her post at the crossroads for a reason no myth fully explains. She doesn't walk the road for you, and she doesn't tell you which fork to take. She just holds the torch up so you can see there's more than one way to go, and so the choosing happens in the light instead of the dark, where the easiest voice always sounds like the right one. That's the whole of it. Not an answer. A little more light at the fork, and the old, unglamorous work of choosing while you can still see. Closing Reflection Name one voice you've been trusting easily — a person, a habit, an app. Ask it plainly: when did you last tell me something I didn't want to hear? Whatever the answer, don't rush to fix it tonight. Just notice, honestly, which of your voices have never once cost you anything to listen to.
Walk into any forest in the Cascades and you are standing on the dead. The fir that fell forty years ago is now the nurse log feeding a row of saplings. The salmon carried uphill by an eagle became the nitrogen in the cedar's needles. Nothing in that forest is wasted, and nothing in it is afraid. We have built an entire industry on pretending we are exempt from this. We drain the body of its blood, fill it with preservatives, seal it in lacquered hardwood, and lower it into a concrete vault—as if the earth were a contamination to be defended against rather than the place we came from. Cremation, for all its simplicity, burns fossil fuel and sends the body skyward as carbon. There is another way, and it began here in Washington. Human composting—the law calls it natural organic reduction—was legalized in this state in 2019, the first in the nation. The process is unhurried and honest. The body, unembalmed, is laid into a steel vessel and surrounded by wood chips, alfalfa, and straw. No chemicals are added. The microbes that already live on the plant material, and on us, do the work they have always done. Over eight to twelve weeks, the body becomes soil—about a cubic yard of it, dark and alive. Families may take some home for a garden or a tree, or donate it to forest conservation land. What was a person becomes, quite literally, ground for new growth. I have sat with the dying, and I can tell you that the question underneath most deathbed fear is not what happens to me? It is did I matter, and will anything of me remain? The Hávamál answers plainly: cattle die, kin die, the self dies too—but what one leaves behind endures. We usually read that as reputation. I have come to read it more literally. A body that becomes soil leaves something behind that you can hold in your hands. Something that feeds. For those of us who keep the old ways, this is not innovation. It is restoration. Our ancestors were returned to barrows and bogs and burial mounds, given back to the land that fed them. The vessel and the alfalfa are new; the covenant is ancient. The earth gives, and the earth receives. Every harvest festival we keep is built on that exchange. It would be strange to honor the cycle all our lives and then opt out of it at the end. This choice is now legal in a dozen states and counting. If it speaks to you, say so—out loud, in writing, to the people who will one day carry out your wishes. Death plans left unspoken become burdens; death plans spoken become gifts. A leaf falls. A seed sprouts. The tree does not grieve the leaf, and the soil does not refuse the seed. When my own time comes, I intend to be useful one last time. That, too, is a kind of prayer. —Silent