Terminal Illness and Imminent Death

The time of terminal illness and imminent death is almost always an exceptionally difficult period, both for the patient and for the family and friends. It was not always like that in the past. As recently as a century ago, dying was commonly regarded as a simple fact of existence, and the end of life was usually treated more pragmatically, often [Page 938]stoically. Currently, the prospect of dying looms large and terrifying, and much of that is due to the fact that our society is emerging from a long period, perhaps five decades or more, of denying the universality of death, and of making it a taboo subject—an action that has deprived most people of any opportunity to build and strengthen preparatory and coping strategies that they might otherwise have developed.

This entry provides a brief overview of the history of social attitudes toward terminal illness and the end of life—a history that materially affects our current attitudes and coping strategies. It also offers an analysis of the main factors contributing to the heavy psychological burden of imminent death and outlines some possible strategies that may enhance coping.

Denial of Death: A Brief History

There is no universally accepted measure by which we can assess a culture's attitude to death. Therefore, any description is of necessity partly subjective. However, it seems that the separation of the process of dying from the daily business of living may have accelerated—certainly in Europe and the United States—after World War II. This change in attitude may have its sociological origins in the move away from war as a solution to political problems after the massive slaughter of the two world wars. At the same time, in the late 1940s, expectations of health were dramatically raised with the advent of effective medications, particularly antibiotics, curing some infections that had previously been common causes of early death. The power of these first antibiotics heralded a wide and major change in the effectiveness of medical treatment in many common diseases, and thus raised public expectations of a longer and healthier life. By the late 1950s and early 1960s, medical successes and breakthroughs, augmented by intense media coverage, raised general expectations of cure for so many disorders that more people expected miraculous cures for most conditions, even terminal illnesses. This atmosphere of unrealistically high expectations made it more difficult for the patient and the family to accept death.

Furthermore, the process of dying became institutionalized, to some extent, and a part of the field of specialists and experts. In many urban centers, death occurred in a hospital or nursing home in over 75#x0025; of cases, and the role of family and friends in supporting the dying person became subordinate to the expertise of medical and nursing staff. There is, of course, little intrinsically wrong with that, but it did foster the perception that family and friends had no place or role at the bedside of the dying person.

Simultaneously, most lives in the developed world were being evaluated by criteria that had become more materialistic. Again, there is nothing intrinsically wrong in summing up a person's life solely by his or her wealth or success, be it artistic, social, or financial, but it does increase the difficulty of accepting the ending of life—a moment at which the person will clearly be separated from the material symbols of worth.

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