The Dynamics of Death Awareness in Hospice Chaplaincy.

Dr. Saul Ebema.

I visited a hospice patient one day. When I arrived at the patient’s home, the daughter took me aside and told me not to tell the patient that I was from Hospice. They didn’t want the patient to know that she was dying and was put on hospice care.

In my work as a hospice chaplain, understanding the social dynamics of awareness of death is vital.  Glaser and Straus analyzed several patterns of communication behaviors between families and dying patients. They found four patterns, “closed awareness, suspected awareness, mutual pretense and open awareness.”[1]

Closed Awareness of Death

This is demonstrated in the illustration above, others know that the patient is dying but the patient doesn’t know he or she is dying. The relatives of the dying person think that by not telling the patient that he or she is dying, they are protecting the patient.

They try their best to maintain this denial of death. In the long run, it affects their personal grieving process. Discussions about death are avoided. Sometimes the patient knows that he/she is dying and the family does not know. This often leads to complicated grief when the patient dies.

Suspected Awareness of Death

In the suspected awareness context, the family tries to deceive the patient about the truth concerning the patient’s terminal illness. The patient however, suspects the truth that he or she dying.

Mutual Pretense

I visited a hospice patient who was in this situation. She knew she was dying, the family knew she was dying but they all denied the fact that she was dying. In this context, the topic of death is discouraged. It’s hard to have any kind of counseling intervention in this kind of situation until after the death has occurred.

Open Awareness

In this context, the patient’s death is no longer secret. The patients know they are dying and the family and friends know the patient is dying. There is normally an open dialogue about death and dying.

This open awareness of death gives the patients and their families the opportunity to reflect about death and plan for the dying process. “Also, the patient is able to make plans and arrangements necessitated by death, e.g., funeral plans, writing a will.”[2]  Ministers counseling the dying offer a supportive relationship in which the dying person has opportunities to work on significant personal concerns.

 Sources

[1] Barney G Glaser and Anselem L. Straus, Awareness of dying (St. Louis, MO: Transaction. 1966).

[2] Joseph Culkin, Psychotherapy with the dying person.

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