PSY 320 Health Psychology, Lecture 11 | Source: Lecture slides / exam notes
Difficulty: Intermediate | Prerequisites: Lectures 9 to 10 (Pain, Quality of Life, Chronic Illness). Familiarity with coping strategies and emotional responses to illness.
This lecture covers how people at different life stages understand, experience, and cope with death, along with the moral, legal, and practical dimensions of terminal care. It pulls together threads from the entire course: the biopsychosocial model, coping strategies, emotional responses to illness, and quality of life all converge here. Understanding death anxiety, the stages of dying, and grief is essential both for exams and for any future clinical or health-related work. You should be comfortable with the chronic illness and quality of life material from Lecture 10 before tackling this content.
Causes of death shift across the lifespan from congenital abnormalities and SIDS in infancy, to accidents and cancer in childhood, to chronic disease in middle and old age. Children's understanding of death develops in stages from seeing it as "a great sleep" (under five) to grasping its finality and biology (around nine or ten). Terror management theory explains death anxiety as existential dread that people manage through cultural worldviews, relationships, and self-esteem. The Kubler-Ross stages (denial, anger, bargaining, depression, acceptance) are well known but do not occur in a fixed order. Terminal care spans palliative care, hospice, and home care, each with distinct advantages and stresses for patients and families.
Sudden infant death syndrome (SIDS)
A condition where an infant stops breathing and dies, more common in lower-class urban environments, when the mother smoked during pregnancy, and when the baby is put to sleep on its stomach or side.
Premature death
Death that occurs before the projected age of 78, mainly caused by heart attack or stroke.
Terror management theory
The theory that humans' knowledge of their own inevitable death causes existential anxiety, which they manage by clinging to things that give life meaning: cultural worldviews, close relationships, and self-esteem.
Kubler-Ross stages of dying
Five stages proposed by Elisabeth Kubler-Ross: denial, anger, bargaining, depression, and acceptance. In simple terms, a model of the emotional journey of dying, though patients do not necessarily move through the stages in order.
Euthanasia
Ending the life of a person who is suffering from a painful terminal illness.
Living will
A document that provides instructions and legal protection for the physician, so that life-prolonging interventions will not be indefinitely undertaken. It does not always ensure the patient's requests are met.
Patient Self-Determination Act
A law requiring health facilities to have policies concerning patients' wishes for life-prolonging therapy.
Palliative care
Care designed to make the patient feel comfortable, as opposed to curative care, which aims to cure the disease.
Hospice care
A model of care that provides palliative treatment and emotional support to dying patients and their families. Painful or invasive therapies are discontinued, and the focus is on improving the patient's social support system.
Thanatologist
A person who studies death and dying. Thanatologists believe that cognitive-behavioural therapies can be constructively employed with dying patients.
Grief
A feeling of hollowness marked by preoccupation with the image of the deceased, expressions of hostility toward others, and guilt over the death.
Infancy and childhood: Key causes include lack of free or low-cost maternal care programmes, congenital abnormalities, and SIDS. SIDS is more likely in lower-class urban environments, when the mother smoked during pregnancy, and when the baby sleeps on its stomach or side. For children under fifteen, accidents and cancer are the leading causes.
Children's understanding of death develops in stages:
Ages up to five: think of death as a great sleep; curious about it
Ages five to nine: the idea that death is final develops, but there is no biological understanding
Ages nine to ten: moderate understanding of the processes involved in death; realise the person will not return
Young adults facing a terminal illness feel shock, outrage, and an acute sense of injustice. They may face a long, drawn-out period of dying.
Middle age: Death becomes more realistic as it is more common in one's social circle and chronic health problems can develop. Premature death (before age 78) is mainly caused by heart attack or stroke. Most people prefer a sudden death because it facilitates a more graceful departure, spares the family from witnessing decline, and does not severely tax finances. Socioeconomic status is a strong determinant of age of death.
Old age: The elderly are more prepared to face death because they have seen friends and relatives die and have often thought about and prepared for their own death. Causes include degenerative diseases and physical decline predisposing them to infectious disease or organ failure. Factors predicting mortality include new illnesses, worsening pre-existing conditions, poor mental health, and reduced life satisfaction. Women live longer than men.
Death anxiety tends to decline with age. Possible explanations:
Older adults may be in denial
People come to terms with mortality and stop worrying about it
Death anxiety is lower among older adults who are sick or infirm, who have lower meaning in life, or who might welcome death
Evolutionary arguments suggest reduced anxiety serves an adaptive function
Terror management theory proposes that awareness of inevitable death causes existential anxiety. People are motivated to reduce this anxiety by clinging to things that give life meaning: cultural worldviews, close relationships, and self-esteem.
Chopik (2017) findings: Having a chronic illness predicted greater death anxiety, as did poor subjective health. Having a source of social support leads to greater declines in death anxiety over time, because it gives life meaning, makes people feel good about themselves, and calms anxiety about death.
The Patient Self-Determination Act requires health facilities to have policies concerning patients' wishes for life-prolonging therapy. The right-to-die movement maintains that dying is more a matter of personal choice and personal control.
Euthanasia is the ending of a person's life when they are suffering from a painful terminal illness. A living will provides instructions and legal protection for the physician so that life-prolonging interventions will not be undertaken indefinitely, though it does not always ensure the patient's requests are met.
People sometimes fall prey to nontraditional or dubious remedies because of hope for a miracle cure, a deteriorating relationship with the formal health care system, or a desire for more humanistic care.
Five stages:
Denial is the patient's initial reaction on learning the diagnosis. It is a defence mechanism for avoiding the implications of the illness
Anger is harder for family and friends to deal with. The patient is not angry with them but at fate
Bargaining involves trading good behaviour for good health
Depression is a time for anticipatory grief, where the patient mourns the prospect of their own death
Acceptance is a tired, peaceful calm in which patients may divide up possessions and say goodbye
Evaluation of Kubler-Ross: Patients do not go through the stages in a predetermined order. The model also does not fully acknowledge the importance of anxiety, which is one of the most common responses to a terminal diagnosis.
Hospital staff play a critical role for the dying patient: they provide physical assistance, help reduce pain, see patients regularly, are the only source of realistic information, and are privy to the patient's act of dying.
Terminal care is primarily palliative (designed to make the patient comfortable), as opposed to curative care (designed to cure the disease).
Risks for staff: Staff may burn out from watching patients die. Patients interpret it as abandonment when physicians spend less time with them, though physicians often redirect time to patients who can benefit most.
Counselling with the terminally ill is short-term, with timing dependent on the patient's desires and energy level. Thanatologists believe CBT can be constructively employed with dying patients.
Terminal illness in children: Children infer about their condition from their treatments and the people around them. Counselling helps therapists take cues from the child, helps parents cope with impending death, restores balance in families with other children, and provides supportive mental health services (including for parents experiencing PTSD).
Hospice care provides palliative care and emotional support to dying patients and their families. Painful or invasive therapies are discontinued, and care is oriented toward improving the patient's social support system. The term "hospice" originally referred to medieval European places of care and comfort for travellers.
Home care is the most popular and economically feasible option. It provides psychological advantages for the patient but is stressful for the family.
Grief is a feeling of hollowness marked by preoccupation with the image of the deceased, expressions of hostility toward others, and guilt over the death.
Grief is more aggravated in men, caregivers, and people whose loss was sudden and unexpected. The biggest burden differs by gender: for women it tends to be financial strain, for men it tends to be the strain of managing a household.
Death of a sibling raises particular complications for children. Children should be prepared for the death, their questions should be answered honestly, and information should be provided at the right time.
Death education involves developing realistic expectations about what modern medicine can achieve and the kind of care the dying want and need. Colleges have developed courses on dying that include volunteer work with dying patients. A potential problem is the unintended encouragement of self-destructive tendencies.
Students often assume the Kubler-Ross stages happen in a fixed sequence. They do not. Patients may skip stages, revisit them, or experience several simultaneously. Treating the model as a rigid checklist is one of the most common exam mistakes.
Students sometimes think death anxiety increases steadily with age. The opposite is more typical: older adults tend to report less death anxiety than younger adults, for reasons ranging from acceptance to denial to reduced meaning in life.
The idea that grief follows a predictable timeline is misleading. Grief is more aggravated in men, caregivers, and those who experienced a sudden loss, and the biggest practical burdens differ by gender (financial strain for women, household management for men).
Students may assume hospice care means giving up. Hospice is a deliberate shift from curative to palliative goals, focused on comfort, dignity, and social support rather than abandonment of the patient.
⚠️ Know the Kubler-Ross stages by name and order, but be ready to explain why the model is considered limited (no fixed sequence, underplays anxiety).
⚠️ Be able to describe how children's understanding of death develops across the three age bands (under 5, 5 to 9, 9 to 10).
⚠️ Terror management theory and the Chopik (2017) findings are likely exam material. Know the three buffers against death anxiety (cultural worldviews, close relationships, self-esteem) and how social support reduces death anxiety over time.
⚠️ Understand the distinction between palliative care and curative care, and be able to compare hospice care, home care, and hospital-based terminal care.
⚠️ Know the characteristics of grief (hollowness, preoccupation, hostility, guilt) and which groups experience more aggravated grief responses.
True or False: According to Kubler-Ross, patients move through the five stages of dying in a strict, predetermined order. (False, patients do not follow a fixed sequence.)
Fill in the blank: According to terror management theory, people reduce existential anxiety by clinging to __________, __________, and __________. (Cultural worldviews, close relationships, and self-esteem.)
True or False: Home care is the most expensive option for terminal patients. (False, it is the most popular and economically feasible option.)
Fill in the blank: SIDS is more likely to occur when a baby is put to sleep on its __________ or __________. (Stomach or side.)
True or False: Grief responses tend to be more aggravated in women than in men. (False, grief is more aggravated in men.)
Q: Describe how children's understanding of death changes from early childhood to age ten.
A: Children under five think of death as a great sleep and are curious about it. Between five and nine, the idea that death is final develops, but there is no biological understanding of how death works. By age nine or ten, children have a moderate understanding of the processes involved in death and realise that the person who has died will not return.
Q: What are the three buffers against death anxiety according to terror management theory, and how did Chopik's (2017) research extend this?
A: Terror management theory identifies cultural worldviews, close relationships, and self-esteem as the three buffers. Chopik found that having a chronic illness or poor subjective health predicted greater death anxiety, while having a source of social support led to greater declines in death anxiety over time because it gives life meaning, improves self-regard, and calms anxiety about death.
Q: What are the key limitations of Kubler-Ross's stage model of dying?
A: Patients do not go through the five stages in a predetermined order. The model also does not fully acknowledge the importance of anxiety, which is one of the most common emotional responses to a terminal diagnosis. The stages are better understood as possible responses rather than a fixed sequence.
Q: Compare hospice care and home care as options for terminal patients.
A: Hospice care provides palliative care and emotional support, discontinues painful or invasive therapies, and is oriented toward improving the patient's social support system. Home care is the most popular and economically feasible option and provides psychological advantages for the patient, but it is stressful for the family. Both prioritise comfort over cure.
Q: How does grief differ by gender in terms of aggravation and practical burden?
A: Grief responses are more aggravated in men than in women. The biggest practical burden also differs: for women, it tends to be financial strain; for men, it tends to be the strain of managing a household.
This lecture is the natural endpoint of the Lectures 9 to 11 arc. The emotional responses to terminal illness (denial, anxiety, depression) are the same ones covered in Lecture 10's chronic illness material, now applied to end-of-life contexts. Pain management from Lecture 9 resurfaces here as a core component of palliative and hospice care. Terror management theory connects to the broader stress and coping frameworks in the course, showing how existential threats are managed through the same psychological mechanisms (meaning-making, social support, self-esteem) that buffer against other health-related stressors.
Death and dying, causes of death lifespan, SIDS, sudden infant death syndrome, children's understanding of death, young adult death, premature death, middle age death, old age death, death anxiety, terror management theory, TMT, existential anxiety, Chopik 2017, right to die, Patient Self-Determination Act, euthanasia, living will, advance directive, nontraditional treatment, Kubler-Ross, stages of dying, denial anger bargaining depression acceptance, palliative care, curative care, terminal care, hospice care, home care, thanatologist, counselling terminally ill, terminal illness children, grief, bereavement, survivor, death education, health psychology PSY 320