Music Therapy Legacy Work in Palliative Care: Creating Meaning at End of life/Le Témoignage Musicothérapeutique En Soins Palliatifs : Créer Un Sens En Fin De Vie

Legacy work is the process of patients creatively expressing and documenting their lives with the goal of leaving something of themselves for future generations. Music therapy legacy work involves working specifically with a music medium to facilitate the legacy work. Although legacy work can occur at anytime throughout one's life, the purpose of this article is to demonstrate its role in creating opportunities for terminally ill patients to find meaning and purpose during the final stage of life. More specifically, examples are presented that demonstrate how the discipline of music therapy can offer legacy work to palliative patients and family members.The concept of suffering will be profiled as it relates to the dying stage of one's life. The impact that meaning can have on one's sense of suffering, coupled with psychotherapeutic interventions that highlight the importance of meaning at end of life will also be reviewed. This article will then look at legacy work as viewed within the Regina Qu'Appelle Health Region (RQHR) Palliative Care setting I work within, followed by music therapy literature relative to legacy work in palliative care. Attention is given to the impact music can have in facilitating life review, reminiscence, in expressing emotions and insights, and in helping patients to clarify their beliefs, values and life experiences.Three case studies will highlight music therapy related legacy work, profiling a palliative patient and family's musical legacy video, a legacy song, and a legacy journal influenced by sessions of The Bonny Method of Guided Imagery and Music. Following this will be suggestions of resources that can be drawn upon to better understand the impact and concept of legacy work, and how to introduce it to patients and family members. Lastly, Therese West's (1994) theoretical framework of four physical and psychological phases that patients may pass through from life to death will be offered as a guideline for understanding when to introduce legacy work to patients.The Concept of Suffering as it Relates to End of LifeThe dying period of one's life may be viewed as one of the various stages that mark the human life cycle, similar to infancy, childhood, adolescence, mid-life, or late-life (Byock, 1996). As with each phase of life, addressing the associated trials and suffering that can occur creates opportunity for a sense of meaning and completion. To better understand how suffering could occur for patients in their personal experience of dying, Byock ( 1996) referred to Cassell's (1982) multidimensional theory of personhood. Cassell suggested that suffering occurred when a person sensed an imminent destruction of self, ending only when the threat had passed or the person's integrity was reestablished in some other way. The various aspects of the self that could suffer and be susceptible to a sense of injury and loss included personal, cultural, political, community, familial and transcendent related aspects. Certain of these dimensions may become more exposed at end of life (Byock, 1996). One's personhood may suffer a sense of loss as roles change or decline, and one is no longer able to fulfill past responsibilities as a coworker, bread winner, or community leader. Suffering can occur as relationships become wounded and challenged when a patient loses the ability to express emotion and fulfill their role as parent or spouse. A sense of loss may occur as previously meaningful structures and patterns of living are replaced by medical treatments, a regime that revolves around one's illness, and a loss of independence. In addition, one's terminal diagnosis, progression of illness, and physical side effects of the treatments may enhance a sense of lost trust in the body and a feeling of betrayal by it. One may experience suffering related to the future, as previously anticipated events such as the graduation of a child, or the marriage of a grandchild may not be witnessed. …