Certain things are just universal. All humans need nutrition. All humans need hydration. All humans need air. There really is no argument to these basic needs for existence. Once our physical needs are met, the priority becomes filling our emotional needs. At the heart of our emotional needs is the desire to feel safe and secure. As children, we are taught that a key way to feel safe and secure is through the approval of our parents, and as we age, we become conditioned to seek out approval of others as well.
The degree of power to which we give others approval of us varies widely and is based on things such as personality, upbringing, and life experiences. One thing there is no need to debate, approval of others feels good and is validating.
We know that approval is tied in to safety and security, so you can imagine during the end of life, if a person isn’t feeling safe and secure, they will seek out approval even more. The ways someone seeks approval can be subtle or direct. Some take medications they don’t want in an effort to get the approval of their doctor or family members. Others get out of bed when they don’t feel like it, or eat a few bites of a meal despite having no appetite. I see patients entertain guests when they’d rather be sleeping, still seeking the approval of others.
Other times approval seeking comes with stories from the past as people use the narrative of their lives to gain validation. Amazingly, some even prolong their dying as a means of gaining the approval of family members who don’t want them to die.
Since approval is a universal emotional need, a helpful thing family and friends can give at the end of life is the gift of approval. The easiest way to think about how to give approval is to give permission. Permission removes any guilt associated with seeking approval and fear of disappointing those we love. Give someone the permission to be tired, to not eat, to be worried, to be angry, to refuse treatment, to feel sad, or ultimately to die.
It’s not just the patient that needs permission during end of life situations. Caregivers and family members need permission as well. They too are seeking approval in an insecure and unsafe reality. One of the greatest areas caregivers need permission is in letting go of the caregiving to step back into the role of spouse/child/friend. It is impossible to provide both total physical care as well as emotional care towards the end of life. Society unfortunately gives approval to the more tangible physical care, despite the more important value that comes with emotional care that only family and loved ones can provide. Often it takes a hospice team to grant that permission.
Just like with patients, we can be responsible for granting approval to caregivers and loved ones. By giving them permission to be where they are, whether angry, sad, worried, not wanting to say goodbye or hoping it was all over.
Permission is a simple way to give approval with untold benefits for those around us.