Death and Dying

"There is no more emotionally connected system than the family, if for no other reason than because no one can ever truly leave it" (Rosen 1998, p. 17). Families are a collection of individuals, with a unique shared history and unique responsibilities to each other. Indeed, the understanding of family in its most expansive sense, includes all generations: those living, those dead, and those yet to be born (Rosen 1998). We may choose to sever ties by ending contact, or terminating legal responsibilities, but in truth, can never truly sever relationship ties. Family ties may be voluntary or involuntary, wanted or unwanted, central to our thoughts or held to the side, and they often extend beyond death.

For any system to operate, it needs certain functions to take place and roles to be played (Rosen 1998). Each family has its own unique structure, functions, relationships, roles and role responsibilities, and interaction patterns (Rando 1984). Family members often carry out many roles in the family, and the more central these roles are to the family's ongoing operation, the more disruptive is the loss of the person who carried them out.

Families also maintain a certain balance and achieve a predictability in normal day-to-day life (Rosen 1998). This can be challenging without the loss of a family member, because families must deal with normative change that comes from such simple things as normal aging of family members and the evolving character of relationships within the family (Doka 1993). When a crisis like a death occurs, the family is thrown into disorder. The stability that has been established in the family is disrupted and, in order to continue to function, the family must somehow regain some sort of stability and shift the various responsibilities among the remaining family members. Death is what Reuben Hill (1949) referred to as a crisis of dismemberment, an apt term for the loss of a part of the family body. This form of crisis occurs when a family member is lost to the family and his or her various role responsibilities must be shifted to at least one other family member.

The family's ability to adapt to a terminal illness or a death is affected by a variety of factors (Murray 2000): the timing of the illness or the death in the life cycle, the nature of the death itself, and the degree to which the loss is acknowledged— that is, the degree to which it is disenfranchised (Doka 1989), stigmatized, or both. In addition, if families have concurrent stressors, if the person is central to the family's operations, or if there was conflict with the person who is dying or has died, the family will be more vulnerable at this time. Families with a variety of resources within and outside the family as well as openness, flexibility, and cohesiveness are better able to handle the various stressors related to the death (Murray 2000).