The Dying and Those Who Care for Them

The end-of-life experience encompasses feelings of hopelessness, death anxiety, guilt, and loneliness. The feeling of awaiting death’s arrival is common amongst the dying. El-Jawahri et al. in 2014 and Kim et al. in 2013 observed that patients that were aware of their terminal diagnosis and understood the implications of such prognosis rated their quality of life lower and showed significant increase of emotional distress and anxiety. Patients sometimes use denial of terminal diagnosis and of the illness itself is often used to avoid loneliness. Because of the suffering, the social, and the physical constraints of an illness, feelings of emotional isolation and loneliness set in. Many studies have highlighted the role of loneliness in end-of-life situations. The dying person feels that no one can truly understand his situation and no one can imagine what it is to die. This is characterized by a feeling of aloneness and loneliness in the face of death. Secondly, as you head towards death, as a terminally ill patient, you start losing your identity and your sense of self. Consequently, whatever made you a unique person starts to disappear from your life and, as a result the dying person may feel a lack of relatedness with their world. 

This overwhelming loneliness is fuelled by the growing awareness that one may die alone separated from others. The physical limitations and the emotional distress  experienced by these terminally-ill patients actively contribute to the progressive isolation from others and eventually to the loss of social interactions, which leads to profound feelings of loneliness. Interestingly, although the majority of ill people wish that they would die at home, surrounded by family and loved ones, the truth -unfortunately - is that most people die alone, in hospital beds. However, even having social support and being surrounded by loved ones does not always protect against loneliness of the dying. Although the dying may wish to conserve their interpersonal relationships intact, healthy people, by nature will fear death and will ultimately avoid any contact with it or with disease. It is, thus, a difficult task for careers to provide the patient with adequate help and emotional support. The dying often feels that discussing their illness and death is inappropriate with loved ones. As a result, patients feel that they ought to conceal the pain and suffering, while keeping their feelings to themselves. Thus, the ill patient has nowhere to turn to but his mind to face this loneliness. To cope with this loneliness, many terminally-ill patients then retreat into spirituality and faith.