Fear of death

In general there is acceptance of death, but it is difficult on an individual/personal level. It is essential to understand that the patient/close ones need support on the road to death. Most know that death is imminent, but at the same time find it inconceivable and unreal and need support and assistance to accept death. Honesty and no pretence will assist in acknowledge of impending death. Those involved with the individual can assist in the moral transformation leading to appreciation of love and caring relationship. This needs simple confident relief of distress (physical/emotional) by reassurance.

Before the advent of modern medicine, illness was of short duration before death. The approach of death was acknowledged and took place at home among family, relatives and friends with the support of the wider community. Today there is chronic disease, with often long suffering before death and when it is imminent, the person is often removed to a sterile hospital room, with only one or two close relatives allowed during visiting hours and removal of the body to the mortuary/funeral home immediately on death.

Is there any justification for the fear of death? It is said that men are disturbed not by the things that happen, but by the opinions about the things: for example, death is nothing terrible…….the thought about death, that is the terrible thing. Perception about death shapes fear about it, focusing on what is in one’s power,namely self-sufficiently and serenity, leading to greater control over beliefs and values- an ancient stoic ideal. But one still is left with deep caring about what death entails.

There are three categories of fear about death and one has to distinguish between one’s own well being (self-interest) and the well being of others:

1. Premature death: where there appear to be no opportunities for a full/satisfying life, especially when it concerns children or young adults- the concept of a “natural lifespan”- to achieve life’s possibilities.
2. The process of dying: concerns fears of pain/disability/suffering and also loss of control / self-determination by becoming vulnerable and dependent, leading to a sense of shame / embarrassment, loss of privacy, intrusion by strangers, relationships and being an emotional / financial burden, debt afterward, isolation, etc. The possibility of suffering, coping with illness and the impact on one’s life / wholeness emerge. Also questions about the purpose /meaning of one’s existence, the role of religion, the constant search / life review, which if it fails, leads to spiritual / moral suffering and even depression, when the services of a psychiatrist may be required.
3. Being dead: uncertainties about life after death, the specific and circumstances, and anxieties about a permanent end or non-existence.

Response of health professionals to death and dying

Therapists need to understand their own responses to death in order to communicate effectively with patients who have life threatening diseases, which may give rise to multiple anxieties in the patient and his/her family. Meaningful life means that each individual experiences his/her own life as meaningful, whereas the dynamics of interaction and responses to death, particularly with the family of a child who has died/ is dying, is complex. Matters become even more complex where a Do Not Resuscitate (DNR) or a Living Will are recorded in the medical record.

There is a need to respect the individual’s “existential fears”, religious beliefs and/or practices which will assist in coping with death and dying. Appropriate professional distance protects the professional, but be careful of over distancing. It is said that medicine (allied health professions) is most likely to attract people with high anxieties about death and that they are high achievers that have survived the fierce competition to enter and complete training, and to achieve position; the ability to cure also leads to perceive power over death, thus dying/dead patients personify weakness or failure, which has to be avoided and/or ignored as it is a blow to the self-image (high achievers need constant reassurance of their abilities). They have a powerful need to exercise control and thus impending or actual death is the ultimate threat to this sense of control.

Health professionals need to display greater humility to face the inexorable reality and to keep the patient’s welfare paramount. Yet, for many health professionals terminal care can result in positive emotions of peace and acceptance of death as a natural process, even a sense of privilege by helping people in their final hours. But there is also deep frustration and burn-out when medical care is used in situations where there is no hope of benefit or when an aloof health practitioner spends very little time with a terminal patient or is insensitive to his/her suffering. Healthy emotions are usually an indication of good health care.

Professional Ethics in Physiotherapy by the University of the Western Cape is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.