The concept of death

Everyone has their own unique idea or concept of death. This is influenced by your past experiences with death. Other influences include your age, spiritual and religious beliefs, emotional development, and community. Movies, TV, and books are filled with images of death. The person with a terminal condition may have lost a family member, friend, or pet in the past. Treating death as a part of life is difficult. But it may help ease some of the fear and confusion around death. Coping with death should be done within the belief system of the person with advanced cancer and their family.

How children and teens view death

Baby

Babies have no real concept of death. But they do react to separation from parents, painful procedures, and any change in their routine. A baby who is terminally ill will need much physical and emotional care so they feel safe and cared for. Keeping a regular routine is important for the baby and their caregivers. Babies can’t tell you what they need. So they often express fear by crying. Use gentle cuddling, hugging, and other familiar methods to soothe them.

Toddler

For toddlers, death has very little meaning. They may get the most anxiety from the emotions of those around them. When a toddler's parents and loved ones are sad, depressed, scared, or angry, they sense these feelings. They become upset or afraid themselves. The terms death or forever or permanent may not have real meaning to toddlers. Even if they have had past experiences with death, they may not understand the relationship between life and death. Use words they understand to answer questions and explain the parent's changes or periods of separation. Try to keep the child's routine as normal as possible. Caregivers can use telephone or video so the child can see and hear the parent in real time.

Preschooler

Preschool-aged children may begin to understand that death is something feared by adults. They may see death as temporary or reversible, as in cartoons. Death is often explained to this age group as going to heaven. Most children in this age group don't understand that death is permanent. They don’t understand that everyone and every living thing will eventually die, and that dead things don't eat, sleep, or breathe. Death should not be explained as sleep to prevent fear of sleeping and a possible sleep disorder.

At this age, children’s experience with death is affected by those around them. They may ask questions about why and how death occurs. Preschool children may feel that their thoughts or actions have caused the death or the sadness of those around them. The preschool child may feel guilt and shame.

When preschoolers become seriously ill, they may believe it is punishment for something they did or thought about. They don’t understand how their parents could not have protected them from this illness.

This same idea may make preschool-age siblings of a dying child feel they are the cause of the illness and death. Young siblings of dying children need a lot of reassurance and comfort during this time.

School-aged child

School-aged children are developing a more realistic understanding of death. They are starting to understand death as permanent, universal, and inevitable. They may be curious about the physical process of death and what happens after a person dies. They may fear their own death because of not knowing what happens to them after they die. Fear of the unknown, loss of control, and separation from family and friends can be the child's main sources of anxiety and fear related to death. Children want reassurance that their parent loves them. They need concrete, basic information about the parent's condition and what to expect.

Teen

As with people of all ages, past experiences and emotional development greatly influence a teen’s idea of death. Most teens understand that death is permanent, universal, and inevitable. They may have had past experiences with the death of a family member, friend, or pet. Like adults, teens may also want to have their religious or cultural rituals observed.

Most teens are beginning to establish their identity, independence, and relationship to peer groups. A major theme at this age is the feeling that they won’t die, that they are immortal. Their realization of their own death threatens all these concepts. Denial and defiant attitudes may suddenly change the personality of a teenager who is facing death. Teens may feel as if they no longer belong or fit in with their friends. They may feel they can’t talk with their parents.

Another important concept among teens is self-image. A terminal illness or the effects of treatment may cause many physical changes. Teens may feel alone in their struggle and scared and angry.

It is important for parents to realize that children of all ages respond to death in a unique way. Children need support. They also need someone who will listen to their thoughts and help ease their fears. Encourage them to keep a journal.

How adults deal with death

Grief is a natural human response to the loss of a loved one. It can show itself in many ways. Grief, and strategies used to cope with it, vary among people and families and also among different cultural groups.

For survivors, the grieving process can take many years and many forms. The challenge of accepting death and dying as the end stage of life is what the grieving process is all about.

What is anticipatory grief vs. sudden loss?

Anticipatory grief

This occurs when someone has a long illness, and their death is expected. Anticipating the loss of a loved one can be just as painful and stressful as actually losing that person. Anticipatory grief allows the family to get ready for death. It can be a time to resolve issues and concerns. It is a time to seek the support of spiritual leaders, family, and friends. It’s also a time to clarify the loved one's wishes for funeral and burial arrangements and other end-of-life issues.

Sudden loss

This refers to a death that happens unexpectedly and suddenly. Examples are a fatal accident, suicide, or heart attack. Such tragedies can leave survivors feeling shocked and confused. Loved ones are often left with many questions. There may be unresolved issues and many emotions, including anger, guilt, and pain. Support from family, friends, and spiritual leaders is key.

What may happen in the case of anticipated loss?

Many people facing their own death are willing to discuss issues of death and dying. This can be a time to discuss spiritual issues, resolve family concerns, reflect on a loved one's life and accomplishments, and express gratitude. Some may feel that they have unfinished work of personal importance to complete. This time is also a chance to put practical matters in order. Here are some examples:

• Is there anyone the person would like notified of their illness? Is there anyone they wish to visit while still able?

• Are there places the person would like to visit, or is there something they would like to do while still able?

• Can funeral expenses be prepaid?

• Which funeral home would the person prefer to handle arrangements?

• Can the person help with obituary information to make sure it is accurate and complete?

• What are the person’s specific funeral wishes?

• If there will be a religious service, can the person facing death help plan favorite readings or music?

• Is cremation or burial preferred?

• If a burial, has a cemetery plot been purchased?

• Does the person want memorial contributions to be made to a certain charity or organization?

• Can the person give information about practical issues? These include wills, bank accounts, lawyer's name, pension plans, retirement funds, and life insurance policies.