I’ve been a member of a hospital ethics committee for nearly 30 years. During that time, there have been patients on respirators for an extended period. The patients couldn’t breathe without the respirator. Yet, when the physicians in charge of the patients’ care concluded that there was no hope for recovery, often families didn’t want the machines turned off. A miracle is always possible, they argued, if not through divine intervention then by the new cure that will be announced tomorrow.
Effect of Advances in Medical Care
Advances in health care make death more difficult to accept than ever before. Death is no longer an inevitable reality for many, the end point of having been born. Death is viewed as a defeat, and anything less than heroic measures to keep someone breathing is considered a failure to treat fully.
As I surpass the age at which three of my four grandparents died, I marvel at the advances that have kept me healthy, active, and relatively free of pain. Luck and genetics play a large part in my healthy condition, but equally so have been the advances in all aspects of medical care, from dentistry to pharmaceuticals to prostheses and surgical equipment, and now artificial intelligence.
There is a downside to this, though. There is a disconnect between ourselves and nature, a hubris that believes that with enough effort and determination, nature itself can be vanquished; death can be postponed indefinitely.
Questioning the Definition of Death
Medical technology has even muddied the definition of death itself. Traditionally, the medical profession determined death by taking a pulse, listening for breathing, and holding a mirror under the nose to look for condensation. No breathing, no pulse: dead.
Not only has technology made these methods of determining the time of death inadequate, but medical advances have also even questioned the definition of death itself. As pointed out by bioethicist David DeGrazia,
The widespread dissemination in the 1960s of such technologies as mechanical respirators and defibrillators to restore cardiac function highlighted the possibility of separating cardiopulmonary and neurological functioning. Quite rapidly, the questions of what constituted human death and how we could determine its occurrence had emerged as issues both philosophically rich and urgent.
Hope has beneficial qualities but it also can become a destructive force. When hope crosses the line into wishful thinking, harm can be done. As pointed out by neurosurgeon Harold Wilkinson,
when promised improvements or recoveries fail to materialize, the impact on the patient and on the patient’s family is at times profoundly negative...If false hope built expectations that were unrealistic and not attainable, the lack of attainment of those goals will be viewed as failure—although partial improvement has in fact been achieved.
Not only does false hope erode trust between patients and doctors, but wishful thinking can also be cruel to the patient. A friend who had terminal cancer told me he felt guilty for being ill, that he had brought it on himself because of a negative attitude. Even at this late stage (he died within two weeks after our conversation), his psychotherapist assured him that with positive thinking and meditation he could get better.
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Increasing Acceptance of Hospice and Palliative Care
Fortunately, increasing acceptance of hospices and palliative care, where the focus is on symptom care and not cures, are encouraging signs that attitudes toward death may be changing. Comfort can be more merciful than medical interventions; letting go can be a kindness. As MSN Robin B. Rome writes,
While dying is a normal part of life, death is often treated as an illness. As a consequence, many people die in hospitals, alone and in pain...The ultimate goal of palliative care is to improve quality of life for both the patient and the family, regardless of diagnosis. Although palliative care, unlike hospice care, does not depend on prognosis, as the end of life approaches, the role of palliative care intensifies and focuses on aggressive symptom management and psychosocial support.
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All creatures born are destined to die. Philosopher Massimo Pigliucci writes, “death itself is not under our control (it will happen one way or another), but how we think about death most definitely is under our control. That’s the part we can work on.” The place to begin is acknowledging that we don’t stand apart from nature but within it. The Hebrew Bible states, “all are of the dust, and all turn to dust again,” while the Book of Common Prayer, often recited at Christian funeral services, says, “Earth to earth, ashes to ashes, dust to dust.” This view isn’t confined to the Western world. The Dalai Lama gives this advice: “We’re all going to face death, so we shouldn’t ignore it. Being realistic about our morality enables us to live a full, meaningful life. Instead of dying with fear, we can die happily because we’ll have made the most of our lives.”
There are different views of what happens after death: bodily resurrection (traditional Judaism), paradise (Christianity and Islam), reincarnation (several Asian religions), and returning to what one was before being born (various Humanist philosophies). What all agree upon is that death is inevitable. Medical advances and its ancillary technology can make us healthier, but it can’t make us immortal. Palliative medicine and hospice care are steps in the right direction, bringing dying back to its rightful place. It is a good beginning.
FAQs
Advances in health care make death more difficult to accept than ever before. Death is no longer an inevitable reality for many, the end point of having been born. Death is viewed as a defeat, and anything less than heroic measures to keep someone breathing is considered a failure to treat fully.
Why is death so difficult to accept? ›
The feeling of disbelief that follows the death of a loved one is an adaptive and temporary response—one that protects from the pain of loss and allows a survivor to manage all of the details that follow a death. Embracing the painful reality does not happen quickly or easily, and it can be an exhausting process.
What is it called when you can't accept death? ›
Thanatophobia is not only death anxiety, but can mean an intense fear, and feelings of overall dread in relation to one's thinking about death.
At what age is death no longer a tragedy? ›
It depends on how much the person was suffering in their later years, or, conversely, how vital they were. If they were in a coma for ten years at age 80, it's seen as less tragic than if they were still vital at age 90. But, all things being equal, probably 80.
What happens 2 weeks prior to death? ›
1 to 2 weeks before death, the person may feel tired and drained all the time, so much that they don't leave their bed. They could have: Different sleep-wake patterns. Little appetite and thirst.
What is the hardest death to grieve? ›
In general, death of a child is the most difficult kind of loss, and bereaved family members are at elevated risk for depression and anxiety for close to a decade after the loss. In addition these parents are at risk for a range of physical illnesses.
How am I supposed to accept death? ›
Through reflection, mindfulness, spirituality, support, and facing our fears, we can find the strength to embrace death as a natural part of life. By living with purpose, practicing gratitude, educating ourselves, and engaging in meaningful conversations, we can develop a profound acceptance of our finite existence.
What does grief do to your body? ›
Grief can cause a variety of effects on the body including increased inflammation,8 joint pain, headaches, and digestive problems. It can also lower your immunity, making you more susceptible to illness. Grief also can contribute to cardiovascular problems, difficulty sleeping, and unhealthy coping mechanisms.
Why is death so scary? ›
Why are we scared of death? Reasons why death is scary can be related to fears of the unknown, of non-existence, of eternal punishment, of the loss of control, or fear of what will happen to the people we love.
How do you accept death and let go? ›
How to deal with the grieving process
- Acknowledge your pain.
- Accept that grief can trigger many different and unexpected emotions.
- Understand that your grieving process will be unique to you.
- Seek out face-to-face support from people who care about you.
- Support yourself emotionally by taking care of yourself physically.
A death in one's 70s is more-or-less accepted as normal, and the 80s are widely considered to be ripe old age and a very full life. Anything much over 90 is insanely successful.
At what age do you realize your mortality? ›
No one likes to think about a time when they won't be here and conversations around death are certainly some of the hardest we can have… but it seems that we do often contemplate the subject within ourselves, with new research revealing that 26 is the average age that people first start to consider their own death.
What age do you stop worrying about death? ›
We get better at this as we age. A 2000 meta-analysis found that fear of death grows in the first half of life, but by the time we hit the 61-to-87 age group, it recedes to a stable, manageable level.
Does a person know when they are dying? ›
A conscious dying person can know if they are on the verge of dying. Some feel immense pain for hours before dying, while others die in seconds. This awareness of approaching death is most pronounced in people with terminal conditions such as cancer.
Which organ dies last after death? ›
The heart is the last organ to fail. The heart stops following PEA, but PEA is not cardiac arrest. The heart finally stops when it arrives at asystole, which is cardiac arrest (Figure 1).
What happens the first 5 minutes after death? ›
For the first few minutes of the postmortem period, brain cells may survive. The heart can keep beating without its blood supply. A healthy liver continues breaking down alcohol. And if a technician strikes your thigh above the kneecap, your leg likely kicks, just as it did at your last reflex test with a physician.
Why is it so hard to let go of someone who died? ›
Letting go evokes feelings of fear because you think that if you do not have intense pain over them being gone, you do not miss them. The pain of grief is gut wrenching, but then so does the anticipation of not having grief over someone so loved.
Why do I have such a hard time dealing with death? ›
This is known as complicated grief, sometimes called persistent complex bereavement disorder. In complicated grief, painful emotions are so long lasting and severe that you have trouble recovering from the loss and resuming your own life. Different people follow different paths through the grieving experience.
Why is it hard to accept losing? ›
Coping with loss always involves the same dynamics. In every case—whether it's the loss of a friendship, a career, a limb, whatever—we are forced to reckon with the fact that we will never experience something or someone again. We are forced to feel an internal emptiness and to accept our pain.
How long does it take to accept a death? ›
Two years on
The length of time is different for each person. For most people their mourning period is a long process and it can take years. After about two years you are likely to know the places, events and occasions that trigger your emotions.
