{"id":75270,"date":"2026-11-12T08:25:00","date_gmt":"2026-11-12T07:25:00","guid":{"rendered":"https:\/\/dasgoetheanum.com\/?p=75270"},"modified":"2026-11-10T22:02:55","modified_gmt":"2026-11-10T21:02:55","slug":"end-of-life-care-as-developmental-medicine","status":"publish","type":"post","link":"https:\/\/dasgoetheanum.com\/en\/end-of-life-care-as-developmental-medicine\/","title":{"rendered":"End-of-Life Care as Developmental Medicine"},"content":{"rendered":"\n

Over the summer, the Medical Section at the Goetheanum invited participants to a symposium on the boundaries and future of palliative care. The focus was on interprofessional exchange, raising awareness about end-of-life issues, and addressing a person\u2019s wishes regarding death in a humane manner rather than through assisted suicide.<\/strong><\/p>\n\n\n\n

\n\n\n\n

Professional end-of-life care takes individual needs into account. It provides attention and physical contact, above all in nursing. It alleviates pain and assesses changes in consciousness. A holistic picture of the human being and a life-affirming attitude shape the work of the therapeutic team. Accompanying a person in a palliative situation is demanding. Their suffering is often existential. Patients express fears: of death, of uncontrollable pain, of long infirmity, or of \u201cbeing a burden\u201d to others. The wish for physician-assisted suicide is being expressed more and more often. Euthanasia organizations invoke the self-determination and autonomy of the seriously ill. This applies, they say, especially in the case of unbearable pain or progressive loss of identity. Undignified suffering can be avoided, they argue; assisted dying is an act of charity, humanity, and compassion. Raimund Klesse, a Swiss geriatric psychiatrist and psychotherapist, disagrees: \u201cAutonomy and self-determination are generally positive concepts, but in the discussion surrounding assisted suicide they become legal terms that neglect the significance of interpersonal reality. Human beings are by nature social and culture-forming beings. They develop in and through relationships. In a good evolutionary sense, the human being is dependent on his fellow human beings. Autonomy can only be realized in relation to others and with their help!\u201d<\/span>1<\/sup><\/a><\/span>  Klesse understands the wish for suicide as the expression of a soul crisis. This crisis can be understood and overcome. To do so, we need our fellow human beings, who can help us to overcome it. Klesse added, \u201cSuch a compulsion toward self-determination is really a lack of trust in the world around us, a rejection of one\u2019s social surroundings.\u201d As a physician, he said, it was not for him to decide when \u201cenough is enough\u201d in an individual\u2019s life.<\/p>\n\n\n\n

When Two Worlds Merge Together<\/h3>\n\n\n\n

Within the therapeutic team in anthroposophic hospitals and hospices, it\u2019s the nursing professionals who spend the most time with the seriously ill. They care for the body and carry out external applications: \u201csounding\u201d washes (gentle washes of the face, hands, and feet with the soft sound of poured water, e.g., with lemon), pentagram rhythmical massage (with gold, frankincense, and myrrh oil), heart compresses (with Aurum-Lavandula cream), or an abdominal wrap (with melissa oil). These treatments relieve physical symptoms, including pronounced weakness, anxiety, disorientation, and digestive difficulties. Loving touch creates trust and has a harmonizing effect. It supports the relationship between the soul and spirit with the body. In the dying process, this relationship often changes, day to day, sometimes, hour to hour.<\/span>2<\/sup><\/a><\/span> While the moment of death, the final crossing of the threshold, is limited in time, the whole process of dying can extend over days or weeks. During this time, consciousness can open to impressions from the spiritual world. The sense world and the spiritual world then appear more closely interwoven than in ordinary life.<\/p>\n\n\n\n

Nurses repeatedly report such experiences among people at the end of life. Research speaks of \u201cend-of-life experiences\u201d (ELEs). In a survey published in 2018, physicians, nurses, and a psychotherapist at Klinik Arlesheim described their perception of ELEs in patients. The most frequent experience reported was a sudden, unusual surge of confidence and energy. The opposite also occurred: an unusual increase in distressing emotions such as anxiety and sadness. They further reported that patients at times perceived another level of reality. Some felt called or drawn by something or someone. They perceived deceased persons who seemed to be waiting for them or welcoming them. Sometimes patients correctly announced the time of their death. Others, despite clouded consciousness, suddenly showed unusual clarity of mind. Terminally ill patients spoke of intense dreams that comforted them or prepared them for dying. They also reported experiences of tunnels and light. Some joyfully stretched out their arms in bed.<\/span>3<\/sup><\/a><\/span><\/p>\n\n\n\n

Not Only Dying in Peace . . .<\/h3>\n\n\n\n

Anthroposophic palliative medicine also supports the sick through medications. It treats restlessness, irritations, and weakness of the members of the human being. Restlessness is common among palliative patients and very distressing. The interprofessional CARE Group has documented a great deal of experiential knowledge on this and drawn up recommendations for medication.<\/span>4<\/sup><\/a><\/span> Effective examples are metallic preparations of gold (Aurum<\/em>), copper, or antimony (Stibium<\/em>). In addition, there are plant preparations of Christmas rose (Helleborus niger<\/em>), mistletoe, and Bryophyllum. In combination with the nursing applications mentioned, many symptoms can be treated effectively. This often reduces the need for pain medication or sedatives.<\/p>\n\n\n\n

\u201cIt is our weaknesses that make us truly human!\u201d said one participant in the symposium. Can we each acknowledge this ourselves? Whoever works in palliative medicine, in accompanying the dying, or in grief support groups must have a clear understanding of their own relationship to dying and death. Birth brings the human being into earthly life. Death leads them out of the earthly body. Both are carried by trust in relationships: human as well as spiritual. Humanity also shows itself in professional practice: in being there for one another and with one another.<\/p>\n\n\n\n

If a patient nevertheless expresses the wish for physician-assisted suicide, the palliative physician J\u00f6rg Eberhardt first asks, \u201cWhat has helped you cope with the present situation so far?\u201d He then offers to find out together, from among the many helpful possibilities, what is needed and what does the patient good. He considers it necessary to promote professional and societal competence in dealing with requests for assisted dying. If a person can no longer recognize the value of their own being, they must be allowed to experience it in the mirror of their fellow human beings. Wishes to die are calls for help. The German S3 Guideline on Palliative Care<\/em> also recommends active listening and empathy with the patient\u2019s situation.<\/span>5<\/sup><\/a><\/span> This includes accepting the wish and taking it seriously. Hasty advice should be avoided. Interprofessional teams can work together to determine acute needs for help and therapy. Experience with the dying, the careful interpretation of behavior, and knowledge of the development of consciousness at the end of life strengthen competence in dealing with wishes for assisted dying. However, we also have to work through our own reluctance and fears regarding this topic. Just as important is the fact that if I oppose (assisted) suicide, I must not be forced to act against my ethics.<\/p>\n\n\n\n

. . . but Living until the End<\/h3>\n\n\n\n

Support during the dying process is continually adapted to the individual\u2019s development. The focus is on caring for the body and the senses as well as the changing state of consciousness. Active and receptive therapeutic eurythmy, art therapy, music therapy, and therapeutic speech formation offer a wide range of possibilities.<\/span>6<\/sup><\/a><\/span> People can experience these even while bedridden, with limited mobility, or in a weakened state. In therapeutic speech formation, an \u201cAh\u201d while breathing out can have a releasing effect. An \u201cAh, yes\u201d deepens the rhythm of breathing. The lyre produces a celestial, melodious sound. Its harmonizing and releasing effect can influence bodily functions and the state of soul. As a cultural element dating back thousands of years, it continues to accompany the dying today. The sense of hearing remains intact until the very end. That is why music therapy can have a profound effect even on patients who are no longer responsive.<\/p>\n\n\n\n

Rudolf Steiner points out that the sense of hearing is carried over into the spiritual world after death. There it conveys a musical experience. As an earthly sense experience, it is far more inward than other sense experiences. \u201cThe first thing the human being needs in the beyond is the sense that passes over from the outwardly musical to the inwardly musical. [. . .] In the physical world, the power of this sense can be perceived when musicians compose. The sense stands there behind musical creation. After death, it becomes a sense through which the human being is directed to their entire surroundings. Then we experience music inwardly. After death, the sense becomes an outer sense, and for a time after death we perceive what goes through the world, for the world is permeated by what is rhythmic, musical, harmonious. [. . .] Just as the child brings their senses with them into physical existence and must first get used to the physical sense world, so the human being in the disembodied state must get their senses used to the supersensible world.\u201d<\/span>7<\/sup><\/a><\/span><\/p>\n\n\n\n

Dying is a thoroughly active process. Some patients even say that dying\u2014like the contractions of birth, or \u201clabor\u201d\u2014is \u201creal work.\u201d Spiritual support can, if desired, be provided through the Christian sacraments for the dying: confession, Communion, and last rites. After death come the blessing of the deceased, the burial, and the act of consecration for the dead. A nondenominational attitude remains just as important as the active involvement of family members. This also applies to people who only became caregivers and companions by destiny, so to speak, during the palliative phase.<\/p>\n\n\n\n

A Developmental Time, A Developmental Medicine<\/h3>\n\n\n\n

Matthias Girke has accompanied terminally ill people as a physician for many years. He sums up the attitude of palliative work as follows: \u201cThe decisive aspect of Anthroposophic Palliative Care is that its approach to therapy is based on development: it is not about accompanying the \u2018final\u2019 days of the patient; it is rather a time of preparation and development, which can already bear fruit during palliative treatment and which prepares for the patient\u2019s future destiny. It is from this conviction that our therapeutic relationship to the patient develops, which, especially in palliative care, allows for growing closeness and a sense of connectedness to destiny.\u201d<\/span>8<\/sup><\/a><\/span><\/p>\n\n\n\n

\n\n\n\n

Translation<\/strong> Joshua Kelberman
Photo<\/strong> National Cancer Institute \/ Unsplash<\/p>\n","protected":false},"excerpt":{"rendered":"

Over the summer, the Medical Section at the Goetheanum invited participants to a symposium on the boundaries and future of palliative care. The focus was on interprofessional exchange, raising awareness about end-of-life issues, and addressing a person\u2019s wishes regarding death in a humane manner rather than through assisted suicide. Professional end-of-life care takes individual needs into account. It provides attention and physical contact, above all in nursing. It alleviates pain and assesses changes in consciousness. A holistic picture of the […]<\/p>\n","protected":false},"author":19918,"featured_media":75024,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[8805,8837],"tags":[11857,11858,8814],"class_list":["post-75270","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-restrospective","tag-ausgabe-44-2026-en","tag-english-issue-46-2026","tag-musings"],"acf":[],"_links":{"self":[{"href":"https:\/\/dasgoetheanum.com\/en\/wp-json\/wp\/v2\/posts\/75270","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/dasgoetheanum.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/dasgoetheanum.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/dasgoetheanum.com\/en\/wp-json\/wp\/v2\/users\/19918"}],"replies":[{"embeddable":true,"href":"https:\/\/dasgoetheanum.com\/en\/wp-json\/wp\/v2\/comments?post=75270"}],"version-history":[{"count":3,"href":"https:\/\/dasgoetheanum.com\/en\/wp-json\/wp\/v2\/posts\/75270\/revisions"}],"predecessor-version":[{"id":75301,"href":"https:\/\/dasgoetheanum.com\/en\/wp-json\/wp\/v2\/posts\/75270\/revisions\/75301"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/dasgoetheanum.com\/en\/wp-json\/wp\/v2\/media\/75024"}],"wp:attachment":[{"href":"https:\/\/dasgoetheanum.com\/en\/wp-json\/wp\/v2\/media?parent=75270"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/dasgoetheanum.com\/en\/wp-json\/wp\/v2\/categories?post=75270"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/dasgoetheanum.com\/en\/wp-json\/wp\/v2\/tags?post=75270"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}