Understanding Death Anxiety Among Hospice Patients

patient and priest

Saul Ebema, D.Min.

In ministering to the dying, pastoral counselors will encounter some major spiritual and emotional issues the terminally ill patients experience as death nears and one of the major issues is ‘death anxiety”.

Carpenito-Moyet, defines death anxiety as “the state in which an individual experiences apprehension, worry, or fear related to death and dying”[1]. In the Nursing Outcomes Classification guide, death anxiety is defined as “vague uneasy feeling of discomfort or dread generated by perceptions of a real or imagined threat to one’s existence.”[2]

Death anxiety is initiated by an increased awareness of death.  In facing death, people typically experience a wide range of anxieties and related emotions like fear, dread, and panic. An analysis of the anxiety of the dying person identifies several central concerns.  Surely, everyone confronts death in a unique way dependent on one’s individual needs, personality, culture, and social situation, but the majority of dying persons experience intense feelings of anxiety and associated emotional stress.

Neimeyer notes “four factors which cause death anxiety.”[3] One is the fear of the unknown. That which is unfamiliar or which cannot be anticipated threatens us a lot. From childhood fear of the dark to the elderly confronted by death, we all try to cling to the security of the familiar. Like the rest of us, the terminally ill are afraid of death. Some of the anxieties are caused by unanswered questions like, what is my fate after death? What will happen to my body after I die? What will happen to my family? How will they respond to my death?

As a pastoral counselor working with someone facing death anxiety, try to answer some of the questions you can answer. This will help reduce some of the anxiety.

The second factor related to death anxiety is the finality of death. There is no return, no cure, no more tomorrow. Therefore, death signifies the cessation of all hope with respect to this world. This thought creates a lot of anxiety for the dying. There is, also, annihilation anxiety or fear of non-existence. The concept of non-being can be very threatening, because it seems to go against a strong and innate conviction that life should not be reduced to non-being.

Lastly, there is the fear of ultimate loss. When death occurs, we are forced to lose everything we have ever valued. Those with the strongest attachments towards things of this word are likely to fear death most. Loss of control over affairs in the world and loss of the ability to care for dependents also contribute to death anxiety. The dying patient mourns the loss which family and friends will experience upon their death. This grief is normally similar to the survivor’s grief after the death.


[1] Lynda J. Carpenito-Moyet, Handbook of nursing diagnosis (Philadelphia: Lippincott, Williams and Wilkins. 2008), 140.

[2]Sue Moorhead et al., Nursing Outcomes Classification (St. Louis, MO: Mosby Elsevier. 2008), 52- 63.

[3] Robert A. Neimeyer, Death anxiety handbook: Research, instrumentation and application (Death, Education, Aging and Healthcare) (Washington, DC: Taylor & Francis. 1993), 34.

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