About Dying

Introduction to Dying

Die: "To pass from an animate to a lifeless state; to cease to live; to suffer a total and irreparable loss of action of the vital functions; to become dead; to expire; to perish..."

Coping is defined as "constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person." More simply, coping is not mastering the stressful demands, but rather trying to manage stressful demands as best we can. Often coping involves becoming content to accept, endure, minimize, or avoid stressful demands. I doubt if there is a more stressful situation that a person having to face his/her own imminent death.

Awareness

A couple of important topics of any discussion about dying involves the rate of dying and how aware everyone is of the condition of the dying person.

Stages and Phases of Dying

The most familiar model of how people react to their own dying is the 5-stage model proposed in 1969 by psychiatrist Dr. Elisabeth Kübler-Ross in her book On Death and Dying. The basis of her model was a series of interviews she conducted in her attempt to determine how people react to their own imminent death. From their responses, she developed a list of five predominant “defense mechanisms” these people used to face the stress of their situation.

Stages of Life-threatening Illness

Closely related to the Tasks of Coping with Dying are the five stages of a life-threatening illness. The tasks of coping usually associated with each stage vary from one stage to another. The connection between the stages and tasks was first proposed by Ken Doka in 1993.

Introduction to Tasks of Dying

As I wrote in the section Coping, coping is an active, choice-laden process involving analysis, redefinition, avoidance, problem solving, expressing emotions, etc. As opposed to being merely an automatic response or defensive reaction to something, coping is the attempt to adapt to and to accommodate life’s challenges. Thinking of coping in terms of tasks helps reinforce its proactive nature, recognizes that coping is not a step-by-step formula, and a person can choose which of the various aspects to work on and when to work on them. In other words, using a task-based model implies that the person coping with dying is an actor, not a re-actor, and has some power over how they adapt to the situation.

Physical Tasks

The most basic aspects of life are those associated with bodily needs since meeting these needs are prerequisites for biological life and functioning. In his well-known hierarchy of needs, Maslow argued that satisfying bodily needs is the indispensable foundation on which all other needs are built. An example is a person who is experiencing intense pain. (S)he is unlikely to be able to focus on higher level needs such as social and spiritual interactions. Many people have known of others who are in such chronic, long-term pain that they are willing to do anything, including taking their own lives, if possible, to end their suffering.

Psychological Tasks

The psychological tasks are made up of three components: psychological security, autonomy, and richness.

Social Tasks

There are two aspects of social living that form the social tasks that are important to a dying person. The first aspect involves the interpersonal attachments and interactions of the dying person while the second involves interactions with certain social groups within society or with society as a whole.

Spiritual Tasks

Of the four tasks, the spiritual ones are the most complicated to describe for a couple of reasons. First, there is no consistent definition of ‘spiritual.” Spiritual does not necessarily mean religious. One can have spiritual concerns separate from religious concerns. Second, and related to no consistent definition, is that there are many spiritual subcultures such as Roman Catholics, Southern Baptists, Muslims, Buddhists, Hindus, Native Americans, atheists, etc. Even within these there are various subcultures. However, people within each subculture can still experience the common themes of the spiritual tasks.

5 Themes of Caring

five "themes" for caring for someone who is dying and some practical suggestions on how to do carryout those themes. You can think of these themes, taken from a publication of the Colorado Collaboration on End-of-Life Care, as the five R’s for caring: Remember,Recognize, Respect, Reinforce, and Reminisce.

Introduction to the Dimensions of Care

The four tasks a dying person faces also define the four dimensions of care for the dying person: physical, psychological, social, and spiritual.

Physical Dimension

Probably the most demanding physical need of a dying person is the control of pain. Physical pain is actually divided into two major categories: acute and chronic.

Psychological Dimension

For many caregivers, the psychological dimensions of care can be more difficult to deal with than the physical dimensions. In the physical dimensions, there is something that the caregiver can try to do to relieve physical suffering: medications, physical contact, etc. However, when the sufferingis psychological, i.e., involving feelings such as sadness, anger, fear, anxiety, and other so-called negative feelings, what can a caregiver do to help?

J. Worth Kilcrease, LPC, PLLC