Death and Dying
Learning Objectives
By the end of this section, you will be able to:
- Discuss hospice care
- Describe the five stages of grief
- Critique issues regarding living wills, Do Not Resuscitate (DNR) orders, and hospice care
Every story has an ending. Death marks the end of your life story (Figure 4.21). Our culture and individual backgrounds influence how we view death. In some cultures, death is accepted as a natural part of life and is embraced. In contrast, until about 50 years ago in North America, a doctor might not inform someone that they were dying, and the majority of deaths occurred in hospitals. In 1967, that reality began to change with Cicely Saunders, who created the first modern hospice in England. The aim of hospice is to help provide a death with dignity and pain management in a humane and comfortable environment, which is usually outside of a hospital setting. In 1974, Florence Wald founded the first hospice in the United States. Today, hospice provides care for 1.65 million Americans and their families.
How do you think you might react if you were diagnosed with a terminal illness like cancer? Elizabeth Kübler-Ross (1969), who worked with the founders of hospice care, described the process of an individual accepting their own death. She proposed five stages of grief: denial, anger, bargaining, depression, and acceptance. Most individuals experience these stages, but the stages may occur in different orders, depending on the individual. In addition, not all people experience all of the stages. It is also important to note that some psychologists believe that the more a dying person fights death, the more likely they are to remain stuck in the denial phase. This could make it difficult for the dying person to face death with dignity. However, other psychologists believe that not facing death until the very end is an adaptive coping mechanism for some people.
Whether due to illness or old age, not everyone facing death or the loss of a loved one experiences the negative emotions outlined in the Kübler-Ross model (Nolen-Hoeksema & Larson, 1999). For example, research suggests that people with religious or spiritual beliefs are better able to cope with death because of their hope in an afterlife and because of social support from religious or spiritual associations (Hood et al., 1996; McIntosh et al., 1993; Paloutzian, 1996; Samarel, 1991; Wortman & Park, 2008).
A prominent example of a person creating meaning through death is Randy Pausch, who was a well-loved and respected professor at Carnegie Mellon University. Diagnosed with terminal pancreatic cancer in his mid-40s and given only 3–6 months to live, Pausch focused on living in a fulfilling way in the time he had left. Instead of becoming angry and depressed, he presented his now famous last lecture called “Really Achieving Your Childhood Dreams.” In his moving, yet humorous talk, he shares his insights on seeing the good in others, overcoming obstacles, and experi