Anticipating Death: The Experience of Anticipating Death of Self in Healthy Later Life

Anticipating Death:

THE EXPERIENCE OF ANTICIPATING DEATH OF SELF

IN HEALTHY LATER LIFE

by

Jennifer B. Ghent-Fuller, RN, BA, BScN, MScN

Copyright 1996 by Jennifer Ghent-Fuller.

Smashwords Edition 2014

ISBN 978-0-9881678-4-1

License Notes: Thank you for downloading this book. You are welcome to share it with your friends. This book may be reproduced, copied and distributed for non-commercial purposes, providing the book remains in complete original form. Small sections may be quoted by other authors with attribution. Other books by this author are available at your favourite retailer.

This book was submitted as a thesis in partial fulfillment of the requirements for the degree of Master of Science in Nursing, Faculty of Graduate Studies, The University of Western Ontario, London, Ontario, Canada, September 1996.

NOTE CONCERNING THIS EDITION (2014)

In order to make this work suitable for any audience, some changes in the order have been made since it was first published in 1996 in hard copy as a Master's Thesis. The chapter on 'Findings' has been moved so it is immediately after the 'Table of Contents' and 'Abstract'. The 'Certificate of Examination', 'Dedication', 'Acknowledgements', 'List of Appendices' and 'List of Figures' have been moved from the beginning to near the end. The contents of the former 'Appendix G: Additional Supportive Quotes' have been distributed into the relevant sections of the first chapter on 'Findings.' The 'Vita' section has been replaced by a section entitled 'About the Author.' Otherwise, the text of the original Master's Thesis is unchanged.

ABSTRACT

The purpose of this study was to illuminate insights of the anticipation of death of self in healthy later life, in order to enhance nurses’ understanding of older clients. An interpretive phenomenological methodology was used to gather and analyze interview data from a purposefully selected sample of four male and four female older adults. Findings describe the participants’ experience of the anticipation of death of self in later life as an on-going process of creating readiness and achieving purpose related to their future death. Participants both reflected and projected their thoughts and activities in five spheres of being: internal being; existence in the world as a solitary being; relationships with other individuals; existence in the world as a part of humankind; and existence after death. The growing proportion of the population which is aged is increasingly older and in need of health care, and furthermore, is being asked to do advance planning for death. In order for health professionals to assist and support older persons undertaking this and other challenges of aging, a deeper understanding of the issue of anticipation of death of self for older clients is necessary.

TABLE OF CONTENTS

ABSTRACT

CHAPTER ONE - FINDINGS

1. The Nature of Reflecting and Projecting

2. The Spheres of Being

3. Creating Readiness

(a) Creating Readiness in the Internal Sphere

(i) Accepting the Inevitability of Death

(ii) Identifying Satisfaction with Life

(iii) Preparing for Death

(iv) Acknowledging Concerns for Future Personal Condition

(v) Responding to Concerns

(b) Creating Readiness in the Sphere of Existence in the Physical World as a Solitary Being

(c) Creating Readiness in the Sphere of Relationships with other Individuals

(i) Perceiving the Impact on Relationships

(ii) Communicating Within Relationships about Creating Readiness

(iii) Anticipating Comforts from Relationships at the Point of Dying

(d) Creating Readiness in the Sphere of Existence in the World as a Part of Humankind

(e) Creating Readiness in the Sphere of Existence after Death

4. Achieving Purpose

(a) Achieving Purpose in the Internal Sphere

(b) Achieving Purpose in the Sphere of Existence in the World as a Solitary Being

(c) Achieving Purpose in the Sphere of Relationships

(d) Achieving Purpose in the Sphere of Existence in the World as a Part of Humankind

(e) Achieving Purpose in the Sphere of Existence after Death

5. The Holistic Experience of Anticipating Death of Self in Healthy Later Life

6. Summary

CHAPTER TWO - OUTLINE OF THE PROBLEM

1. Background and Significance

2. Statement of the Problem

3. Study Purpose

4. Research Question

CHAPTER THREE - LITERATURE REVIEW

1. Earliest Work

2. Study of the Contemplation of Death as Abnormal Thought

3. Study of the Contemplation of Death as Anxiety or Fear

4. Studies Relating Level of Death Anxiety to Other Attitudes or Personality Characteristics

5. Study of Contemplation of Death as Disinterest

6. Contemplation of Death as Awareness of Finitude

7. Death as Defined by the Individual

8. Summary

CHAPTER FOUR - METHODOLOGY

1. Overview of the Methodology

2. Sampling

3. Data Collection Method

4. Analysis and Interpretation

5. Protection of Human Rights

6. Declaration of Self in Front of the Text

7. Validity and Trustworthiness

8. Summary

CHAPTER FIVE - DISCUSSION

1. Relation of the Findings to Previous Literature on the Anticipation of Death in Healthy Later Life

2. Implications for Nursing Education

3. Implications for Nursing Practice

4. Implications for Future Research

5. Conclusion

APPENDIX A: Letter of Information

APPENDIX B: Letter of Introduction

APPENDIX C: Notice of Participation Decision

APPENDIX D: General Interview Guide

APPENDIX E: Personal History Sheet

APPENDIX F: Certificate of Approval of Human Research

APPENDIX G: Certificate of Examination

REFERENCES

DEDICATION

ACKNOWLEDGEMENTS

ABOUT THE AUTHOR

Figure 1:The Anticipation of Death of Self in Healthy Later Life: Creating Readiness and Achieving Purpose in the Context of Five Spheres of Being

CHAPTER ONE: FINDINGS

The healthy older adults in this study were in the process of integrating the experience of anticipating their future death into their concept of self. Two major process themes encompassed the experience of integrating anticipated future death into self-concept: creating readiness and achieving purpose. The experience of anticipating future death was portrayed in five different spheres of being. These five spheres of being were: their internal being; their existence in the physical world as solitary beings; their relationships with other individuals; their existence in the world as part of humankind; and their existence after death.

This chapter outlines the experience of the participants as they portrayed it and describes how experience of anticipation of death of self is best understood through integration of the process themes of creating readiness and achieving purpose throughout five spheres of being. The five spheres of being represent different mental projections of the self into the world, and the final mental projection of the self out of the world. Quotations from the interviews were included to illustrate the themes. Additional supportive quotes are found at the end of most sections.

1. The Nature of Reflecting and Projecting

The nature of reflecting on the thoughts of their own future death, or future non-existence in the sphere of internal life, was described by three participants as often being fleeting, or flashing:

It's a fleeting thought that goes through your mind, that I don't have as many years to life, life is shorter, I don't have as much time to do these things.

One of these participants described his reflection of such fleeting thoughts as being fairly frequent:

Um, I suppose, to be honest, um, in just a very fleeting way you might think of this almost every day, uh, you know certainly several times a week. I'm at the stage now, where the first thing I turn to in the paper will be the obituaries (little laugh), because, to be conversant, I want to know what has happened to people that I know. And uh, I'm sure that's a sign of age, of the stage you're at.

The participants described various situations in which these fleeting thoughts occurred. The commonality for these situations was that such fleeting thoughts occurred during moments of solitary reflection when the participants were not actively engaged in interchange at the time the thoughts surfaced, as illustrated by one participant:

Now, all sorts of things will impinge, the telephone will ring or there'll be ... you know, so that you uh.. In the 20th century, or the end of the 20th century, I think we often don't have much time alone by ourselves, or we don't allow ourselves to be alone, which is a shame.

Two participants described a type of reflection that was longer and that was related to experience in relationships, as follows:

Well, I think very often um, one can say, I just want to get on sort of with what I'm doing now and you just push it out of your mind. And whereas, and, you know, you don't want to be morose about it, um. So, but, there are other times when you do think about it more fully if you go to a funeral of a good friend, or something like that. Or that period, where there is someone in your close circle of family or friends, who is ill, well then this will surface more.

Another participant related longer reflection which was triggered by his experience of autumn:

There are times that I'm driving along. You drive along through the fall and I suppose metaphorically you realize that you're sort of in that stage of life and everything is changing, and then the leaves eventually drop off and then so will you.

Three participants described brief or fleeting mental projections of anticipation of their own death into their conversations with their children (see Section 3 (ii)). However, most of the projecting described herein reflected integrative thought of long duration, as evidenced by participants referring to how they used to think, or how their thoughts had changed over the years.

In this introductory section, both fleeting and continuing prolonged reflecting and projecting, which the participants related, was described. For five of the eight participants, the relating of their experience of anticipating death of self included either fleeting reflections on their own future death or fleeting projections of their own future death into their spheres of being. Two of the participants initially stated that they did not ever think about their own death, and then went on to describe their fleeting thoughts. This commonly identified fleeting nature of reflections and conversations about death of self was an unexpected and interesting phenomenon.

Additional Supportive Quotes: Re:. The Nature of Reflecting and Projecting

1. Well, since I'm healthy I don't even think about it now. I honestly don't. Oh, maybe it might flash through my mind that I'm not going to be here forever.

2. Researcher: How often do you think about your own future death, how often does that enter your mind?

Participant: Well, very often lately, because of circumstances.[Her sister had died two months previously]. As I stood there in front of that packed church, giving that eulogy, I knew that most of them knew our family background. Uh, our mother had such a high cholesterol, she was used as a guinea pig years ago at Sunnybrook hospital and was glad to do it because she lived for about nine years after her first heart attack, so that, uh, and my father had died of that, and my sister apparently was loaded with cholesterol and I felt that uh, that people were looking at me standing there, and that I might self-destruct right there, and I began to, I was worried that with a family history like that I know that's very, you know, your family that you come from and their medical problems are a good part of it, so I uh, I came home and her doctor who was the head of cardiology at TGH, the Toronto Hospital then, uh, was concerned about me and she put me in touch with a doctor here who trained there at Toronto Hospital, and I went for tests. I was concerned, I thought, you know, another couple of years and I'm gone.

3. You know, that you've hit 65; this is the age where most people retire, and so therefore this is the right time for you to say, OK, let's bring this to an end, and then you look at the other things that you