Death, loss and grief are fundamental and profound aspects of the human experience that have long been a long and contested construct (Blakemore and Jennett, 2001). Nevertheless, death tends to be a topic of conversation that is avoided – even feared – because most people have never been with a dying person or know what to expect (Mannix, 2018).
On inspection, we and our students have found that the taboo related to death and dying extends to most physiology textbooks – the basic reference texts for student healthcare professionals (Brown, 2022). Searches using key words like “death”, “dying” and “mortality” yield few or no results in their indexes, while “apoptosis” and “necrosis” yield detailed information about cellular death. Similarly, searches of curriculum documentation using the same terms yielded expectations of student knowledge and understanding of “end of life care”, “palliative care” and death certification. The data show clearly that there is a void in explanation of physiological mechanisms that underpin the changes that the human body normally goes through at the end of life.
We are our bodies. Just as conception, pregnancy and birth mark the beginning of a person’s life, dying is a physiological process with recognisable stages of progression leading to the final stage when vital activities of living cease. The trajectory of each unique death depends on whether death is brought about by old age, malnutrition, dehydration, major trauma or terminal injury like suicide or drowning. However, textbook explanations of clinical signs such as Cheyne-Stokes breathing, Cushing’s triad or “death rattle” do little to explain what a dying human body is actually experiencing.
We designed a workshop based around selected video clips from James Bond movies and core physiological concepts (Michael and McFarland, 2020) to enable students to learn about and discuss fundamental mechanisms that normally precede a person’s death. Trigger warnings were used in advance and at the start to help to prepare students ahead of the sessions, reduce anxiety and promote feelings of safety within the groups.
The workshop was structured around activities designed to help students to recognise the physiological changes that are characteristic of loss of essential characteristics of cellular homeostasis which in turn leads to failure of body organs as the person approaches the end of life. Breakout discussions enabled students to share their ideas about death as an integral part of the human life cycle as well as some of the social aspects related to own culture.
Feedback from the pilot sessions has been remarkably positive.
Although there is little published literature addressing the effectiveness of learning about death and dying, some studies about psychological training have shown promising results (Siverdale and Katz, 2005; Weaver, Balkan and Decker, 2022). We share our thoughts about why sound understanding of core physiological concepts relevant for death and dying has the potential to reduce anxiety and help student healthcare professionals to be better equipped to communicate appropriately with dying and bereaved people.