Ihe practice of palliative care learns that the ambivalence of patients is usual, even systematic: it is very common for a patient, especially in the advanced phase of a serious illness, to sometimes express at the same time that he is aware of be at the end of their life but are planning a trip within a time frame that seems unrealistic.
This ambivalence can manifest itself through requests: a request for euthanasia one day, which disappears if the patient sees that expectations and needs are met, or if he has had a warm moment with loved ones. I remember the memory of this friend who died of AIDS in the 1990s and who declared without ambiguity, when his disease was diagnosed, that he would not experience decline (in other words, that he would kill himself ). I have rarely witnessed such an evolution and such a long agony. As the disease worsened, the initial convictions seemed to give way to a desire for life, whatever the conditions of that life.
This ambivalence must be heard and respected. Being attentive to the patient’s speech also means respecting their defense mechanisms. What is it about ? People with severe illness experience significant anxiety. They develop defense mechanisms, unconscious psychological processes that enable them to cope with difficult situations and the anxiety they generate, as psychologist Martine Ruszniewski has shown (Faced with serious illness, Dunod, 2001). This can lead to speech or behavior that is difficult to understand for those who are not used to analyzing it (aggressiveness, denial, rationalization, etc.).
Conflicting demands
The doctor-patient relationship is complex. It allows sometimes contradictory demands to be expressed that must be heard, decoded and which can change over time. It is fine practice. Not all doctors are familiar with it.
And we must not deny the ambivalence of the other actors. The entourage is not exempt from it: how often do we see, do we hear families who, sincerely loving the sick person, suffer from witnessing a long end of life, which seems meaningless to them. After the death, many of them say they are “unprepared” for this mourning. Yet they were calling for a quick death shortly before. Health professionals themselves are not immune to a certain ambivalence.
Ambivalence is not specific to the end of life and occupies a place in everyone’s psychic functioning. But it takes on a particular dimension in this context.
You have 48.48% of this article left to read. The following is for subscribers only.