Knowledge of Death as a Crisis in Hospice Care

Hospice patient

By Dr. Saul Ebema.

One of my friends used to have dizzy spells that often came and went. He decided to go to the doctor to have some tests done on him in order find out what was wrong with him. The results of the tests indicated that he had brain tumor that had metastasized beyond treatment. The doctors recommended for him to be put understand hospice care. The news of his diagnosis took all of us by surprise and it immediately took him and his family into crisis mode.

The news of a diagnosis of terminal illness is often a crisis. Parad and Caplan defined “five aspects of crisis caused by the knowledge of impending death.”[1] First, this stressful event poses a problem that by definition is insolvable in the immediate future. In this sense dying is the most stressful crisis because it is a crisis to which we bow but do not solve.

Secondly, the problem taxes one’s psychological resources since it is beyond one’s traditional problem solving methods. One is faced with a new experience with no prior experience to draw from, for although one has lived amidst death, that is far different from one’s own death.

Thirdly, the situation is perceived as a threat to one’s goals. Dying interrupts a person in the midst of life; and even in old age it abruptly confronts one with the goals set in life.

The fourth aspect is characterized by tension that mounts to a peak, and then falls. As one faces the crisis of death knowledge, there is mobilization of either integrative or disintegrative mechanisms. The peak of anxiety usually occurs considerably before death.

The fifth aspect awakens unresolved key problems from both the near and distant past. Problems of dependency, passivity, narcissism, identity, and more may be activated during the dying process. Hence one is faced not only with the immediate dying process but also with unresolved feelings from one’s own lifetime and its inevitable conflicts.

All the above mentioned issues which are caused by the knowledge of impending death make the patient feel trapped by the illness. The reality that they will have to lose all the things they have worked for and all the people they have loved in their life time, causes loss of emotional and psychological balance.

According to Verwoerdt, “during this crisis of the knowledge of death, the patient struggles to attain any sense of balance for these three reasons”[2]: First, the illness itself depletes the individual of energy required to maintain appropriate coping mechanism. Second, the individual has had no previous experience with death to assist with the adaptation to this new reality. Third, healthy adaptation requires the expectation of pleasurable results in the future. This is absent in the patient facing a terminal illness.

For these reasons, the crisis of the knowledge of death becomes an extremely difficult and overwhelming experience. The patient then begins to go through stages of dying.


[1]Howard J. Parad and Gerald Chaplan, “A framework for studying families in Crisis.” Journal of Social Work 5 (1960): 3- 15.

[2] Adrian Verwoerdt, Communication with the fatally ill (Springfield, IL: Charles C. Thomas, 1966), 56.

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