People whose level of mental retardation is mild may reach the formal operational stage, the stage at which abstract reasoning occurs and people have the ability to think about thinking, to think about the existential self. They would appreciate the universal nature of death and that the same rules applying to all players, even people whom they don't know.
There are few empirical studies that examine the relationships among the constructs of death, cognitive ability, age, and other sociodemographic variables. One intriguing question is whether age affects a person's understanding of death when cognitive ability is held constant. Are people with mental retardation who are old more likely to understand the meaning of death than their younger counterparts? In a well-designed study of 65 mentally retarded adults, Lipe-Goodson and Goebel 7 found that age and, to a lesser extent, IQ were related to understanding the concept of death. It appears that people with mental retardation who are old have a "better" concept of death than their younger counterparts. This is important because it suggests that life experience, as well as cognitive ability, helps us to understand what persons with mental retardation may be thinking and feeling about their mortality or that of someone they care about. Thus, it would seem that opportunities for people with mental retardation to participate in rituals and ceremonies of dying and death may compensate for some of their cognitive limitations.
Mary C. Howell
Hospice is a concept of care. The word comes to us from a medieval institution or way-stations for travelers. In the last several decades