Do we die alone? A philosophical exploration into the lonely nature of dying with implications for palliative care

Given that all human beings are bound to their own biological and thus perishable body, everybody dies – ultimately – alone. Although it is widely recognized that dying can be accompanied with loneliness, the current concepts of social, emotional and existential loneliness do not give insight in what it means in the face of death to be fundamentally thrown back on oneself as a finite human being, i.e., as a human being that is involved in (dealing with) his own imminent death. Because death annihilates all relationships with others, the world and oneself, ‘ultimately dying alone’ means that in the face of death there remains nothing to which – with regard to our own end – we can hold on, except to the meaning of our own death. Given that aloneness refers to a factual state of being separated, and loneliness to the negative perception of this state, loneliness of dying refers to a lack of relatedness to (aspects of) a life-transcending perspective in which one’s own death has a meaningful place, or – put shortly – to a lack of meaningful relatedness to one’s own death. Adequate support for the loneliness of dying implies that caregivers (1) are aware that people may suffer from the lonely confrontation with death without being able to express and communicate their suffering to others. It is important that caregivers (2) understand death not only as a state of non-being, but also as an (ontological) possibility of the dying to give meaning to his ow (ontic) death. In this respect, it can be helpful to see the meanings that people attribute to death not ‘merely’ as illusions, but as the ‘natural’ outcome of what it means to be a finite human being and – hence – of what it means to relate understandingly to one’s own death. Further, it is important that caregivers (3) develop a sensitivity for the broad variety of meanings that the dying attribute to death. These meanings may relate to various material, existential and metaphysical aspects of death and may merge and disappear concurrently, one after another, or mixed up with each other, depending on the attention one gives to each meaning. Finally, it is important that caregivers (4) understand the suffering from loneliness of dying not only from the factual situation of the dying person, but also from his potential. This means that the caregiver not only tries to connect to the person’s suffering in relation to his perceptions of death, but also seeks to help the dying person to rise above his or her experience of these perceptions. By connecting to the dying’s images, thoughts and feelings about death, asking for the dying’s deepest longings regarding other possible meanings of death, and encouraging the dying person to give further substance and focus to it, the lonely nature of dying may be assuaged. Adequate care for the loneliness of dying therefore places high demands not only on caregivers, but also on professional associations, healthcare organizations and education centers. Each in their own field, they may generate attention to the often silent confrontation with death, build up expertise in supporting patients and next of kin to give meaning to death, and give the loneliness of dying a full place in palliative care. In order to achieve this, it is important to include in the WHO-definition of palliative care that palliative care is not only about early identification, impeccable assessment and treatment of problems – as is currently the case – but also about paying attention to the wide variety of meanings that people (may) attribute to death.