Support for the Dying Patient

We distinguish between the process of dying and the moment of death. Intensive developmental processes are associated with the process of dying (post traumatic growth) and determine the nature and dignity of this decisive time at the end of life, which can be like a liberation of the patient from their illness. We are familiar with the physical processes, but equally also with the emotional processes such as the biographical review and taking leave of the people connected with us, as well as the always impressive spiritual developments. Dying and the moment of death belong to life like pregnancy and the moment of birth. The symptoms of suffering and also the burden of illness need our therapeutic support.

The moment of death occurs instantaneously compared to the sometimes lengthy process of dying and denotes a threshold between earthly life and post-mortality. The process of dying, on the other hand, usually extends over a longer period of time. Its beginning is inconspicuous and often only discernible in retrospect. In the process of dying, we support the patient’s impressive efforts and activities through palliative care – because dying is an exhausting and challenging activity and by no means just a “letting go”. In contrast to the process of dying, the moment of death cannot be arbitrarily influenced: just as the moment of birth does not originate from conscious planning and a date being set, neither does the moment of death. Here each person has their very own individual time. The moment of death is part of the wisdom and composition of destiny which no medical intervention should influence.

The action of the human constitutional elements in dying

In accompanying the dying person, we see decisive changes in their physical, life, soul and spiritual nature. The physical changes are unmistakable: the physical organism declines in consumptive diseases. Cachexia gives increasing emphasis to the shape, less to the connective tissue. Each person has their own shape and “form”. It is the expression and “language” of their individuality and often reveals new, previously unknown sides of their being. Instead of anabolic and regenerative life processes, catabolic metabolic processes predominate as a sign of the weakened life organisation. Often the breathing and heart rate are accelerated and indicate the increased, catabolic action of the soul and astral organisation. The latter is then no longer able to develop an alert and clear consciousness. Rather, inflammatory metabolic processes mean reduced consciousness, fatigue, exhaustion.  Thus acute inflammation is associated with fatigue and sleep. When the soul and astral organisation unfolds freely on the basis of the nervous and sensory system, wakeful consciousness develops; conversely, when it works increasingly in the metabolic and limb system, consciousness recedes. Rapid breathing and a high heart rate are visible signs of the increased metabolic activity of the patient’s constitutional elements. The detachment of the life organisation, which is otherwise so intensely connected with the physical body, requires a great effort on the part of the human constitutional elements.

The I-organisation is connected with warmth. Often we find a cooled periphery, cold extremities and a congested centralised warmth organisation. In the development of fever, we are familiar with two phases: shivering with cool extremities and a centralised warmth organisation and – usually following this – the development of a fever. The pale fever then becomes a red fever with a reddened face. In the first fever phase, the nervous and sensory system is active; in the second, the inflammatory processes of the metabolic and limb system. The I-organisation cannot develop a balance between these two polar functions in the dying patient. So, on the one hand, we observe the fever; on the other hand, we are familiar with the cooled periphery.

The action of the constitutional elements in the moment of death

With the moment of death, the constitutional elements detach themselves from the body: some dying people consciously close their eyes or even fold their hands as a deliberate act of the I‑organisation and self-determined conclusion of life on earth. Consciousness – and with it the astral organisation – recedes, the breathing quietens in frequency and depth with increasing pauses, blood pressure drops although the tachycardic heart rate is often maintained. The life processes have given way to comprehensive degenerative processes. The physical body is increasingly released from the integrating forces of the person’s being and handed over to the laws of external nature. Thus the fluids in the body no longer obey the vital processes of the organism but laps into heaviness, for example in oedemata and anasarca. At the moment of death, a touching intensity in the atmosphere in the room arises; the stillness and transcendence of this moment can be experienced. The moment of death belongs to the sacred periods in our life and touches us in a similar way to the moment of birth and the first meeting with the child.

Medicinal support in the dying process (end of life care)

The following recommendations refer to the dying phase in the sense of end of life care. We distinguish it from the treatment needs of the palliative phase of illness (see fear: https://www.anthromedics.org/PRA-0563-EN; pain: https://www.anthromedics.org/PRA-0585-EN; dyspnoea: https://www.anthromedics.org/PRA-0589-EN; oedema: https://www.anthromedics.org/PRA-0591-EN; importance of consciousness: https://www.anthromedics.org/PRA-0957-EN). 

Incense, gold and myrrh are three important substances used with the dying person. Thus aurum is related to the action of the I-organisation, incense to the astral and myrrh to the etheric organisation. In the soul they act on the thinking, feeling and will of the dying person.

  • Olibanum comp. amp. WELEDA : up to several times daily s.c.
  • Aurum comp. amp. WELEDA : up to several times daily s.c.

Composition of the medicines specified: Olibanum comp.: Aurum metallicum praeparatum D30, Olibanum D12, Myrrha D6. Aurum comp.: Aurum metallicum D6, Olibanum D3, Myrrha D3. 

Here they seem to be “helpful” when decisions need to be taken: sometimes it can be observed how, for example, a somnolent state of consciousness becomes clearer again in connection with such medication, and days of a brighter consciousness turned towards the world follow. On the other hand, the individuality often detaches itself more easily from the body after such medication. It is not, of course, an “end of life medicine” but it brings order to the action of the constitutional elements and enables the individual to make a decision which is appropriate for their destiny and to carry it out at the right time. Thus these medicines play an essential role in the care of the dying person. The three substances reference their original gift by the Three Kings: “They brought the child gold, the symbol of outer, wise power; myrrh, the symbol of the victory of life over death; and finally incense, the symbol of the cosmic ether in which the spirit lives,” as Rudolf Steiner characterised it more than 100 years ago (2).

Aurum combines the qualities of light and heaviness . In this way it takes on the situation of the dying person who often wants to rid themselves of the heaviness of their body through restlessness and attempts to uncover themselves or undress, or even by trying to get up in order to approach the light they already feel. 

  • Aurum metallicum praeparatum D10 amp. WELEDA : up to several times daily s.c.

Aurum is therefore one of the essential medicines for the dying patient.

Case history: A patient with advanced ovarian cancer is in our palliative and hospice care. Shortly before her death, she told the nurse about her present experience: “Everything is so infinitely dark.” Immediately after the injection of Olibanum comp., her inner experience changed and the patient said: “Everything has become so light!” (3).
This case history draws attention to the way that intense inner experiences occur in an outwardly calm patient close to the moment of death, of which nurses and doctors should be aware in order to find the specific medicinal treatments. 
 

External treatments in nursing

External treatments obtain a special importance in nursing care. Many dying people report a tightness in the chest which is significantly improved by

  • Aurum / Lavandula comp. cream WELEDA : 1 x daily

as a heart ointment compress. 

This discomfort arises from the process in which the constitutional elements are released which is closely related to the heart: “Death comes about in such a way that at the moment of death the connection which exists between the etheric and astral body on the one hand and the physical body on the other hand dissolves, specifically in the heart. The heart lights up in a kind of way and then the etheric body, astral body and I rise up above the head.” (4)

Michael Bauer (1871 – 1929), who experienced the death of Christian Morgenstern (1871 – 1914), gave an impressive account of such lighting up: separated by several rooms, Michael Bauer witnessed his quiet death in the spirit. He says that at the moment his friend’s soul left the physical shell, he saw “a golden sea of light burst from his heart, flooding the whole bed with radiance and light” (5). Children, too, report about such light. An 11-year-old boy experienced it in his severe illness and associated this light with the “great heart” of the world, the sun: “I just streamed out of my body ... I heard someone singing ... It became bright, like in the middle of the sun. But I was not blinded, I myself was also just a kind of light. The singing became louder ... It felt within me as if I were singing it myself” (6). Often dying people experience music, a resonance in different qualities. The sound-like laws of the world, which were known as the harmony of the spheres in ancient mysteries, are absorbed by the soul which often mixes them with memories (“Can you also hear how there is playing up there?”).

The evening Einreibung is one of the essential treatments and makes it easier for patients to fall asleep:

  • Cuprum metallicum praeparatum 0.4 % ointment WELEDA: 1 x daily

and as required

  • Copper ointment red WALA: 1 x daily and as required

or with

  • Lavender oil 10 % WELEDA : 1 x daily and as required

or

  • Lavandula, oleum aethereum 10 % WALA: 1 x daily and as required.  

In the morning, treatment with

  • lemon as a supplement when washing

invigorates and refreshes.

These and other nursing measures support the daily rhythm of waking and sleeping which is still important also for the seriously ill patient.

The rose  has a special significance in the therapeutic support of the dying person and has a harmonising effect. In the tragic scene of the dying Faust, Goethe pointed out the importance of the rose for the dying person: in the struggle with Mephistopheles for Faust’s immortal part, angels scatter roses to help Faust in his confrontation with evil, “as a symbol of the spiritual love coming from on high”, as Rudolf Steiner characterised it (7).

Rose oil is used as an external Einreibung:

  • Rosa e floribus 10 % oleum WALA : 1 x daily and as required

The Aurum/Lavandula comp. cream already mentioned also contains essential rose oil.

Other external treatments are effective in supporting medicinal pain therapy.

For abdominal complaints, the oxalis compress has proved its worth:

  • Oxalis e planta tota W 10 % oleum WALA : 1 x daily
  • Oxalis, Folium 10 % ointment WELEDA : 1 x daily

and for distended abdomen

  • Melissa oil WALA : as a local Einreibung or oil cloth(8). 

For cramp-like abdominal pain symptoms, there is positive experience with

  • Chamomilla e floribus W 10 % oleum WALA : as a local Einreibung or oil cloth (9).

Upper abdominal complaints, e.g. liver metastases, liver capsule pain, are often alleviated by the

Furthermore, valuable help in pain syndromes, e.g. bone metastases, is offered by (10):

  • Solum oil WALA : as an oil compress or Einreibung, 1 x daily and as required.

This oil can provide an envelope and thus build up a protective space.

The pentagram Einreibung (see also: https://www.pflege-vademecum.de/pentagrammeinreibung.php), done with Aurum / Lavandula cream, provides important assistance for decision-making and development particularly in dying processes that are experienced as stagnant. It can be supplemented with the TAO tones of the lyre (h-a-e-d), which stand for the Tetramorph (human being, bull, lion and eagle), thus connecting this fourfoldness with the fivefoldness of the pentagram (11).

Care of the patient’s external surroundings plays an essential role. Sometimes the particularities and also the quirks of the person detaching themselves from their body shape their immediate environment. On the one hand, this is something that is very personal to them and deserves our respect; on the other hand, peculiarities sometimes develop for the correction of which the patient is grateful.

Comparable to the newborn child, the dying person also increasingly develops into a being of the senses and then lives increasingly as if in their surroundings. For this reason, the configuration of the room as the patient’s immediate environment, but also paying attention to the light and warmth conditions, are of particular importance. In addition, the inner attitude of those who encounter the ill person in their various functions during the day determines the atmosphere.

Eurythmy therapy and the artistic therapies

During the period of a prolonged dying process, artistic therapies take on a special significance. Their selection is based on what is individually possible for and required by the patient and its quickly noted effectiveness. Eurythmy therapy takes up the exercises that may already be familiar to the patient in small movements that are also possible for the bedridden person. It is also possible to perform eurythmy therapy for the patient. They then carry it out inwardly through their active observation. An important eurythmy therapy exercise is the so-called “Hallelujah”.

A longer path of practice in painting therapy gives rise to new qualities. If, for example, in the first phases of this artistic therapy the focus was on working on the disease process, and if this theme was later followed by tasks that are an expression of the emotional experience, the pictures created in the last phase more often take on motivic features. Grimm’s fairy tales are important motifs here. In these intensely experienced images, the eternal spiritual being expresses itself in its transient shells and points the human being beyond any abstraction to their inner, indestructible core of being. Sometimes patients create the motif of water or the abyss in the paintings. Occasionally they also paint the light that shines as brightness towards the dying person at the moment of death.

Music therapy has a special significance in the accompaniment of a dying person. It alleviates anxiety, restlessness and tension and addresses spiritual content through sound, which becomes a source of strength for the patient. The lyre is a suitable instrument.

The therapeutic qualities of the tones and intervals have a differentiated effect on the threefold nature of the experience of fear; that is, the consciousness-affecting shock-like fear, the fear that is experienced in the rhythmical system, and finally the fear that is associated with restlessness and inner upheaval. A familiar song can sometimes be a comfort and help for the dying person. Finally, musical motifs or small pieces carry a spiritual message that develops into great strength for passing through this phase. Dietrich Bonhoeffer’s (1906-1945) profound reflections describe this. Shortly before his execution, he described the importance of music and here especially of a special piece of music by Beethoven (1770 1827): It is strange how music heard only with the inner ear, if one devotes oneself to it in a collected way, can be almost more beautiful than music heard physically; it has greater purity, the slag falls off; it acquires a ‘new body’! There are only a few pieces that I know well enough to listen to from inside; but especially with the Easter songs it succeeds particularly well. The music of the deaf Beethoven becomes existentially more comprehensible for me, especially the great variation movement from Opus 111 ...”. (from Berlin-Tegel prison, 2 April 1944) (12).

Development in dying

The process of dying  reveals three stages and developmental steps. First of all, the healing processes that can be observed to the very end point to life forces that underlie the formation of the body and keep regenerating it. Wounds heal “to the end” and thereby give the patient the experience of becoming “whole” again also bodily, of achieving bodily integrity and overcoming an injury. These generative life forces are directed and guided by an all-inclusive order and wisdom which can be seen in all forms and functions of the human body. They come from a world that belongs to the primordial ground of our being and is considered the “Father World.” Out of this divinity the human being is born, from it originate all generative, body-forming actions during life.

In contrast to this, dying appears from the bodily aspect as “extinction”, as “decomposition” in the literal sense of the word, in that the eternal being wrests itself out of the transient sensory manifestation of bodily existence. This spiritual birth is served by the enormous efforts that the dying person takes upon themselves, from which they sometimes suffer so much and which call on our therapeutic assistance. Dying is connected with spiritual “birth”. Death and resurrection, and thus the relationship with the Christ being, are manifest in the individual likeness at this decisive stage of life. The birth in the world beyond sensory perception, which begins at the moment of death, is connected with the power of resurrection which shines towards the human being arriving in the other world. Each death is not a “succumbing to illness”, as it so often says in obituaries. Rather, the illness appears overcome and no longer necessary. A higher level of recovery has been reached. The feeling of inner health reported by some patients (“actually, I am healthy”) points to this development and should not be misinterpreted as an illusion and denial of the existing situation, but should be related to the being of the person as it is experienced inwardly and detaches itself from the body.

After all, decisive changes in consciousness occur as the eyes close to this world and open anew to the light of the spiritual world, of which near-death experiences tell so impressively. This consciousness-illuminating, “enlightening” quality is related to the “Holy Spirit”. It is no coincidence that “holy” and “health” are linguistically related. The patient experiences phases which – also in the terminally ill person – on the one hand relate to the bodily healing processes, on the other hand encompass the detachment from the body in dying and on the way to spiritual birth, and ultimately lead to awakening in the consciousness which faces the spiritual world.

1 From: Girke M. Internal Medicine. Foundations and therapeutic concepts of Anthroposophic Medicine. 2nd ed. Berlin: Salumed Verlag; 2016.

2 Steiner R. Ursprungsimpulse der Geisteswissenschaft. GA 96. Lecture of 17 December 1906. 2nd ed. Dornach: Rudolf Steiner Verlag; 1989.

3 The authors are indebted to Anja Girke for this reference.

4 Steiner R. Vor dem Tore der Theosophie. GA 95. 4th ed. Dornach: Rudolf Steiner Verlag; 1990, p. 30-31.

5 Bauer M. Gesammelte Werke Band 3: Christian Morgensterns Leben und Werk. Stuttgart: Verlag Urachhaus; 1985, p. 377.

6 Schwenk A. Ich konnte nicht mehr länger leben. Unterlengenhardt: Gesundheit aktiv; 2006; p. 16.

7 Steiner R. Anthroposophy in the Light of Goethe’s Faust. CW 272. Lecture of 4 September 1916. Hudson: SteinerBooks; 2014.

8 Available at https://www.pflege-vademecum.de/2714.php (01.03.2021).

9 Fingado M. Therapeutische Wickel und Kompressen. 6th ed. Dornach: Natura Verlag im Verlag am Goetheanum; 2012.

10 The authors are indebted to Rolf Heine for this reference.

11 The authors are indebted to Katrin Klatt for this reference.

12 Ruprecht E. Tod und Unsterblichkeit. Volume 3: Vom Realismus bis zur Gegenwart. Stuttgart: Verlag Urachhaus; 1993, p. 446.



Research news

Safety of anthroposophic medicines ensured!
Anthroposophic medicinal products (AMPs) are widely used in Europe and worldwide. A retrolective safety analysis of pharmacovigilance data included 99.4% (1596/1606) of all AMPs marketed in Germany during the study period 2010 - 2017. The relative frequency of adverse drug reactions for AMPs was 1.5 per million maximum daily doses sold. The vast majority of patients (91.9%) recovered or were recovering from adverse reactions and there were no reports of fatal outcomes. The original article with detailed results is published open access: 
https://doi.org/10.1007/s40801-021-00262-7.


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