In the second installment of Ask a Death Doula, we will be discussing the topic of forgiveness and how Death Doulas can help patients and families give and receive it.

Forgiveness is the path to unconditional love. It is a vital component to both patients and families to have a positive end of life experience. We focus on forgiveness during the Stabilization Phase of the patient’s journey. The Stabilization Phase, also referred to as the “Work Phase,” is a time when pain is being managed and all acute issues have been identified and addressed in the Shock Phase, leading to the highest quality of daily life for both the patient and families. It is a time when the patient can interact with those around them and hopefully have lucid conversations. This will allow wonderful work to be done in terms of facilitating conversations and addressing unresolved issues, which will lead to the possibility of forgiveness.

As a Death Doula, we want to help patients and families capitalize on this window of opportunity so that they can accomplish finding forgiveness and bring resolution and closure to any lingering issues. By now we have established trust with our patient and created a bond with them, allowing us to conduct a life review and have personal conversations with them. A lot of this work can be done simply by discussing emotions and issues that have been buried within them for many years and patients can do much of this work themselves just by opening-up about their past regrets. We never push, only guide and encourage them to speak about their life during this time.

A Life Review is an evaluation of one’s life at the end stage of life where depression, unresolved issues and guilt may be alleviated. It is a tool that Doulas may use to help the patient remember positive memories, find acceptance within themselves, address current negative thoughts so that they may be dispersed, as well as appreciate the worth of their lifetime achievements.

While conducting a life review, always ask open-ended questions to your patient. Examples of some open-ended questions we will utilize include:

1)      “What kind of work did you do for a living?”

2)      “Where did you grow up?”

3)      “How did your parents meet?”

It is also important to remember to ask yourself “How can I help this person find closure and forgiveness?” Patients will confide in you and express guilt for things they have held onto from their past. We want to address issues such as disconnection to certain family members that they have not spoken to in a long time. Our patient is dying and if they wish to reach out to someone they have not seen or heard from in many years, it is important for us to attempt to make that possible for them. Bridging relationships and giving them time to speak and resolve issues can make a much more positive end of life experience. We encourage giving private time to the patient and those they wish to mend relations with so that they may feel free to share apologies, as well as give and accept forgiveness from one another.

There are Two Types of Forgiveness:

1)      Forgiveness of Self

2)      Forgiveness of Others

Forgiveness of others is generally much easier to achieve. People tend to hold themselves much more accountable for their own actions when they regret something they have done when they are at end of life, as opposed to others who have caused them pain. Sometimes, however, a patient will not want to offer their forgiveness to someone else. It is important to remind them that forgiveness is for them and not the other person. They are offering it to let go of their resentment so that they can bring peace and tranquility into their life in their final days. One technique we can use to help a patient find forgiveness for someone else is to look at the person who has hurt them as a child themselves. Ask questions such as, “Do you know what their life was like?” This can help turn feelings of anger into feelings of empathy and help us resolve these internal issues. Forgiveness of self is generally more difficult to accomplish, but you must remind the patient that they deserve forgiveness just like everyone else. This is not a time to punish themselves for the past.

Forgiveness can change everything and create a positive passing for our patient and their loved ones.