Relief and Guilt After a Loved One's Death

This page is for caregivers who feel both relief and guilt after someone dies of cancer. It explains why the two arrive together, and when grief needs more help.

The relief comes first, sometimes within minutes of the death. Then, close behind it, the thought: what kind of person feels relieved?

That pairing is so common it is close to the standard experience of a caregiver's bereavement. The American Cancer Society lists guilt and relief side by side among normal responses to a death, along with shock, numbness, anger and helplessness. Most people get several at once.

The relief itself is covered more fully in the companion piece on relief as a normal response to a death. What follows here is the other half: the guilt.

Relief feels like a verdict. It seems to say something about how much you loved them, or how willing you were to keep going. It is not a verdict. It is a nervous system registering that a long emergency has ended.

Guilt is doing something else. It tries to hand you back control over an event you never controlled: if the death was your fault, then it was preventable, and a world where deaths are preventable is less frightening than the real one. Guilt is often grief looking for somewhere to stand.

They tend to be the same few scenes, and they tend to start around three in the morning.

• Hospice. We should have called weeks earlier. Or: we called, and it felt like giving up on him.
• Stopping treatment. Maybe one more line of chemotherapy. Maybe the trial in the next state.
• The hospital. We should have taken her in. Or: we should never have taken her in.
• The last conversation. What you said, or did not say, or snapped.
• Not being there. You went home to sleep, and it happened while you were gone.

Each replay presents itself as new evidence. It is the same evidence, run again.

One test is worth applying to every replay: did you know then what you know now?

You decided under uncertainty, with an incomplete picture, exhausted, usually inside a deadline somebody else set. Hindsight supplies the ending, then judges the decision as though the ending had been visible. It was not.

Hospice timing comes up often as a regret. It is rarely as clear in the moment as it looks afterward. Ask the hospice team what would realistically have changed.

NCI's professional bereavement guidance reports that meaningful communication before a death, but not being present at the moment of death, is linked to better outcomes on measures of depression and complicated grief.

If you are punishing yourself over the ten minutes you were out of the room, weigh them against the months you were in it.

Ordinary grief is savage, and it moves. It comes in waves, ambushes you on anniversaries, and slowly loosens its grip. NCI says grief symptoms usually lessen between 6 months and 2 years after a loss, though there is no typical timeline.

Complicated or prolonged grief is different: it does not loosen. NCI describes symptoms that do not improve, last a long time, cause extreme distress and interfere with several areas of life. ACS lists warning signs. They include feeling numb or that the loss is not real, intense sadness with bitterness or anger, trouble enjoying good memories, avoiding reminders, and constantly missing the person or feeling life has no meaning without them. NCI notes that grief lasting 12 months or longer may need clinical attention. If you are stuck, there is no need to wait that long to ask for help.

One more thing worth naming. Disenfranchised grief is grief that the people around you do not treat as a real loss. This can happen because the relationship was difficult, because you were an in-law or an ex, or because everyone assumes a long illness gave you time to prepare. It is harder to carry mostly because it goes unspoken.

• Hospice bereavement services. ACS says hospice benefits often offer grief support for up to 13 months after a loss. Ask the hospice what they offer you
• A grief counselor or therapist — NCI reports that cognitive behavioral therapy helped grief symptoms in research, and that psychotherapy with antidepressants can help when depression is also present
• A bereavement support group, in person or online, through a hospice, hospital or community organization
• Your own doctor, if you are not sleeping or eating

If you are thinking about harming yourself, do not wait for an appointment. Call or text 988 (Suicide and Crisis Lifeline), or call 911. If you are worried about someone else, ACS advises staying with them, calling their doctor, going to the nearest emergency room or urgent care, or calling 911.

For the specific decisions that get replayed most — hospice timing, stopping treatment, whether to admit someone to hospital — there is a separate piece on why caregivers second-guess end-of-life decisions.

• American Cancer Society, Grief and Loss, and Depression and Complicated Grief.
• NCI, Bereavement (PDQ), patient and health professional versions.