The Final Chapter

DYING AND DEATH

KEY THEME

Attitudes toward dying and death are as diverse in late adulthood as they are throughout the lifespan.

KEY QUESTIONS

It is tempting to view death as the special province of the very old. Of course, death can occur at any point during the lifespan. It’s also tempting to assume that older adults have come to a special understanding about death—that they view the prospect of dying with wisdom and serenity. In reality, attitudes toward death in old age show the same diversity that is reflected in other aspects of adult development. Not all older adults are accepting of death, even when poor health has severely restricted their activities (Jun & others, 2010).

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As psychologist Robert Kastenbaum (1992) wrote, “Everyone lives in relationship to death at every point in the lifespan.” In other words, long before encountering old age, each individual has a personal history of thinking about death. Some people are obsessed with issues of life and death from adolescence or early adulthood onward, while others, even in advanced old age, take more of a one-day-at-a-time approach to living. And, feelings about and attitudes toward death are also influenced by cultural, philosophical, and religious beliefs (Gire, 2011; Rosenblatt, 2007).

MYTH SCIENCE

Is it true that dying people go through five predictable stages—denial, anger, bargaining, depression, and acceptance?

In general, worries about death tend to peak in middle adulthood, then decrease in late adulthood (Neimeyer & others, 2004; Russac & others, 2007). At any age, people respond with a wide variety of emotions when faced with the prospect of imminent death, such as when they are diagnosed with a terminal illness.

The scientific study of death and dying owes much to pioneering psychiatrist Elisabeth Kübler-Ross (1926–2004). Based on interviews with hundreds of terminally ill patients, Kübler-Ross (1969) proposed that the dying go through five stages. First, they deny that death is imminent, perhaps insisting that their doctors are wrong or denying the seriousness of their illness. Second, they feel and express anger that they are dying. Third, they bargain—they try to “make a deal” with doctors, relatives, or God, promising to behave in a certain way if only they may be allowed to live. Fourth, they become depressed. Finally, they accept their fate.

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The Last Lecture People vary greatly in how they cope with impending death. At the age of 45, Dr. Randy Pausch, a computer science professor at Carnegie Mellon University, learned that he had pancreatic cancer and was given just a few months to live. Pausch reacted by delivering his now famous “Last Lecture,” written in response to the question, “What would you say if you knew you were going to die?” Titled Really Achieving Your Childhood Dreams, Pausch’s lecture was upbeat, humorous, and inspirational, and has since been viewed by millions online. Pausch died about 10 months after giving his speech, which you can view at http://www.cmu.edu/randyslecture
SHNS photo by Pam Panchak/Pittsburgh Post-Gazette

Although Kübler-Ross’s research did much to sensitize the public and the medical community to the emotional experience of dying, it now seems clear that dying individuals do not necessarily progress through the predictable sequence of stages that she described (Kastenbaum, 2000, 2005).

Rather, dying is as individual a process as living is. People cope with the prospect of dying much as they have coped with other stresses in their lives. Faced with impending death, some older adults react with passive resignation, others with bitterness and anger. Some people plunge into activity and focus their attention on external matters, such as making funeral arrangements, disposing of their property, or arranging for the care of other family members. And others turn inward, searching for the meaning of their life’s story as the close of the final chapter draws near (Kastenbaum, 2000).

But even in dying, our life story doesn’t just end. Each of us leaves behind a legacy of memories in the minds of those who survive us. As we live each day, we are building our legacy through our words, our actions, and the many choices we make along the way.

Each of us began life being completely dependent on others for our survival. Over the course of our lifespan, others come to depend on us. It is those people whose lives we have touched in some way, whether for good or for ill, who will remember us. In this sense, the final chapter of our lives will be written not by us, but by those whose life stories have intersected with our own.