by SarahRose Black, MMT, MTA, RP, CKN Music & Creative Therapies Editor
The use of music in palliative and end of life care is neither new nor novel. This approach to whole-person care at the end of life has been employed in various care settings around the world for centuries, in different cultural practices, health care institutions and homes. Music has long been able to offer a sense of comfort, emotional support, opportunity for psychosocial processing, and physical symptom relief for those facing end of life, as well as support for their family members.
When the provision of medical assistance in dying (MAiD) became legal in Canada, health care institutions and providers had to ensure preparedness in order to provide support within the scope of their various roles. In the midst of multiple changes in health care as a result of the legalization of MAiD, many professional organizations and governing bodies specified their involvement through publishing position statements or guidelines for practitioners. Music therapists in Canada have been involved in providing support for people requesting the intervention, along with their families and care teams. In addition to the traditional scope of practice for music therapists working in oncology, palliative, and end of life care, music therapists may now be involved in providing music as a part of medical assistance in dying. Because music permeates all aspects of life’s journey, including pivotal, meaningful, and difficult moments, music may accompany a patient and their family through MAiD, either in processing the decision around choosing MAiD, or during the actual intervention itself.
MAiD includes circumstances wherein a medical practitioner or nurse practitioner, at an individual’s request: a) administers a substance that causes an individual’s death; or b) prescribes a substance for an individual to self-administer to cause their own death (CPSO, 2016). Those who request MAiD go through a series of assessments to determine eligibility before being approved to receive the procedure. Due to the recent and new nature of the intervention, very little research has been published on the role of music and MAiD, however I have used music in my own practice with patients who have requested and received MAiD, and many music therapists across the country have also shared their own experiences of working in this milieu.
Music can play a role at any point in a person’s experience of illness, and can equally be offered at any point during MAiD, including during the assessment period, as well as the actual time of intervention, depending on the person’s preferences and wishes. Music therapists may offer music psychotherapy to patients in order to support their psychosocial processing of their emotional and mental states, using music listening, writing, or analysis as a reflective tool to create opportunities for discussion on what is important and/or meaningful to that patient. Often, non-verbal moments of listening to music can provide an open and non-judgemental space for a patient to reflect or process complex feelings. Music/song writing can be a way of creating legacy pieces for family or friends, or for a patient to creatively self-express their own feelings and thoughts. Music/lyric analysis can be a form of reflection or articulation of emotional states, as songs often contain meaning and can powerfully echo our own experiences. In my own clinical experience, both patients and their families have found one or more of these processes to be supportive. Music at bedside can also provide pain and symptom management support, encouraging deep breathing and physical relaxation.
During the time of intervention, patients may request a specific song (live or recorded) to be played. Often, this song may represent something meaningful or connect the patient to a specific time in their life. At times, patients have created playlists to have played during their final hours, or in the case of the MAiD intervention, during their final moments. Songs chosen for this occasion may also represent a mood state, such as a feeling of calm, or perhaps joy, relief, or peace. As every individual’s musical preferences are highly varied, so are patients’ choices for music during MAiD.
While music therapists specialize in the role of music in health care, and psychosocial oncology/palliative music therapists may specialize in the role of music in the dying process, many other health care providers have engaged patients and families in conversations around music during MAiD. Nurses, physicians, and allied health team members have brought up the role of music during the intervention, and have often been the ones to “press play” on the iPod or CD player at the patient’s chosen moment. Music therapists can support psychotherapeutic processing and live music at the bedside, but in my own palliative care teams (both in a hospital and in residential hospice), I encourage other clinicians to ask about musical preferences for MAiD, if they feel comfortable doing so.
Just as music accompanies life’s moments of joy, excitement, and celebration, music also accompanies life’s moments of fear, grief, loss, and pain. Because of the permeating nature of musical associations, and music’s ability to ease or arouse our bodies, minds, and spirits, music can be a meaningful and deeply important part of medical assistance in dying for patients, families, and health care teams.
For more information on Medical Assistance in Dying, please read Dr. Madeline Li and Dr. Gary Rodin’s recent CKN article Personalized Medicine and MAiD at UHN
SarahRose holds a Masters degree in music education from the University of Toronto, and a Masters degree in music therapy at Wilfrid Laurier University. She is the founder and coordinator of the first music therapy programs at the Princess Margaret Cancer Centre and Kensington Hospice in Toronto. Her clinical work and research is focused mainly on quality of life for acute palliative care, hematology, and hospice populations. She is also a Suzuki music educator, piano accompanist and singer/songwriter.