For the Dying, Music Can Be Magic
How music can transform the dying experience for patients and their caregivers
(Editor’s note: This story is part of a special report for The John A. Hartford Foundation.)
At a time when health care costs are soaring and health providers are strained for time, arts-based innovations can offer excellent patient care at the end of life. Music thanatology, a professional field within palliative care that began surfacing in the 1980s, is one such innovation. Its practitioners use live harp and vocal music to address the needs of dying patients and their loved ones. (Thanatology is the scientific study of death.)
During a music vigil, the music thanatologist offers music in a prescriptive way. With careful attention to the patient’s vital signs and physiological needs, he or she adjusts the elements of music — such as melody, phrasing and rhythm — to provide an individually-tailored response. The goal of a music vigil is to relieve suffering and to bring beauty and comfort to the dying process.
Music thanatology can help with symptoms like respiratory distress, pain, restlessness and agitation. It can provide support when a patient is actively dying or being taken off life support. The music vigil is a calm, peaceful space where patients and families can rest together, process emotions and, at times, make meaning of a difficult transition.
Research has confirmed its benefits. According to a 2015 study of family members’ views of the music vigil, music thanatology “has benefits, almost no risk, minimal cost and may improve patient-family experience of the dying process.” A 2006 study of the effectiveness of prescriptive harp music found that after a music vigil, patients were less agitated and wakeful and had slower, deeper respirations with less effort, concluding that music thanatology could be both beneficial to dying patients and “the focus of a promising new line of research in palliative care.”
Music Thanatology Helps Families Navigate the Dying Process
Tony Pederson, president of Music-Thanatology Association International and a member of the integrated care services department at JourneyCare, a Chicago-area health care agency for patients with serious illness, says modalities like music thanatology, music therapy, art therapy and massage therapy are vital to "whole-person care," especially in hospice. “If we’re going to be setting the benchmarks for how you provide great end-of-life care, then all these things are essential,” he said.
Pederson has been a music thanatologist at JourneyCare for 15 years. In addition to offering music vigils, he answers questions and provides information to families about the dying process. “Our culture has done a poor job in the last hundred years preparing people for death, and so when it doesn't happen like the movies, people aren’t sure what do or expect or even how long to prepare for it,” he said.
“It’s unimaginably stressful for the family, so I make a point of trying to give them the tools that I use,” he added. Pederson explains to families that they might see changes in the breath and pulse, cooler temperature and other physical signposts as death nears. He tries to provide families with a picture of the paths the patient may take. “Death is always going to be a mystery. There's always going to be some anxiety and fear about that,” he said. “But the process of dying is something that's knowable. And we can shepherd people through that.”
How Music Can Change the Culture of Health Care
“I love having a harp in the hospital,” said Julia Smith, a music thanatologist, harpist and singer at Providence Willamette Falls Medical Center in Oregon City, Ore. "[The harp] represents something that’s so foreign to our modern medicine,” she said.
While music thanatologists primarily see patients at the end of life, nurses also refer patients to Smith for symptoms like anxiety, pain and distress. She recently saw a patient with severe dementia who was yelling and swearing. “As soon as I started to play he just started to calm down,” she said. The soft, repeated chords that Smith played had an immediate calming effect. Afterward, Smith took her harp to the nearby nurse’s station. “That’s the first peaceful moment that I’ve had all day,” one of the nurses said of the music.
Music thanatology can bring powerful changes in patient experience and can change institutional cultures as well. When the Family Maternity Center opened at Providence St. Patrick Hospital in Missoula, Mont. in 2015, music thanatologist Mary Werner recorded a lullaby that would play on the overhead speakers when a baby was born. She was inspired by her colleague, Peter Roberts, a music thanatologist in Australia who encouraged the hospital where he works to play music when a baby is born, as well as when a patient dies.
Over time, several groups at Werner’s hospital — including nurses, chaplains, patients, families and the hospital’s Healing Experience Committee — suggested the idea of playing music after a death, and she participated in a working group for implementation. This process included the creation of a formal workflow to introduce the music to patients and families and to document whether they would like to opt in.
Full Circle Music launched in September 2017. When a baby is born, Providence St. Patrick Hospital plays a verse from Hush Little Baby. When someone dies, the hospital plays a phrase from Dvořák’s Symphony No. 9. The music is heard throughout most of the hospital.
Playing music after a death has quickly become a part of the hospital’s culture. The earliest comments were a request for a longer piece of music, which Werner soon recorded. Over the program’s first year, she has noticed that even families who decline a music thanatology visit may agree to the overhead music. “I can't think of one experience where I've asked a family or patient where they haven't said, ‘Oh that sounds wonderful. We'd love that,’” Werner said.
When the music plays overhead, it gives caregivers the opportunity to acknowledge what goes on within the walls of the hospital every day. “We can all take a moment to say we’ve taken care of somebody,” Werner said. “And we can think of them now, and we can think of their families and just take a minute to honor that.”
To find a music thanatologist in your area, consult the associates directory on the Music-Thanatology Association International website.
The John A. Hartford Foundation is a private, nonpartisan, national philanthropy dedicated to improving the care of older adults. The leader in the field of aging and health, the Foundation has three priority areas: creating age-friendly health systems, supporting family caregivers, and improving serious illness and end-of-life care.