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Death Is Not Comfortable

Researchers have recently suggested [1] that it would be helpful for those experiencing terminal illness to interface with a computer in order to establish funeral plans, wills and even discuss spiritual matters.  An experimental trial [2] is underway to see if this “non-judgmental” service will be of benefit.  The underlying premise is that people will be less anxious about “discussing” their impending death with a robot rather than a person with whom they are emotionally connected, because such interactions might be uncomfortable and might result in the dying person “worrying about what someone else thinks.”

While no one would suggest that terminally-ill persons who are naturally distressed should take on additional burdens, it seems that a goal of having them feel comfortable during such an intense and disturbing time is not on point.

The Effectiveness Of Automated Therapy

Research projects have attempted to test the viability [3] of non-human, non-face-to-face therapy for a variety of problems.  Interventions utilizing a “Chatbot [4]” and sometimes called “Cybertherapy [5]” are an effort to see if computer and virtual connections can assist an existing therapeutic relationship through enhancing frequency and immediacy of contact, and lowering costs.  Such efforts are also being considered as stand-alone interventions to address the reality that the vast majority of people in the world outside of the West have little-to-no access to professional therapy, can’t afford it if it is available, or, would so fear the cultural stigma associated with counselling that they would never seek it.

Systematic evaluation [6] of cybertherapy/chatbox procedures has suggested that in some circumscribed domains, there is some evidence [7] for the efficacy of such interventions.  The interpretation of this research is that for a limited range of problems [8]—particularly those that involve distorted thought patterns that can be challenged and corrected by logic—computer or virtual therapy may have some role, perhaps as a natural extension of the “self-help” industry which has for years thrived in paperback.  On-line content is thought to be more engaging, easier to update, and more exquisitely tailorable to a person’s needs (think about how your favorite retail site seems to know the next product you “need”).

What is less clear is whether people who are suffering from more complex psychophysiological issues, severe emotional problems, or difficulties in their interpersonal relationships, can be assisted adequately without the benefit of an interpersonal connection.  Volumes of research have indicated that the most powerful “ingredient” common to successful counseling and psychotherapy is the therapeutic alliance [9], that is, the felt connection and experience of warmth and caring that is fostered by an effective therapist who is working with a person in need.

The Real Question

Perhaps the most important question raised in the article is not whether there is a role for computer assisted self-help, but rather when, where, and for whom it should be considered.  The key point of discernment regards what a dying person most needs.  Facing death can be a lonely, alienating experience.  While information about legal options and logistical planning may be a genuine need, it is difficult to assert in any manner that this is the primary need (cf. an ER doctor setting a broken arm during a heart attack).

It is conceivable that for some persons there is such a significant fissure in proximal relationships that it might feel impossible to consider reaching out to family or friends for support and counsel.  Some elderly may even worry that their adult children do not have the empathic capacity to be there for them, fearing that their own failure to provide nurture in the past will be revisited upon them at the hour of death.  Yet still, in these circumstances the person needs the individual touch all the more, and the assertion by the researchers that somehow it is advantageous to consider proposing a standard of care that depersonalizes one of the most poignant and personal stages of life seems unconscionable.

The Real Answer

Given the inherent interpersonal nature of the human person—and the dignity that each person deserves from the moment of conception until natural death—the real need during this last stage of life is to have truly compassionate, radical accompaniment: ideally from those who have been one’s companions through life’s journey.  If there has been a fracture in a family, this is the time for reconciliation and healing.  It is here that one can offer the connection which will sustain the dying; not by promising some illusion of comfort, but by suffering alongside them.  In so doing, we offer that sense of belonging to someone who may genuinely feel as if he is nearing the precipice, falling into an abyss where he belongs to nothing and no one.

While “Woebot, Philosopher & Life Coach” (not kidding… [10]) may provide the worried soul 10 minutes of needed Socratic dialogue and the safety of avoiding human intimacy when sharing one’s vulnerabilities, our suffering brethren at the end of life deserve a fleshy, messy hand to hold, and a shoulder to cry on.