Time of Death

The rapidity with which terminally ill people die depends on the nature of the illness, the age and lifestyle of the patient, the manner in which the illness is treated medically, and certain psychological factors. A longer dying trajectory is usually less stressful for survivors and gives the patient a better chance to settle remaining financial and family matters. However, a shorter dying trajectory may be preferable when the patient is severely deteriorated and in great pain. Supporters of physician-assisted suicide argue that dying with dignity rather than remaining connected to tubes and machines while enduring suffering for weeks or even months is a fundamental right of a human being. When the dying trajectory is fairly long, the reactions expected by the patient vary with his or her age. Older, dying patients are expected to be more passive and less emotional, whereas younger people are expected to be more active and resistant in the face of death (Sudnow, 1967).

Though most people do not have the ability to determine the exact time of their death, psychological factors can hasten or delay death. Folklore is full of stories of people who felt that it was time for them to die and decided simply to give up and let it happen. Those who have difficulty coping with the pain, frustration, and expense of a prolonged, fatal illness may vacillate for a period of time between the desire to live and the desire to end it all, eventually deciding in favor of the latter. The results of uncontrolled observational and correlational studies also indicate that at least some people possess the ability to either hasten or delay death by means of their own thoughts, feelings, and motivations (Kastenbaum & Aisenberg, 1976; Phillips & Smith, 1990; Trelease, 1975). Indirect evidence of the role of psychological factors is also found in numerous anecdotes indicating that people can be scared to death (e.g., Barker, 1968; Kalat, 1984) or simply die because of feelings of helplessness and hopelessness (Engel, 1971; Seligman, 1975, 1992). Furthermore, data from more rigorous scientific investigations on nursing home patients indicate that death can be hastened when patients are made to feel totally dependent and permitted no voice or choice in what they can do or what is done for them (Langer & Rodin, 1976; Rodin &Langer, 1978). Whether or not they are able to control the time of death by their feelings and behavior, many individuals are reportedly aware that they are about to die (Kalish & Reynolds, 1981). In addition, people often show signs of impending death in their behavior. There is, for example, evidence for a terminal drop— a decline in cognitive and sensorimotor abilities and personality characteristics such as assertiveness—during the last few months in the lives of older adults (Lieberman & Coplan, 1969; Riegel &Riegel, 1972).

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