Tuesday, August 16, 2011


We have been having a dialogue within my Hospice regarding the use of the term "death" and the the term "transition."

It has been said that "words have power," but in the process of this discussion we have all learned that different people use words in different ways, and that what matters most is what each person actually means. Respecting each other, and respecting each other's words, is an important part of working together as a Team.

To some degree this dialogue began when my friend Jackie Vance RN, who directs the Clinical Practice Guideline program for AMDA (a conventional national organization for physicians who work in the Long Term Care Continuum) wrote in her Blog that the term "discharge" should not be used. This reflected a thought of the AMDA "Transitions of Care" committee that people "transition," they are not "discharged."

And I reflected in a comment to Jackie that language reflects how we look at our patients, and at ourselves.

The TOC committee felt that patients should not be viewed as gotten rid of, and that communication should reflect continuity. And continued caring.

In a paper presented in March, myself, Dr Rajapakse, and Dr Crecelius (a former president of AMDA and Chair of Public Policy Committee) reflected on discharge by "death" vs the term "transition"

Death to us implied "the end -finality - fear of the unknown - loss - hopelessness - loneliness - lack of connection - anxiety - fear"

Transition to us implied a sense of "hope - connection - ainticipation of a journey - a focus on living the current moment - calm - peace - harmony"

And I concluded "death like transition are words draped in despair." Jackie published my comment with her excellent Blog


When i published comments within my Hospice, many of my co workers began to follow my terminology and talk in terms of patient "transitioning."

And the good part of this is the opening of dialogue, and the openness to spirituality. But we have had some problems - just as some co-workers feel uncomfortable having spirit suppressed by the term "death" - some co-workers feel uncomfortable with the term "transition." We speak of "time of death" in a professional way because it is clear and succinct; and some people do view death and the terminology surrounding it in a spiritual way.

And I have come to believe that it is important to promote dialogue and respect everyone's words. What is important is respecting the spiritual history of the patients, and being present and caring as well as being technically skilled and accurate.

In the bond between human beings, we are team mates and patients and parents and children - and we all matter more than our physical form. And hospice to some degree is about that - not simply the relief of physical pain, but as well the relief from "suffering."

When I started this discussion about the difference between the words "death" and "transition," I was more certain of the importance of the difference between the words, but as time goes on, I am more certain of the importance of the dialogue, and of the need to proceed with respect always for patients and for colleagues. I am happy to work with a Team where the dialogue is carried on with respect, and where the spirit behind the words really does matter.

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