We have now reached the end of the lifespan. While it is true that death occurs more commonly at the later stages of age, death can occur at any point in the life cycle. Death is a deeply personal experience evoking many different reactions, emotions, and perceptions.

“Everything has to die,” he told her during a telephone conversation.  “I want you to know how much I have enjoyed being with you, having you as my friend, and confident and what a good father you have been to me.  Thank you so much.” she told him.  “You are entirely welcome.” he replied.  He had known for years that smoking will eventually kill him.  But he never expected that lung cancer would take his life so quickly or be so painful.  A diagnosis in late summer was followed with radiation and chemotherapy during which time there were moments of hope interspersed with discussions about where his wife might want to live after his death and whether or not he would have a blood count adequate to let him proceed with his next treatment.  Hope and despair exist side by side.  After a few months, depression and quiet sadness preoccupied him although he was always willing to relieve others by reporting that he ‘felt a little better’ if they asked.  He returned home in January after one of his many hospital stays and soon grew worse.  Back in the hospital, he was told of possible treatment options to delay his death.  He asked his family members what they wanted him to do and then announced that he wanted to go home.  He was ready to die.  He returned home.  Sitting in his favorite chair and being fed his favorite food gave way to lying in the hospital bed in his room and rejecting all food.  Eyes closed and no longer talking, he surprised everyone by joining in and singing “Happy birthday” to his wife, son, and daughter-in-law who all had birthdays close together.  A pearl necklace he had purchased 2 months earlier in case he died before his wife’s birthday was retrieved and she told him how proud she would be as she wore it.  He kissed her once and then again as she said goodbye.  He died a few days later (Overstreet).

Except for a handful of illnesses in which death does often quickly follow diagnosis, or in the case of accidents or trauma, most deaths come after a lengthy period of chronic illness or frailty (Institute of Medicine (IOM), 2015). A dying process that allows an individual to make choices about treatment, to say goodbyes and to take care of final arrangements is what many people hope for.  Such a death might be considered a “good death.”  But of course, many deaths do not occur in this way. While modern medicine and better living conditions have led to a rise in life expectancy around the world, death will still be the inevitable final chapter of our lives.

Not all deaths include such a dialogue with family members or being able to die in familiar surroundings.  People die suddenly and alone.  People leave home and never return.  Children precede parents in death; wives precede husbands, and the homeless are bereaved by strangers. In this chapter, we will look at death and dying, grief and bereavement, palliative care, and hospice to better understand these last stages of life.