Death and Dying

There is disagreement as to when dying begins. In a sense, dying begins at birth. As Colin Murray Parkes, Pittu Laungani and Bill Young (1997) note, "Life [is] an incurable disease which always ends fatally" (p. 7). Typically, though, dying is considered as starting at a point close to the end of one's life when a life-threatening illness or condition develops. A variety of approaches can be taken: dying can be seen as beginning when the facts are recognized by the physician, when the facts are communicated to the patient, when the patient realizes or accepts the facts, or when nothing more can be done to preserve life (Kastenbaum 1998). Kenneth Doka (1995–96) broke the process of dying into three phases: the acute, the chronic, and the terminal phases of dying, in which the individual initially is given the diagnosis, then lives with the disease and then, finally, succumbs to death.

Like the dying person, the family goes through their own dying process. Families who are faced with the potentiality of the death of a family member generally will follow a pattern of changes, according to Elliott Rosen (1998):

Preparatory phase. In this phase, fear and denial are common. The family may be highly disorganized and the illness is highly disruptive to normal family operation. The family turns inward and is protective of itself and of its members. Anxiety may be higher at this time than at any other point in the dying process.

Living with the disease/condition. This phase can be quite long, and the family may settle into their new roles within the family. Supporters may become comfortable in their caregiving role and adjust to the idea of death. This is an important adjustment, because a great deal of the care for the terminally ill is provided by family members (Mezey, Miller, and Linton-Nelson 1999). Other roles may shift throughout this phase, including those of the terminally ill person. The family may close itself off from others. The family may be less disorganized during this phase, but the reorganization may not be healthy if, for example, the family isolates themselves and refuses offers of help. Anxiety is related to finances, resource availability, and caregiving. As Doka (1998) notes, this phase "is often a period of continued stress, punctuated by points of crisis" (p. 163).

Final acceptance. Usually the shortest phase, death is accepted and family members may say goodbye, although not all family members are equally willing to accept the death. The family is again disorganized and in shock, and roles no longer work as they did in the last phase. The family may become anxious of how others will think of them and view them, which can cause the family to move to extremes, becoming closer or moving further apart.

Throughout this process of moving toward the biological death of the family member, some or all family members may see the dying person to be socially dead (Sudnow 1967). In this, the dying person is seen to be "already dead" with the result that they may then become more and more isolated, as others move on with their lives and visit less and less frequently.

In a model similar to Rosen's, Doka (1993) includes a fourth phase, which he calls recovery, where the family resumes and reorders family roles and expectations. This may take place relatively smoothly, or may be complicated by the reluctance of some family members to give up the roles they held during the illness.