SOCIAL AND
PSYCHOLOGICAL ASPECTS OF DEATH
Death is increasingly being described in social and psychological terms
as well as legal and ethical ones. According to the World Health Organization, about 52 million people died in 1995. That is about the same number that died 35 years ago, even though the population doubled in that time. More than 17 million people died from infectious diseases. Over 11 million children died before the age of 5, and about 8.4 million of these were under age one; over 22 million people died who were at least age 65. Cancer was responsible for about 6.6 million of the deaths. Standardized death rates per 100,000 population range from a little over 400 in the most developed countries (426 in Sweden is the lowest) to over 2,500 in some of the countries with the poorest health care; the rate in the United States is 505. In developed countries most deaths occur as the result of chronic diseases.
Traditionally death occurred in the home, but the 20th century has seen a shift to more institutionalized and hidden death in hospitals and nursing homes, where family plays a less central role. Since the 1970s, some have challenged this social change, wanting to make dying a more natural and open part of life. This has been furthered by the hospice movement. An idea that originated in the Middle Ages, it was pioneered in modern times by Dame Cicely Saunders, who founded St. Christopher's Hospice in London, England, in 1967. The purpose of a hospice is to provide human, palliative care for the dying, either at home or in settings that are as much like a home as possible. These programs focus on social,
psychological, and spiritual needs as well as medical ones. The majority of hospice
patients are cared for at home by a combination of family members, nurses, and health aides. Hospices serve nearly 500,000 patients per year.
PSYCHOLOGY OF DYING
The Swiss psychiatrist Elisabeth KŸbler-Ross found that many dying patients are comforted if someone listens to their openly expressed fears and thoughts. She observed that many patients, after the shock of learning their condition, go through five psychological stages: denial, anger, bargaining, grieving, and acceptance. Patients may be assisted in reaching acceptance by having health professionals, family, and others openly talking about death.