By Beth Erickson, Ph.D.

During my thirty years as a practicing family and marital psychotherapist, I have observed countless times people’s profound confusion on a central issue: What can they control?  And what can’t be controlled?

Control (or lack of) During End of Life Care

People may be the most confused about what they can and cannot control when a loved one is dying. For example, people often believe they can control the course of a loved one’s illness.  Rationally they realize it is not up to them, but that doesn’t stop them from trying. And when they can’t succeed, (for example, the person has a life-threatening condition) they often feel like failures.  For some, “controlling” the situation may really mean “preventing,” which is impossible in terminal situations.

Even as a trained doctor, I was not immune from this kind of irrational thinking.  My closest sister was killed instantly when she was hit by a truck on the rider’s side of the car she was driving.  I experienced survivor’s guilt.  My “reasoning” went something like this:  “If I had been riding with her, I would have been hit first.  Then she’d be alive now, because I could have kept her alive.”  Although I knew intellectually this was illogical, it was several months before I could unhook emotionally from these tangled thoughts.

Figure Out What You Can and Cannot Control

For the sake of both you and your loved one, it is essential to understand what you can and cannot control.  Trying mightily to control the uncontrollable will only postpone and prolong the inevitable. It also will frustrate you, your loved one, and the medical personnel trying to help.  Worse yet, you may end up depriving your loved one of dying with dignity and in peace.

For example, after my mother’s oncologist said there was nothing more he could do for her, one of my sisters insisted, “Mother’s going to get well!”  Left up to her alone, Mother would have had to endure more and more radical treatments up until the moment of her death.  Fortunately, another sister and I were able to help Mother state her wishes.  So our sister’s voice was trumped by the wishes Mother explicitly expressed.  And Mama died in peace three weeks later.

Three Elements You Cannot Control

1. The course of a loved one’s illness.  It is human nature to want to prevent illness and suffering of your loved ones. But unless you have the medical expertise to do so, you only can lessen your dying loved one’s emotional burden.  You cannot change the course of the illness. If you were a physician, you would know to disqualify yourself from treating a loved one directly, knowing you lacked the necessary objectivity.  As a caregiver, you must accept that you cannot eliminate your loved one’s burden, hard as you try.  You only can lessen it. 
2. The suffering (physical and emotional) that you and your loved one will experience in facing death.  This is a time of raw emotions for both you and your loved one.  Expect that.  And accept it.  For example, you and your dying loved one may have had a difficult relationship, and you may experience little or no grief or sadness as your loved one is dying (or after they have passed).  This does not mean you feel no emotion.  In fact, you may expect to feel jagged emotions that are shards of past difficulties.  You may experience intense moments of grief at times. All this is normal. 
3. You cannot prevent the reemergence of unresolved family dynamics.  Sometimes old dynamics show up in disputes about approaches to the loved one’s illness and imminent demise. The best you can hope to do is to take charge of your own emotional reactions.  In this way, you will do your part to minimize family tensions. Strive to find out your loved one’s wishes so you can minimize family squabbles about each person’s opinion. Advanced Healthcare Directives or Living Wills clearly state this.  Make compromises with family members where there are disputes or where your loved one’s preferences are unclear.

Loss is painful. Anticipating inevitable loss is, too. As the Serenity Prayer, the mantra of Twelve-Step programs, says, learn to accept what you cannot change.  Have the courage necessary to change what you can.  And try to develop the wisdom to know the difference.