The Terminally Ill and Dying Patient

  • Kurt FritzscheEmail author


In conversations with the terminally ill, it is always noticeable how much these patients hold on to images, wishes, and future perspectives that embody something unreal, utopian, and illusionary for outsiders. It seems like an illusionary misjudgment of reality. This adherence to apparent illusions has a high significance for patients, and an external assessment, from the point of view of an alleged certain reality and so-called common sense, does not do justice to this phenomenon. Whether denial of the incurability of a disease is useful or harmful to the patient is a controversial issue. From a psychoanalytical point of view, the fantasies of inviolability and immortality are regarded as necessities of life. The physician should recognize denial as a protective illusion and avoid forced confrontation with reality. Patients often oscillate between the illusion of immortality and acceptance of the reality of cancer leading to death. The doctor should make the patient feel supported by an empathic relationship to him/her, so he/she is able to at some point let go and find peace.


Dying Palliative medicine Denial Misjudgment of reality Feelings related to dying Empathic conversation 


  1. Back AL, Arnold RM, Baile WF, Fryer-Edwards KA, Alexander SC, Barley GE, et al. Efficacy of communication skills training for giving bad news and discussing transitions to palliative care. Arch Intern Med. 2007;167:453–60.CrossRefGoogle Scholar
  2. Bakitas ML, et al. Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer. JAMA. 2009;302(7):741–9.CrossRefGoogle Scholar
  3. Fallowfield LJ, Jenkins VA, Beveridge HA. Truth may hurt but deceit hurts more: communication in palliative care. Palliate Med. 2002;16:297–303.CrossRefGoogle Scholar
  4. Fallowfield L, Jenkins V. Communicating sad, bad, and difficult news in medicine. Lancet. 2004;363:312–9.CrossRefGoogle Scholar
  5. Freud S. Civilization and its discontents. Oxford, England: Hogarth; 1930.Google Scholar
  6. Freud S. Reflections upon war and death. In: Rieff P, editor. Character and culture. New York: Collier Books; 1963. p. 107.Google Scholar
  7. Saunders C, Sykes N. The management of terminal malignant disease. London: Edward Arnold; 1993.Google Scholar
  8. Singer AE, et al. Symptom trends in the last year of life from 1998 to 2010: a cohort study. Ann Intern Med. 2015;162(3):175–83.CrossRefGoogle Scholar
  9. Temel JS, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. NEJM. 2010;363:733–74.CrossRefGoogle Scholar
  10. Tolstoy L. The death of Ivan Ilyich. UK: Penguin Classics; 2016.Google Scholar
  11. Zimmermann C, et al. Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet. 2014;383:1721–30.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Psychosomatic Medicine and PsychotherapyCenter for Mental Health, Medical Center - University of Freiburg, Faculty of Medicine, University of FreiburgFreiburgGermany

Personalised recommendations