Chapter 12: Psychological Issues in Advancing and Terminal Illness

Infants and young children typically lack comprehension of death's permanence, viewing it as temporary, while adolescents and young adults face death primarily through accidents and violence, and middle-aged individuals confront mortality through chronic disease onset. Advancing illness presents patients with escalating treatment dilemmas, including decisions about invasive procedures with severe side effects and the emergence of ethical questions surrounding end-of-life autonomy, euthanasia, and physician-assisted dying, prompting many to establish living wills and do-not-resuscitate orders. Elisabeth Kübler-Ross's foundational stage model describes adjustment to dying through denial, anger, bargaining, depression, and acceptance, though contemporary understanding recognizes these responses as non-linear and individually variable rather than fixed sequences. The chapter addresses critical psychological impacts including threats to self-concept from physical deterioration, social withdrawal driven by patients' desire to spare loved ones emotional burden, and pervasive communication breakdowns surrounding mortality discussions. Medical and psychological management emphasizes the importance of clinical thanatology, palliative care through hospice services, and home-based alternatives that prioritize dignity and comfort over cure-focused interventions. Special consideration is given to dying children, who often intuitively recognize their terminal status despite adult efforts at concealment and require therapeutic support to process existential fear. The chapter concludes by addressing bereavement in survivors, explaining that grief produces complex emotional and physiological responses including immune system compromise, and emphasizes the necessity of formal death education to prepare individuals for both personal losses and supportive roles during others' mortality crises.