17.1 Biological, Psychological, and Social Aspects of Death and Dying

Death can involve not just death of the physical body, but also loss of the self and relationships. Death can also induce feelings of anxiety and loneliness.
The experience of death can vary considerably. Different causes of death have different trajectories that vary in terms of how sudden death occurs and whether decline is steady or fluctuates.
Life expectancy, how long a person’s likely to live, is influenced by a combination of factors, including behavior and lifestyle. Life expectancy also varies by race/ethnicity and geographic location.
Psychosocial aspects of death include coping with bad news as well as dealing with the discomfort many people feel when talking about death. Some people prefer to get as much information as possible when faced with bad news, but others try to avoid it.
Culture can influence how people view death, including their opinions on brain death, euthanasia, and organ donation. Cultural factors can include collectivistic versus individualistic orientations, religious/spiritual beliefs, and views about gender roles. Having religious or spiritual beliefs is often associated with positive feelings about death as going to “a better place,” but this can also put stress on people to accomplish certain tasks while alive. People without religious or spiritual beliefs don’t appear to fear death more than people with strong religious or spiritual beliefs.

17.2 End-of-Life Care

Care at the end of life can be provided in the hospital, at home, or in hospice facilities. Each setting has pros and cons related to autonomy and privacy.
The hospice philosophy regards death as a normal part of life and focuses on making the dying person comfortable and relieving pain rather than trying to cure the patient.
The end of life can involve several important decisions, such as what to do with one’s possessions, what kind of care a person wants or doesn’t want, and who gets to make decisions if the patient is unable to do so. Formalizing these decisions in legal documents called advance directives can reduce arguments and uncertainty.
Ethical issues related to death often involve questions about euthanasia and assisted suicide. The legality of euthanasia and assisted suicide varies from place to place around the world and sometimes within countries (e.g., the United States).

Grief is the emotional response to loss. There are several theories about what grief looks like; some theories propose grief is a series of stages or themes that people progress through, others regard it as a narrative, and others describe grief as a process of emotional adjustment and orientation.
Contextual factors can influence the experience of grief. Deaths that are sudden, involve a child, or are associated with stigma can produce grief that’s harder to resolve than deaths that occur after a long illness, involve an older adult, or are socially recognized.
Grief involves a physical response as well as an emotional one, putting the bereaved at risk for health problems associated with stress and impaired immune system functioning.
Rituals such as funerals can be comforting and provide a sense of closure. Specific rituals and practices vary by culture. Technology such as videoconferencing and social media offers opportunities for people who can’t be there in person to participate in these rituals as well.

A life review, a thoughtful examination of one’s life, is often associated with good outcomes such as decreased emotional distress and improved quality of life. Even if a life review turns up unhappy memories, it may be possible to resolve them.
Defining a “successful life” is highly individual, but often involves having a sense of purpose, feelings of autonomy and competence, and close connections with other people.
Similarly, defining a “good death” is somewhat individual, but typically involves wanting to be free of pain, having loved ones present, feeling respected, and having autonomy. Cultural factors can influence the degree to which these are prioritized.