THE BLOG

The End-of-Life Paradox

05/07/2011 10:57 am 10:57:30 | Updated Nov 17, 2011

It seems that whenever Marian visits her dad, he wants to go over certain things: where his will is located, where to find his stocks and bank book, and even where to find the charcoal suit that he wants used when he is laid out in his casket. To Marian, such conversations are morbid, distressing and perplexing. At 82, her father is relatively healthy, independent and maintains an active life. Why does he always seem to focus on death -- especially when she is around?

Often adult children experience what I call this end-of-life paradox. Their older parents want to speak about the logistics of death in detail. Or, maybe they want to review end-of-life care plans contained in advance directives, just at the time when it is most difficult emotionally and spiritually for their adult child to listen to such conversations.

The end-of-life paradox results from the different places the generations are in their own spiritual development and how each makes sense both of life and death. Older persons recognize that even if they are active and healthy, they are nearing the end point of life. Victor Marshall, a sociologist, used the term "awareness of finitude" to describe the appreciation for the life cycle that older people may exhibit. Death is perceived as closer. This does not mean that they expect to die immediately, but rather that they realize that death is part of life. They are reluctant to plan too far into the future. Time is now primarily viewed through the past or in a curtailed vision of the future. You can often hear it in the subtle shifts in language. My mom, for example, was in good health but older when she began to say to my son, as he planned his marriage, "Hope I'm around to enjoy your wedding day!" At the time, she expressed this hope without fear or anxiety.

The awareness of finitude also often engenders a concern with a good, appropriate death. This means that the person wants to die in a way consistent with their values, wishes or earlier life. For one person, this may mean dying in peace -- pain-free and reconciled with others. To another, it may mean fighting with the fates, or others, until the very end. As individuals contemplate that death, they may want to share that information with others around them. On a practical level, that might mean that older persons are intent on instructing their adult children about their estate, advance directives, and even their wishes about funerals and other rituals.

Adults in the middle of life are in a different place developmentally. They are often struggling with an "awareness of mortality." This means that they are moving from the childhood acknowledgment that "people die" to a much more personal recognition that someday they, too, will die. In middle life, the awareness of time is like a Janus Mask -- looking both forward to the decades yet to live and also backward toward the time already used. The normal process of aging, as well as the deaths and illnesses of peers, contributes to this understanding. A major prompt to this painful struggle is the death of parents.

Yet the discussion suggests that this may create a paradoxical situation: As older adults may need to address the issues of their death, middle-aged children struggling with their own awareness of mortality may be deeply threatened by their parents' death and hence avoid such discussion. That same paradox may trouble adult children's end-of-life decision making as they confront the death of an older parent. Only by addressing these issues together can both generations meet their developmental needs.