Live music can be comfort to the terminally ill
The prescription also helps patients’ families
When there seems to be nothing left that can be done to help patients who are nearing the end of their lives, what is there to do?
Health care professionals face this frustrating question often, when aggressive treatment or heroic measures are no longer appropriate.
Although the answers are hard to come by, a new measure that is winning acceptance involves using music for palliative purposes for the terminally ill patient.
Physicians receive little training in medical school on how to provide care for the dying patient, explains Linda Emanuel, MD, PhD, vice president for ethics at the American Medical Association.
"They also may be caught in the dogma that declares physicians must fix the problem, and if they can’t, there is nothing more they can do," she says.
The Chalice of Repose Project Inc., a clinical practice and certification and training program at St. Patrick’s Hospital in Missoula, MT, offers physicians something "to prescribe" when all else fails: music.
"When all reasonable curative or interventional medical procedures and practices — such as surgery or chemotherapy — have been exhausted, and it is clear that illness cannot be reversed, the goals of care must shift focus from the disease to the whole person," says Therese Schroeder-Sheker, academic dean of the program and founder of the field of music thanatology.
Music thanatology is one such holistic modality that focuses on the patient’s physiological as well as spiritual suffering. Music thanatologists soothe dying patients with music from their harps and voices.
Not the same as music therapy
A term coined by Schroeder-Sheker, music thanatology is not synonymous with music therapy; rather, it is a subspecialty of palliative care that features "prescriptive" music for the dying, she explains. (For other ways music can be used in hospitals, see related story on p. 28.)
"It is not improvisation, nor is it entertainment, or ambient music, or distraction therapy," she stresses. "Music thanatology is a contemplative activity with clinical applications."
Prescriptive music brings substantial relief from many different kinds of distress.
"Anxiety, fear, nervousness, and anger subside," she says. "Intense emotional pain and suffering can be reduced dramatically, and patients have said the music has brought them peace by helping them accept the inevitability of their dying."
Clinicians trained at St. Patrick’s attended deathbed vigils of more than 2,225 patients throughout the health care continuum in the Missoula area since the program began in 1992.
Music vigils are a form of comfort care for terminally ill patients who have a prognosis of six months or less of life, explains Sue Moore, a music thanatologist practicing with the Hand in Hand Hospice, which serves 15 rural counties in Northeast Georgia.
"As a music thanatotolgist, my goal is to lovingly assist the physical and spiritual needs of those near the end of life. Music vigils also help family members because they create a climate in which emotional healing can take place," says Moore, who was one of the first interns to receive certification from the Chalice Project.
The musician clinicians, who undergo a rigorous two-year training and supervised internship at St. Patrick’s, make very careful clinical decisions based on how the patient responds physiologically and emotionally, she says.
For example, Moore takes into consideration the patient’s diagnosis, prognosis, and symptoms as well as his or her response to the music. "Then I adjust the music accordingly. I may change the piece itself or the key, tempo, volume, or the volume of the accompaniment," she explains.
That’s why such prescriptive music can’t be prerecorded. "Music thanatologists must be able to respond to the patient’s fluctuations in respiratory patterns or the sudden spikes of an inflammatory condition," she explains.
Moore also stays away from playing familiar contemporary hymns not only because of a potential for unpleasant associations but because such music tends to "ground" patients. "But prescriptive music is meant to be unbinding," she says.
Although prescriptive music is used for every age and condition from cancer to AIDS, the work is "dramatically significant" in cases where the patient is experiencing respiratory distress, regardless of the primary diagnosis, says Schroeder-Sheker.
It’s also especially effective in cases of extubation, when family members are gathered around the bedside and can grieve openly as the layers of mechanical life-support systems are removed one by one.
Patients with slowly moving degenerative diseases, such as dementia, Alzheimer’s, and multiple sclerosis can also benefit from this method, she adds.
Another program that prepares harp practitioners to provide music during the transitioning process is the International Harp Therapy Program. The program is connected with the University of Vermont, Shands Hospital in Gainesville, FL, St. Charles Hospital in Bend, OR, and San Diego Hospital.
Christina Tourin, director, says in addition to the intensive training in inclusive attention and resonant kinesiology for hospice patients, their practitioners are trained to work in health-related areas as rehabilitation units, ICUs, pediatric wards, and nursing homes. These facilities offer the harps not only as a means of comfort but for personal empowerment.
Sources
• Sue Moore, Strings of Solace, P.O. Box 3017, Gainesville, GA 30503-3017. E-mail: [email protected].
• Chalice of Repose, St. Patrick Hospital, 554 W. Broadway, Missoula, MT 59802. Telephone: (406) 329-2801.
• International Harp Therapy Program, P.O. Box 1134, Jericho Center, VT 05465. E-mail: [email protected]. Web site: www.harprealm.com.
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