Moving Beyond Death Anxiety to Reflections on Mortality

Understandably, no topic is more fraught with denial, anxiety, and avoidance than that of considering one’s mortality. Much of the work on the “good death” has focused on end-of-life or palliative care. For the healthy, it may be considered macabre to contemplate their mortality; it may seem fatalistic, negative, and something that pulls one away from the present joy of living today. Yet, it can also remind us of the inevitable and consider how we want to spend today as well as whatever time we have left.

Defining the good death

A great deal has been written in the psychological literature about successful living. Successful living seems more under one’s control than successful dying. For most, the last day of one’s life is unknown, and how and where it may happen cannot always be dictated. Meier and colleagues (2016), in their examination of qualitative and quantitative peer-reviewed studies (U.S. and globally), described perspectives from the patient and the family. Meier et al., called for public dialogue about successful dying. Their findings may be instructive and meaningful to a broad range of people, even those who are not confronting a terminal illness.

Dying individuals and their families identified preferences for the dying process (i.e., where one died, who was present, how, and when). Pain-free status and emotional well-being (dying at peace) were among the top themes. The dying individual tended to identify religiosity/spirituality as a theme for "the good death" more so than family members. Family members’ view of the good death tended to be more congruent with the dying individual’s desires than with those of health care providers. However, families’ identification of a good death or “successful dying” differed somewhat from that of the patient’s view. That is, family more often reported these themes than the dying relative. For example, family identified life completion (saying goodbye, acceptance of death, having a life well lived); quality of life (ability to live life as usual, having hope, pleasure, gratitude, and a belief that life was worth living); dignity (respect, independence); and presence of family.

Meier et al. underscored that it was the dying individual’s perspective that was important, more so than other-driven definitions. The playwright’s direction to “exit laughing” may be a benchmark for the good death. Palliative care has embraced the viewpoint of allowing for death with dignity and control, and not after suffering from prolonged and debilitating illness. Meier et al. noted that healthcare providers considered the dying process one where the patient passes quietly, not engaging in futile treatment, and highly valuing the patient as having a pain-free status, dignity, and emotional well-being.

Psychological benefits of reflecting on mortality

Is there a benefit for the healthy to contemplate topics such as successful dying and the good death? Considering one’s mortality may provoke anxiety, feel out of step, odd, and even bizarre or taboo. However, as much as we may wish to blanket such considerations in denial, death is an inevitability. Indeed, we live with its shadow cast upon our consciousness.

Death anxiety, originally a Freudian concept, may have forwarded such denial, that we avoid considering mortality to preserve a sense of immortality. There may be a psychological benefit to such considerations and a deepening of meaning in life even when it is not activated by illness or triggered by end-of-life events. Block (2001) described “growth and transcendence” at the end of life as “the art of the possible.” This art of the possible may offer lessons to all of us, whether we are young, middle-aged, old, healthy, or ill. It may forward an integration of awareness and appreciation of one’s mortality and lead us to live in a more present fashion.

Viktor Frankl considered the awareness of death as an existential process that augmented meaning—a primary need for human beings. Although such reflections risk provoking death anxiety, psychoanalyst Erikson (1982) suggested that uncomfortable feelings could also be triggers in the latter stages of adult development toward moving away from despair and into generativity (growth). Erikson and other psychoanalytic and humanistic thinkers suggest that rather than death denial, death awareness can forward authenticity (living aligned with values) and existential truthfulness as opposed to alienation, fear or avoidance-driven states. The existential challenge of such awareness is developing a tolerance for the anxiety provoked by direct reflection on one’s mortality. Existential theorists suggest that purposeful awareness of mortality or death can trigger authentic living, self-awareness that is not distorted by fears, demoralization, or hopelessness.