For some reason, I am very skeptical of a calm acceptance to death.
You'll have to take my word for it -- it surprises me a lot how frequent it is.
I would think anyway that a person would have an acceptance of death after a period of getting used to the idea.
That's generally true. Many such people are elderly (or at least somewhat elderly) and have been aware for many years that they're in the last years of their life. They've also lost spouses, siblings, friends, etc. And when I talk to patients about it some of them are pretty brutally frank -- they say some variant about how they've had a full life and they don't want to deal with painful medical procedures, resuscitations, etc. They sometimes don't even want to bother with diagnostic tests -- in other words if I make some diagnosis like cancer they don't want it pursued or treated.
I think the "getting used to the idea" part may be brought about mostly through a period of pain and promise of relief from that pain.
That's certainly true in some cases, and in fact I've taken care of many young people (even adolescents and school-age kids) who have gotten to that point after years of chronic illness. Life is definitely worse than death for some, and some people know it.
But it's not always the case. I've had a number of patients in their 90s who have been healthy and living independently all their life, then suddenly get diagnosed with some horrible terminal illness. And after the shock wears off, they often develop this calm resignation about it, like they knew it was going to happen at some point anyway.
Well, I'm not sure it's a hypothetical perspective. It's certainly anecdotal, and conversations about this subject are very difficult, very personal, and very heterogeneous. That said, there really are some common threads that merit generalization. And this is a type of conversation that I have several times a week.
I am again very skeptical of acceptance in the instance of death. There is a sheer existential factor that needs to be accounted for.
Some people DO experience that existential conundrum, though it's actually family members of the patient who focus on that more. They try to hang on and hang on unrealistically at times. But some people just never think about such things. It's not that they aren't insightful or have their own kind of wisdom or reflection. It's just that they focus on other things. And it's pretty common!