Trends in Death Education Research and Suggestions from a Medical Humanities Perspective

Article information

Keimyung Med J. 2025;44(1):66-73

Publication date (electronic) : 2025 June 13

doi : https://doi.org/10.46308/kmj.2025.00087

Yu-Jin Ku¹, Kyung-Ju Jang^2,3, Jae-Ho Lee^2,3,4, Jae-Hoon Bae^,2,5

¹Secondary Education Research Institute Attached to Teachers College of Kyungpook National University, Daegu, Korea

²Department of Medical Humanities, Keimyung University School of Medicine, Daegu, Korea

³Student Support Center, Keimyung University School of Medicine, Daegu, Korea

⁴Department of Anatomy, Keimyung University School of Medicine, Daegu, Korea

⁵Department of Physiology, Keimyung University School of Medicine, Daegu, Korea

Corresponding Author: Jae-Hoon Bae, MD, PhD Department of Medical Humanities, Keimyung University School of Medicine, 1095 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Korea E-mail: jhbae@dsmc.or.kr

Received 2025 April 16; Revised 2025 May 26; Accepted 2025 June 2.

Abstract

Introduction

Recent news and various media have frequently highlighted major accidents, murders, suicides, and other incidents, exposing individuals to deaths of others either directly or indirectly [1]. These events not only cause individual harm, but also have a psychological and social impact on society as a whole, making discussions and perceptions of death increasingly important. In particular, the 2018 implementation of the “Hospice, Palliative Care, and Life-sustaining Treatment Decision-making Act”, along with the coronavirus disease 2019 (COVID-19) pandemic, has significantly altered the way death is viewed. These developments provided a strong impetus for the movement to discuss and address death [2-4].

In Korean society, aging is often associated with an increasing proximity to death. Death is often viewed as an issue pertaining to elderly or terminally ill patients. Consequently, domestic death education is primarily implemented in social welfare centers and lifelong education institutions as a way to successfully navigate old age through programs such as ‘death education,’ ‘death preparation education,’ and ‘well-dying education’ [5-9]. These programs are provided through an academic foundation that understands and studies death. In contrast, in the field of medical sciences in Korea, death education is primarily focused on ‘hospice palliative care’ and ‘end-of-life care’, and its scope is limited [9]. This narrow focus leaves a gap in providing a comprehensive approach to understanding and preparing for death. Since death affects all age groups, death education should not be restricted to the elderly or patients with incurable diseases. In response to societal demands for public discussion on death, death education requires educational alternatives based on a broader perspective and understanding [1]. In particular, college students, who are in the early stages of adulthood, have limited educational opportunities in this regard and often lack knowledge, awareness, and experience concerning birth and death [9-11].

According to a 2023 statistical survey, over 75% of deaths occur in medical institutions [12]. This reflects the characteristics–a medicalized society–and emphasizes the central role of physicians in the process of dying [9]. Medical students, who are future doctors, will regularly be exposed to the death of others. However, their death education does not differ significantly from that of college students. Their first exposure often occurs through cadaver dissection. While most medical students perceive death education as a mandatory subject, except for a few medical schools where it is offered as an independent course, death education is generally addressed as a part of similar courses in most medical schools [9,13]. This has promoted calls for academic interest and institutional preparation regarding death in medical education [9,13,14].

Recent studies emphasize the importance of death education in medical training, highlighting its influence on medical students’ attitudes toward patients [13-15]. The process of understanding and preparing for death not only helps medical students develop clinical sensitivity toward patients and their families but also contributes to development of medical professionalism. Therefore, providing medical students with education that promotes a deep understanding of death and human dignity can strengthen their professionalism and improve both their quality of life and relationships with patients [14-16].

This study was conducted to provide foundational data for designing death education courses and extracurricular programs in medical schools based on trends in death education research conducted in Korea. It analyzed recent trends in death education research after the COVID-19 pandemic. To explore recent trends in death education research, studies from the past five years were comprehensively analyzed by publication year, publisher, academic journal field, research subjects, research methods, and research approach. It also examined the current status of death education in the medical sciences and proposed future directions for its implementation.

Methods

Data analysis

This study, which was conducted as a literature review, established the analysis elements and coding system for identifying research trends in death education through a theoretical examination, as shown in Table 1. The analysis areas were divided into research characteristics, methods, and approaches, with reference to the analysis patterns of previous trend studies [17,18]. Although the detailed analysis elements varied across different trend studies, these three common analysis areas were used in several studies. The analysis elements for the research approach were based on the study by Lee and Jang [16], which analyzed five approaches to death education proposed by Eddy and Alles [19]: The framework for the analysis was modified and supplemented based on previous research (see Table 1). The 85 final papers were classified and analyzed by publication year, publisher, research subjects, research methods, and research approaches to understand recent research trends.

Table 1.

Analysis framework

An inter-coder agreement procedure was conducted to minimize subjective errors in judgment during the coding process and ensure the validity of the coding system. A random sample of 20% of the analyzed papers was selected, and the coding results were compared with those of a co-researcher, a qualitative researcher with a Ph.D., based on the analysis framework. After coding, the inter-coder agreement rate between the co-researchers was 94.1%, confirming the high reliability of the coding process. Furthermore, for frequency analysis of the results, Microsoft Excel 2019 (Korean version) and a free word cloud visualization tool(wordclouds.com, The Netherlands) were used to present the findings [13].

Results

Overall research trends in death education

Research trends by publication year are shown in terms of paper frequency and percentage (Table 2). The highest number of publications occurred in 2020 with 24 papers (28.2%), followed by 2022 with 20 (23.5%), 2024 with 16 (18.8%), 2021 with 14 (16.5%), and 2023 with 11 (12.9%). These results indicate that a significant number of papers are published annually.

Table 2.

Analysis of research papers by year of publication

Regarding research trends by research subject (Table 3), out of the 85 papers, excluding 25 papers (29.4%) that did not specify their research subjects, college students were the most frequent subject with 19 papers (22.4%), followed by elderly people with 11 papers (12.9%) and children/adolescents with 9 papers (10.6%). Adults were the subjects of 4 papers (4.7%), infants of 3 papers (3.5%), and a mixed group of subjects also accounted for 3 papers (3.5%). Additionally, there were 11 papers (12.9%) categorized as “others,” including 2 papers on social workers, and 1 paper each on hospice team members, well-dying education institutions and instructors, researchers, death education instructors, funeral directors, volunteers, pastors and theologians, prospective teachers, terminally ill patients and their caregivers, and occupational therapists. The field with the most research was education (25 papers, 29.4%; Table 4), followed by humanities (21 papers, 24.7%), interdisciplinary fields (14 papers, 16.5%), and medical sciences (13 papers, 15.3%). Within the humanities, religious studies accounted for seven papers, theology for six, and philosophy for two, with religious studies being the most prevalent in death education.

Table 3.

Analysis of research papers by research subject

Table 4.

Analysis of research papers by academic field

A total of 65 journals were included in the paper-by-journal analysis (see Table 5). The “Korean Journal of Religious Education” had the highest number of papers, with 6 papers (7.1%), followed by “Culture and Convergence” and “Korean Medical Education Review” each with four papers (4.7%).

Table 5.

Analysis of research papers by journal

Regarding the analysis by research method (Table 6), literature review was the most commonly used method, accounting for 41 papers (48.2%). Quantitative research, including statistical analysis through surveys, experimental design methods, and trend studies, comprised 21 papers (24.7%). Qualitative research, including interviews, case studies, and other analytical methods, accounted for 20 papers (23.5%). Mixed methods research, combining two or more approaches such as quantitative, qualitative, or literature review methods, was represented by three papers (3.5%).

Table 6.

Analysis of research papers by research method

When analyzing the research approach (Table 7), the most prevalent approach focused on curriculum and method, accounting for 33 papers (38.8%), followed by philosophical approaches in 13 papers (15.3%), psychological and counseling approaches in 18 papers (21.2%), sociological approaches in 20 papers (23.5%), and medical-legal approaches in 1 paper (1.2%).

Table 7.

Analysis of research papers by research approach

Research trends on death education in the field of medical sciences

Among the studies on death education conducted over the past five years, a detailed analysis of the 13 papers published in journals within the medical sciences field is presented in Fig. 1. Since 2020, more than two papers were published each year over a five-year period.

Fig. 1.

Number of journals published by year in the field of medical sciences.

In the field of medical sciences, the primary research subjects of death education were college students, with six papers focusing on them, followed by two papers on elderly individuals; one study on college students, graduates, and professors; and one mixed-methods study targeting adults aged 19 and above. Additionally, one study each focused on adults and volunteers, and studies without a specific target group (Fig. 2).

Fig. 2.

Number of journals by research subject in the field of medical sciences.

In medical sciences, a word cloud was visualized using 57 keywords presented in 13 papers on death education (Fig. 3). The results revealed that the research topics related to death education were broad and approached from multiple perspectives. The visualized keywords included various core concepts, such as attitudes toward death, community nursing, hospice and palliative care, well-dying, medical education, medical humanities, grief, death identity crisis, and life-sustaining treatment technologies. This indicates that death education plays a significant role in the medical and nursing fields. In particular, educational approaches focused on attitude changes toward death and death preparation have been highlighted as important research topics in the medical sciences [20,21].

Fig. 3.

Keywords of death education research in medical sciences (A), total (B).

Discussion

This study aimed to suggest the direction of death education through an analysis of research trends in the field and lay the foundation for utilizing this as basic research material. The recommendations for death education research in this study are as follows:

First, there is a need for further research on medical-legal approaches. Research on improving well-dying legislation is currently limited to one study [22]. Because legal and ethical issues related to death have emerged as significant social concerns, it is necessary to address these issues in medical education. With rising social interest in issues such as assisted dying, expanding the scope of research on death education from medical and legal perspectives is essential.

Second, the low proportion of research on infants and adults among the research subjects highlights the need to expand research on death education targeting these groups. Prior studies have also noted that the proportion of research involving infants and adults is low [17], which suggests a lack of research on appropriate death education for different age groups. Specifically, death education for infants and adults must reflect their developmental characteristics and psychological needs. Thus, further research on these topics should be promoted [11].

Third, death education research targeting medical students has focused on hospice care and narrative medicine. Medical humanities can compensate for the dehumanization of medicine and communication deficiencies, playing a vital role in building trust between doctors and patients and providing effective treatment and care [15,17]. These studies show that medical students experience educational courses that help them develop attitudes and coping abilities toward death and that methods for effectively integrating death education are evolving. Death education in medical schools should be designed as an independent subject rather than being offered merely as a component of existing courses. Moreover, extracurricular programs that can contribute to graduation outcomes and personal growth of medical students should be developed and provided.

Ultimately, the goal of medical education is to cultivate doctors who are not only skilled in medical procedures but also possess professionalism that enhances physical and psychological trust in patients through communication and support, expanding the scope of care through self-development. Death education can provide the educational benefits of developing healthcare professionals with both professional expertise and human qualities. Through this, medical students can offer genuine care to patients, based on a deep understanding of human life and death.

The limitations of this study are as follows. First, this study analyzed only domestic journals that were indexed or candidates for indexing; however, it is recommended that future research expand the analysis to include international papers and all death education-related search terms.

Second, the study period was limited. As existing research trends were based on 2019 data, this study was limited to the last five years, from 2020 to 2024. Therefore, future studies should set a broader timeframe to analyze changes in research frequency according to evolving research trends and societal changes.

Third, this study sought to derive implications for medical education by examining the overarching research trends in death education. However, this was limited by insufficient availability of relevant data for in-depth analyses. Future studies should place greater emphasis on research specifically related to medical education, and address these limitations through more comprehensive and systematic data collection efforts.

In conclusion, this study analyzed trends in death education research, drawing the following conclusions: Topics within the medical sciences vary, including attitudes toward death, hospice and palliative care, well-dying, medical education, medical humanities, grief, and life-sustaining treatment technologies. These diverse studies demonstrate that death education addresses educational needs that extend beyond factual knowledge about death, encompassing social, cultural, psychological, and ethical aspects. Research on death education for medical students suggests that it can play an important role in shaping attitudes toward death and addressing healthcare and medical ethics issues. The need for death education targeting college students is increasingly emphasized, as helping students understand death and take responsibility for it can have a positive impact on future healthcare settings and social relationships.

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