The chapter aims to present the research problem, overview of the research study, and other pertinent information related to the topic. The discussions included in the chapter are further divided into several subsections, which include Introduction to the Problem, Background of the Study, Statement of the Problem, Purpose of the Study, Rationale, Research Questions, Significance of the Study, Definition of Terms, Assumptions and Limitations, Theoretical Framework, and Organization of the Remainder of the Study.
Each of the subsections contributes to the general understanding and justification of the research. Introduction to the Problem Defining the term “death” yields several meanings because of the multiplicity of fields concerned and the variety of perspectives held by people with regard to the term. For example, a biologist would define the term based on the physiological processes that occur before, during, and after death. On the other hand, an anthropologist might explain it according to the cultural beliefs and values that the group attaches to death.
The multiplicity of definitions often associated with the term leads to difficulties in obtaining an all-encompassing and holistic definition of the said term. Nonetheless, several definitions from existing literature are adopted in order to obtain a better understanding of death. First, the journey of life consists of several phases and death forms part of the said phases (Levete, 2010). People possess different beliefs that potentially dictate their decisions as to what stage they place death.
For some, death is considered to be the last stage while others see it as a springboard for another phase in life (Levete, 2010). Second, death is also defined by the 1968 ad hoc committee of the Harvard medical School to be the “irreversible loss of functioning in the entire brain, both the higher centers of the cerebral cortex that are involved in thought and the lower centers of the brain that control basic life processes such as breathing” (Sigelman & Rider, 2005, p. 485).
More so, the committee provided four criteria that would render a person dead, which includes a) absolute unresponsiveness to any stimuli including the most painful kinds, b) absence of movements for one hour and inability to breathe for three minutes without the help of a ventilator, c) exhibit no response, and d) uninterrupted horizontal electroencephalogram (Sigelman & Rider, 2005). The definition provided by the committee relies mainly on biological indicators that allow people to determine whether a person is dead or alive. The concept of death often produces a fear among some individuals (Leadbeater, 1996).
The said fear stems from the uncertainty associated with the events that would happen after death and other beliefs, which includes elements of hell, punishment, and following rules (Leadbeater, 1996). As of the present, there is no scientific theory or tool that allows scientists and researchers to make specific descriptions regarding the experience that a person would have after death. While there are cases heard regarding people who have allegedly resurrected from the dead, its frequency is very low and remains insufficient to prove the kind of events that precede death.
Aside from the feelings of uncertainty, individuals are also affected by the beliefs related to death, which includes ideas related to hell and punishments in afterlife. The perspectives related to hell and punishments in after life, together with other beliefs that aggravate fear of death, is mostly related to culture and religion. The affiliation of individuals to a particular culture or religion leads to different beliefs regarding hell or punishments after death. The fear regarding the experiences related to hell and the punishments would also add to the fear experienced by people because these usually connote pain and suffering.
In terms of demographics, there are studies that indicated a difference between the degree of fear experienced by younger age groups and that experienced by the elderly (Cicirelli, 2002). Based on these studies, the relationship between age and fear of death is inversely proportional (Cicirelli, 2002). The findings show that the younger people express a greater amount of fear in comparison to the fear expressed by the elderly. Nonetheless, the “Fear of the Unknown,” which is related to the feeling of uncertainty with regard to death, remains directly proportional with the variable of age (Cicirelli, 2002).
The said relationship between the two variables means that the younger people have lesser fear regarding the unknown, while the elderly have greater fears related to such variable. Background of the Study The hospice is home to patients who are terminally ill or are in the last stages of their lives. In the United States, hospices are more commonly seen from two perspectives. First, hospices serve as sources of profit for entrepreneurs (Bushfield & Deford, 2009). The said institution serves as a center that provides care needed by patients in exchange for a fee.
Certifications and partnerships with medical institutions sometimes exist where hospitals seek the help of hospice care providers for their terminally ill patients. Second, hospices are also regarded as “medical care delivery systems” (Bushfield & Deford, 2009, p. 7). The primary purpose of the hospice care institution is to provide patients with a place that can be considered as “home” and receive all of the health services they need prior to their death (Bushfield & Deford, 2009). The estimates in 2006 show that 36% of patients who died in the United States happened to be under the care of hospice institutions (Bushfield & Deford, 2009).
It is worthy to note that the current landscape in the said hospice institutions is composed mostly of elderly patients with around 85,900 in the year 2000 (Vierck & Hodges, 2003). In addition, the 2000 sex ratio of hospice patients shows that there are more males than females (Vierck & Hodges, 2003). The present study investigates the phenomenon of fear in relation to death among hospice patients. More specifically, the researcher takes gender differences into consideration. Previous studies, as mentioned in the preceding paragraph, evaluated fear of death in relation to the variable of age.
Based on the said research studies, there is an inversely proportional relationship between age and fear of death. A related study on the attitude of individual towards death show that there is no difference between the perspectives of patients from hospice programs from those who reside within community dwellings (Tomer, Eliason, & Wong, 2007). However, there is little understanding of how it differs among male and female hospice patients. In terms of gender differences, male and female individuals are known to have several differences in terms of emotional, mental, and physical aspects (Osborne, 1970).
Williams and Dunn (2008) have included a discussion regarding the difference between the male and female brains and the implications of such differences. The male brain are characterized in the following terms: more area of the cortex for spatial-mechanical functions, boredom shuts down the brain, the corpus callosum develops at a different rate…, the male brain tends to compartmentalize and focus, and if the frontal lobe is not fully developed yet, the male brain will be more susceptible to responding emotionally through the amygdale. (Williams & Dunn, 2008, p. 20).
As a result, the males are more likely to focus on single tasks, are responsive through visual stimuli, require connections between objects to be clear, and are more adept to action-related activities (Williams & Dunn, 2008). On the other hand, the female brain is more likely to stay active despite boredom, has a prefrontal cortex that is comparably more active than men, possesses a cortex that leans more on emotional and verbal processes, has frontal lobes that mature earlier than that of the male brain, and a greater degree of connection between the two hemispheres that results to multitasking abilities (Williams & Dunn, 2008).
In relation to these characteristics, the females are more likely to respond to verbal and emotional stimuli, have the ability to concentrate to tasks, have lesser difficulties in multitasking and task-shifting, express greater attention to a variety of topics, and have lesser impulsivity (Williams & Dunn, 2008). However, there is a contrasting comment in relation to rationality of male and female individuals, as cited in Altman, Ivry, Wolfson, and Arkush (1998), which states that “…in the case of the faculty of sense, the faculty of representation and the faculty of reason, male and female do not differ” (p.
114). In terms of fear and anxiety related to death, there are differences found in relation to the variable of gender. According to Nussbaum (2000), women possess a greater ability to accept death in comparison to men, who actually see death as an adversary. The finding is related to the expected social role for men, which is to earn and provide for the entire family, and the anticipated absence of a person who can be responsible for the said role (Nussbaum, 2000). A similar finding is stated in Tomer, Eliason, and Wong (2007) but showed that women express a more powerful emotion related to fear of death.
The said fear stems from the loss of social character and self (Tomer, Eliason, & Wong, 2007). A variety of discussions currently exist in relation to gender differences in relation to fear of death but there are several contradictions as to whether it is the men who possess a greater degree of fear or the women (Neimeyer, 1994). However, the findings of recent research studies have shown that there is indeed a higher level of fear among women (Bryant, 2003; Neimeyer, 1994). Based on the findings shown above, the present research study aimed at clarifying whether gender difference does exist in among patients in the hospices.
The existing differences between the two genders have led to different characteristics and impact to the male and females. The impact of the said differences on the fear of death proves to be an interesting topic. Statement of the Problem The research study deals with determining and evaluating the impact of gender differences to fear of death among hospice patients. The hospice program is known to be a place where the medical and personal needs of the patients are fulfilled during the last days of their lives. The setting and the condition of the patients are taken into consideration because of their vulnerability to the topic of death.
Purpose of the Study The primary purpose of the study is to pinpoint the gender differences in relation to fear of death among hospice patients and to consequently identify the relationship between the two variables. More specifically, it unravels the perceptions and fear of the male and female hospice patients in relation to death. In so doing, the researcher is also able to fulfill the objective of obtaining an understanding of the general fear exhibited by the patients towards death at this certain stage in their lives.
The findings of the study are expected to contribute to the understanding of gender differences, especially in specific instances that relates to their condition, and contribute to the existing body of knowledge with regard to the topic. In addition to this, the study also serves the following purposes: 1. To serve as the basis for future researches regarding gender differences with specific reference to patients under a hospice care program; 2. To identify the specific areas of difference among the male and female patients when it comes to the fear of death; 3.
To enrich the discussions related to the fear of death and gender differences; and 4. To serve as a guide for patient care and understanding in the hospices. Rationale of the Study The study places focus on the topic of gender differences, which is an issue that has been reviewed several times in the past. However, the specific emphasis on the experience of hospice patients provides ample justification for the conduct of the study. In this study, the medical conditions and experiences of the hospice patients are considered factors that bring them closer to the concept of death.
The said particular stage often elicits a different response in terms of fear among individuals of different age and genders. Nonetheless, the researcher wanted to bring forth and highlight the specific experiences of male and female patients in hospice programs, regardless of age, in order to identify the significant differences between the two groups of respondents. The identification of such differences enables the researcher to identify its relationship with the concept of death. In relation to this, the study serves as a two-fold guide for professionals and academicians from the fields of natural sciences and social sciences.
First, it provides knowledge in relation to the specific needs of male and female individuals in relation to the fear that they are experiencing, if any, towards death at their particular stage. With its specific focus on the male and female genders, it also sheds light into the different medical attention and requirements of the male and female patients. In addition to this, the present study can be a springboard for understanding whether fear affects the medical symptoms of the patients and vice-versa.
Second, it contributes to the specific discussions that attempt to distinguish the differences between fear of death among male and female patients in the hospice institutions in relation to their genders. Several researchers have focused in unraveling the particular differences between the two genders in terms of the biological, social, emotional, psychological, religious, and other aspects. Debates have also spurred as to whether these differences indeed exist based on the understanding of authorities in different fields.
In addition, knowledge of the differences among male and female individuals has also been studied based on a variety of experiences and the difference among the response of individuals coming from the two groups. However, the distinctive differences between the male and female patients and their fear of death received less attention during the past years. Conducting a study that focuses on this particular group of respondents, in relation to the fear of death, results to an updated understanding of the gender differences among the responses of the patients.
The said knowledge can be used for a variety of purposes that ranges from enriching the debate in gender differences up to serving as a guide for the purpose of identifying the applicable courses of action in relation to the needs of the said group. Research Questions In relation to the research problem of this study, the researcher aims to answer the following specific questions: 1. To what extent do gender differences within Hospice patients exist with respect to fear of death? 2. What is the perception of the male and female hospice patients regarding death? 3.
What is the level of fear expressed by the male and female hospice patients in relation to death? 4. What are the known differences in relation to the fear expressed by the male and female hospice patients? 5. What are the known differences in relation to the perceptions of male and female patients regarding death? 6. What is/are the response/s of male and female patients when confronted with the concept of death? 7. Based on the perspective of the male and female patients, does their medical condition contribute to their fear of death? Significance of the Study
The findings of the study serve different populations: academicians, policy-makers in hospice institutions, health care professionals, and the patients themselves. First, the academicians from different fields of study would gain better insights in relation to the social and medical implications of the study. The findings of the study can be used as a springboard for similar or related studies in order to bring clarity to the issue. Likewise, it can also serve as a reference for discussions related to gender differences, fear of death, and hospice patients.
Second, the findings are also of benefit to the policy-makers in hospice institutions. As mentioned earlier, the hospices serve the purpose of providing patients with a place they can call home during the last few days of their lives. The particular condition of the patients and the critical role of the hospice in their medical needs require policies that are holistic in approach with the purpose of addressing all the needs of the patients. In relation to this, the information taken from the study helps policy-makers identify additional areas where services can be improved or added.
For example, the hospices can include or enhance existing therapies implemented for aiding anxiety problems among the patients. Likewise, the results of the study can be used for the purpose of initiating programs and other services that are not yet in existence. For example, the hospice can introduce new programs and activities that would address the fear of patients towards death. To make it more specific, the activities should target fear in relation to the patients’ genders.
Consequently, the policy-makers of the hospice institutions could initiate relevant studies on whether there is a relationship between the gender of the hospice patients and their health care needs. In so doing, the institution is able to provide services that are geared towards integrating gender characteristics and needs into the program. However, the policy-makers should be reminded that the consideration given towards gender should not be used to segregate and place one group at a disadvantageous position.
Rather, it should serve as a bridge that connects the gaps between the two groups and a means of addressing gender-specific needs. Third, the results of the study are also of help to health care professionals. The information gathered can be used as a guide in understanding and addressing the medical needs of the hospice patients, especially for those who engage in the direct delivery of services for the patients. In relation to service delivery, the health care professionals would better understand the specific needs of the patients and address these properly.
Also, the health care professionals would also be able to pinpoint specific needs related to a particular gender when addressing anxiety and other related medical needs. In addition to this, it could also possibly lead to new changes in terms of standards and requirements in the delivery of services for hospice patients. Lastly, the findings of the present study serve the welfare of the patients by allowing them to understand their perceptions and fear in relation to death. In so doing, the patients are well-informed of the stage they are going through and the differences between their experiences based on their gender.
By being properly informed of their conditions, the patients can communicate with their health care providers in terms of their needs and become more open with their experiences. Definition of Terms The following terms are defined for the purpose of the present study: DEATH – the “irreversible loss of functioning in the entire brain, both the higher centers of the cerebral cortex that are involved in thought and the lower centers of the brain that control basic life processes such as breathing” (Sigelman & Rider, 2005, p. 485).
FEAR OF DEATH – otherwise known as thantophobia, is the anxiety or concern expressed by the patients regarding death and its dangers. GENDER – is considered as a “social structure” and refers to the practices and activities engaged in by an individual in relation to the expectations of the society (Connell, 2009, p. 10). GENDER DIFFERENCES – the perceived and observed differences between the male and female respondents. HOSPICE – profit-serving institutions that also act as “medical care delivery systems” for terminally-ill patients (Bushfield & Deford, 2009, p. 7).
HOSPICE PATIENTS – individuals who receive medical treatments under a hospice program. TERMINALLY-ILL – the condition of a patient wherein he/she gradually progresses to death. Assumptions and Limitations The study takes several assumptions into consideration. First, the common denominator shared by the patients is their vulnerability and risk related to death. The researcher treats all respondents as terminally-ill patients and does not place any regard for the differences in medical illnesses. While some may have a higher level of risk compared to the others, all of them are simply categorized as “terminally-ill” at the period of the study.
Second, the researcher also assumes that the respondents have provided correct and sufficient data in the data-gathering instruments used for the study. Despite their medical conditions, the respondents are considered fit to supply the needed information in the instruments used for the research. In addition to this, the following serve as the limitations of the study: 1. The data is applicable to patients from the hospice institutions only and cannot be used to conclude for patients in other areas. 2. The study is applicable for patients who are only terminally-ill and does not include patients who are under different medical conditions.
3. The study does not provide for age-specific conditions because it is focused on gender and existence in the hospice institutions. 4. The study does not include information related to the specific medical conditions of the patients in relation to their fear of death. Theoretical Framework The study is guided by the terror management theory as its theoretical framework. The terror management theory is a perspective that emerged during the 1990s (Weiten, Lloyd, Dunn, & Hammer, 2009). The said theory attempts to discuss the people’s awareness of death and need for self-preservation (Weiten et al. , 2009).
Figure 1. Terror Management Theory Source: Weiten, W. , Lloyd, M. , Dunn, S. , & Hammer, E. (2009). Psychology applied to modern life: Adjustment in the 21st century. Belmont, CA: Wadsworth Cengage Learning. Based on Figure 1 above, there are two important elements that serve as the starting point of the terror management theory, which are the awareness of the inevitability of death and self-preservation instinct. The said elements are related to the fear of people towards the potential for death-related anxiety and terror.
The possibility of anxiety and terror caused by death leads people to have the need to enhance feelings of self-esteem and the need to defend the cultural worldview. Based on the theory, the two needs previously mentioned form an anxiety buffer that serves to counteract for the death-related anxiety and terror. The present study also depends on the interrelationships between the several variables in the terror management theory in order to provide a theoretical framework for understanding the results of the study.
The patients are known to harbor feelings of their instinct towards self-preservation and their awareness of the increased possibility that death could happen. The researcher is bounded by the fact that the patients are ruled by their increased risk towards death and an even higher need for self-preservation. The researcher would have to introduce gender differences based on the elements of self preservation, awareness of death, need to defend cultural worldview, and need to enhance feelings of self-esteem. Organization of the Remainder of the Study
The entire study is divided into different chapters based on the standard outline found for similar research studies. The said chapters are numbered chronologically and are labeled Introduction, Review of Related Literature, Methodology, Analysis of Findings and Discussions, and Summary, Conclusions, and Recommendations. Each of the chapters mentioned has its own purpose and contains relevant information based on its primary aim. In addition to this, each of the said chapters is also divided into different subsections to achieve a coherent and organized flow of discussion.
Chapter 1, also referred to as the Introduction Chapter, contains background information related to the topic. It also informs the readers of the importance and theoretical framework used to understand the particular phenomenon being studied. To a certain extent, it equips the readers with the needed knowledge in order to grasp what the research is all about. Chapter 2, otherwise known as the Review of Related Literature, serves as a compilation of information found in other sources in relation to the topic.
The Review of Related Literature provides a discussion on what is already known about the topic and also identifies the gaps found in the existing literature. Aside from these, the chapter also informs the readers of the existing information that could be used in interpreting and analyzing the study. Chapter 3, also known as the Methodology, provides discussions regarding the specific approach implemented by the researcher in order to gather the needed data for the study. Likewise, it includes relevant information regarding the tools and paradigm that guided the researcher in the data-gathering process.
Specific details are provided in order to justify the need for the approach and tools used by the researcher. Lastly, sufficient information is also provided in relation to the validity and ethical considerations of the data-gathering process. Chapter 4, which refers to the Analysis of Findings and Discussions, presents that information gathered by the researcher. In this chapter, the data is analyzed and tied back to the literature discussed in Chapter 2. The researcher also answers the specific research questions and research problem stated in Chapter 1 through the data gathered from the respondents.
Chapter 5, the last chapter, is dedicated to the Summary, Conclusions, and Recommendations of the researcher in relation to the problem. The chapter includes information that wraps up the discussions made in the different chapters. More specifically, it contains a summary of the findings and the conclusion that can be derived from the study. In the end, it also contains the recommendations suggested by the researcher for future studies and for the actors involved in providing care for hospice patients. References Altman, A. , Ivry, A. , Wolfson, E., & Arkush, A. (1998).
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