Life Cycle and Death

Death is an integral and inevitable component of the life cycle and can occur at all developmental stages. Children and young adults may die, and older adults must die. Death at varying stages of the life cycle presents unique developmental and psychosocial challenges for the dying person and for his or her family. Medical and technological advances over the past century have changed the manner of death as well as the process of dying, leading to an increase in death anxiety and increased burdens on family caregivers. During an often prolonged dying process, the dying person and family members grieve multiple losses, including roles, hopes and dreams, material and emotional support. Finding meaning at the end of life can lead to lessened psychological distress for both the dying patient and for the patient's loved ones.

In 1900 the leading causes of death were accidents and infectious illnesses, which resulted in a relatively rapid dying process. Death most often occurred at home with all family members as active participants in caring for the deceased. In contrast, by 2001, 9 of the 10 leading causes of death were from chronic diseases with long deteriorating declines. The prolonged experience of dying in this century has given rise to changes in how care is delivered and who shoulders the burden of extended caregiving. Further, advanced technologies are prolonging the lives of children with congenital anomalies and chronic diseases. It is important to recognize that while the final stage of death may occur in a hospital, much of the prolonged dying process takes place at home. The meaning of the death and the nature of the loss, then, vary depending on the phase of the family life cycle.

The Family Life Cycle

Development, growth, and change are lifelong processes occurring in a sociocultural context. The family is the primary social vehicle for transmitting cultural worldviews and values. The death of a family member impacts the entire family as a functional unit, because all family members are interconnected and interdependent.

The awareness of the inevitability of death creates anxiety, as humans are wired for selfpreservation. A shared cultural worldview that imbues life with order and predictability and provides rules and standards for behavior by which individuals attain a sense of value and self-worth alleviates the unconscious terror of annihilation. The family, as the primary mediator of culture, [Page 644]organizes around the roles and rituals that support a worldview that death occurs at the end of a long, productive, meaningful life. How death is anticipated and experienced and mourned by the individual and the family is largely a function of whether it is consistent with or challenges this cultural worldview. In general, unanticipated and “unscheduled” deaths, deaths due to violence, deaths associated with multiple losses or other major stressful events, or deaths resulting in the loss of ongoing social support, result in less successful adaptation for surviving family members.

Death during Childhood

More than 50,000 children die in the United States each year. The U.S. infant mortality rate is higher than that of most Western European countries. The main causes of death during the first year of life are congenital abnormalities and sudden infant death syndrome. After the first year, the main cause is accidents, followed by cancer. A child's sudden death presents obviously different challenges for the family than does death following a long illness.

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