Over nine hundred years ago, Hildegard von Bingen conceived of the word viriditas or greening as a way to describe the potential of our individual and communal life journeys from birth through death.

As palliative care musicians, we acknowledge death as the culminating act of our lives. We hold an awareness that we are all dying every moment and every day of our lives, just as the musical tones that we strive to create with precision and beauty gradually fade from our hearing. The rhythmic movement of death is ever present with its final unknowability. Grace is ever before us, beckoning us onward.

As developed by Therese Schroeder-Sheker, Music-Thanatology is a contemplative practice with clinical applications. It presents a praxis of art, spirituality, and science in compassionate service to those who are dying.

Music, using harp and voice, is dynamically and individually prescribed to the dying person to help alleviate physical, emotional, and spiritual pain and suffering. The larger mystery of the overall unbinding process that happens within the patient and family, as well as the medical staff, is gently supported and the possibility of a blessed death that is unique to the dying person and their loved ones is facilitated.

Music-Thanatology is considered a contemplative practice because we know that to enter into relationship with someone who is dying calls for deep listening and an inner capacity for transformation. In this manner of openness and relationship, sound can emerge with a sensitivity and artistry that is truly prescriptive to the needs of the dying person.

The clinical decisions of the music- thanatologist arise through an embodied synthesis of phenomenological observation in relation to disease processes, compassionate intention reflected in musical artistry, and careful monitoring of the countenance and vital signs.

Working within a body-systems phenomenology, the music-thanatologist closely observes physiological patterns and changes within the respiratory, circulatory, and metabolic systems of the patient. The resulting application of music may stimulate, suppress, or soothe the respiratory patterns, pulse, and body temperature of the dying person as needed.

clayThe music that is delivered to the patient is considered prescriptive and is not unlike a pharmaceutical compound in that the quality, dosage, and intent is specifically applied and correlated to the patient’s needs.

Affecting the physical processes changes the entire inner world of the dying person. As physical pain is eased, emotional and spiritual suffering may be felt and eased, respiration finds a new balance, and a deep rest and relaxation will often be experienced. A peaceful rest, a sensation of beauty, an awakening to eye contact with a loved one — all of these experiences, even for just a few moments, hold the potential for reconciliation, the release of emotional turmoil or anxiety, and the re-integration of the dying person into the fullness of life.

The efficacy of the prescriptive music is not related to the patient’s outward responsiveness or ability to hear. The entire surface of the skin acts as an extension of the ear and so the music is helpful for hearing impaired as well as comatose patients.

Music-Thanatology vigils are effective for patients with respiratory compromise and during extubation procedures where the music is able to synchronize with and support the respiratory process of the person. Patients with cancer, respiratory and infectious diseases, and also those with degenerative diseases, such as Alzheimer’s, dementia, and multiple sclerosis, have been found to benefit from music-thanatology vigils.

Many nurses report that their patients find deep, restful slumber after a music-thanatology vigil, and patients often require less morphine in dosage and frequency.

Physicians are able to offer music-thanatology as an integrative modality when life expectancy is a year or less, or as a standard component of comfort care when aggressive biomedical treatment is no longer viable. Hospices and nursing homes include music-thanatology services in their commitment to providing a standard of life and beauty that fulfills the promise of long-term care.