Psychological Responses to Terminal Illness and Death

The Death Dilemma and Terminal Care

Characteristics of the Death Dilemma

• Existential
• Uncertain
• Irreversible
• Insoluble
• Shocking
• Inexplicable
• Mystery

Needs of the Terminally Ill Patient

Meeting these needs is crucial for the patient's well-being:

• Physical: Symptom relief and recovery.
• Psychological: Safety, understanding, and esteem.
• Social: Acceptance and belonging.
• Spiritual: Love, reconciliation, and self-assessment.

Psychological Characteristics of the Terminally Ill

Regression

The patient becomes more childlike.

Self-Awareness (Folding Over)

The patient is highly aware of themselves, detecting any signal related to their condition. This also occurs in the chronically ill.

Anguish

Especially common in patients who lack religious ties.

Factors Influencing Coping with Death

• Personal Factors:
  • Personality
  • Ability to solve problems
  • Age and sex
  • Attitudes and values
• Factors Associated with the Disease: Course, development, pain, treatment, and care.
• Sociocultural Factors: Resources, health support, and social support.

Hope for the Terminally Ill

Hope can be influenced by several factors:

Factors that Decrease Hope:

• Feeling devalued
• Neglect
• Isolation
• Lack of information
• Pain and discomfort
• Inability to communicate fears

Factors that Increase Hope:

• Feeling valued
• Significant relationships
• Realistic expectations
• Being informed
• Pain and symptom relief

Models of Terminal Illness Stages

The Kübler-Ross Model (Terminal Phase)

This model has been widely criticized because the phases can change order (except the last) and not all individuals experience every phase, especially patients who die earlier.

1. Phase of Denial: Patients deny everything related to death, making plans for the future as if nothing bad will happen.
2. Anger Phase: The patient becomes aggressive and asks many questions. At this stage, it is necessary to support the family so they understand what is happening and do not experience rejection.
3. Negotiation or Agreement: Often involves making promises, especially to God, if the patient holds religious beliefs.
4. Phase of Depression: The patient gives up. They suffer because they know their own death is imminent.
5. Acceptance/Adaptation Stage: Denial appears to be replaced by a sense of peace or adaptation.

The Buckman Model (Stages of Terminal Illness)

1. Stage 1: Coping with the diagnosis.
2. Chronic Stage: Experience of the disease (often involving depression).
3. Final Stage: Acceptance (not always achieved).

Child Development of the Concept of Death

First Stage (0–5 years)

Death is viewed as temporary, reversible, and a separation. Children at this age:

• Cannot understand death as irreversible, lasting, or permanent.
• Associate death with the absence of vital functions.
• Do not grasp the universality of death.
• Link death to absence and life to presence.
• Ask many questions.
• Exhibit temporal decomposition (confusion of time).
• Use magical thinking and egocentrism.

Second Stage (5–9 years)

Children begin to identify death with a person (e.g., the Grim Reaper). They believe death:

• Only affects the older, sick, or weak, not strong and healthy children.
• Have rudimentary knowledge of the three fundamental components (irreversibility, cessation of function, universality).
• Mention specific causes of death.
• Express feelings of fear, sadness, and surprise.

Third Stage (9–11 years)

Death is understood as the irreversible end point of life. Children at this stage:

• Understand that everyone dies.
• Fear death.
• Understand death is universal.
• Provide abstract explanations, such as serious illness, old age, or accidents.
• Death Reactions include:
  • Immediate emotional and painful internal dialogue.
  • Resuscitation (attempts to reverse or deny the finality).