Facing Death: Living With Life-Threatening

Facing Death: Living with Life-Threatening Illness

The experience of confronting death has serious implications both for those who are diagnosed with a life-threatening illness and the family members who attempt to provide support and compassion during this difficult time. DeSpelder and Strickland (2008) have identified four styles of awareness that are typical of family interactions under these conditions: closed awareness, suspected awareness, mutual pretense, and open awareness. Although these various styles can all contribute, in one way or another, to a gradual acceptance of a family member's imminent death, some are more productive to facilitating discussion than others. Fear of death, and an inability to know how to communicate with those who are dying, can lead family members and friends of those with a life-threatening illness to engage in a pattern of "taboo and avoidance" (DeSpelder, 2008, p. 257). This can result in the patient becoming isolated from social interactions through a kind of "social death" (DeSpelder, 2008, p. 257) which serves only to heighten the patient's sense of alienation and hopelessness.

The work of sociologists Barney Glaser and Anselm Strauss provides us with four styles of awareness that shape our ability to communicate about death. In the closed awareness context, the patient does not know that he or she is dying, although other family members might. A total inability to communicate about the process of death is typical of this style. The suspected awareness context is a style in which the patient believes that he or she might be dying but has not received confirmation from doctors or family members. The sense of secrecy surrounding death often leads to anxiety in family members which further confirms the patient's suspicions. In the mutual pretense context, both the patient and family members are aware that the patient faces a life-threatening illness. Despite this awareness, both parties engage in communication patterns that use unspoken rules and behaviors to imply that the patient will recover and that death is not a possibility. The open awareness context deals most directly with the subject of a patient's imminent death. In this context, the patient and family members provide support to each other by discussing death, illness, and pain in a direct and open manner.

In a family facing life-threatening illness, a closed awareness style would involve a great deal of secrecy. All conversations would have to direct attention away from the prospect of illness and death so as to keep the patient unaware. This would place a great deal of emotional strain on the family members, as they would carry the burden of their knowledge as well as the weight of the secret. The suspected awareness style would be equally difficult, as family members would be placed in the position of perhaps having to actively lie to the patient once they grew suspicious. This would make open and productive communication near-impossible, as there would be a lack of trust on both sides. The conversations in a family operating under a mutual pretense style would involve a complex system of rules and code words all designed to avoid speaking about the illness that all parties are aware of. There would be a great deal of pressure on all family members to not break the agreed-upon silence which could result in individuals retreating from the family unit or becoming angry. The conversations that take place amongst families engaging in the open awareness style are characterized by detailed discussions about the illness, death, and the emotions surrounding these pivotal events. Although the family members and the patient may be just as fearful or upset about death as those families who utilize the other styles of communication, the open awareness style allows for a greater level of mutual support. These awareness styles may change over the course of an illness as the patient and his or her family receive more details about the prognosis from health care providers.