Mortality and motivations: Clinicians’ integrity engaging death within complex cultural context

摘要

This broad ranging discussion examines the clinical encounter and deconstructs psychological and cultural context and implications, finally honoring the comprehensive awareness that the clinician requires for best practice in encountering mortality. Clinicians engage client disease and dying presentions, and ultimate mortality. Communicating mortality openly or subliminally is not always conscious. Mortality awareness can produce stress and untoward behaviors. Psychological mortality avoidance, citing Kierke-gaard’s existential paradox, and the death (in both senses) of Joseph Campbell’s cultural hero illumine socio-cultural elements including the elusive “good death”, sequestration of death from society, and the concept of managing death in volume. Cultural diversity awareness and the concept of transcendence clarify outlier and hybrid cultural client presentations demanding maximal clinician flexibility. Mortality Salience Theory predicts contracted world view when confronted with mortality, demanding sensitivity to a variety of responses. A hospice approach may not be best for some, despite a lack of new alternative to that paradigm. Managing mortality awareness and dying stresses the clinician by the weight and loneliness of perhaps unpopular decisions, by responsibility to community in managing death, and by the take-home exposure of the clinician’s family to the concept of death and mortality. Aptitude for managing death depends on clinician self awareness and a good match with practice venue. Clinician integrity and consciousness of motives and responses allows engagement or deferral as necessary without threat to identity.