Presentation on theme: "Chapter 19 Death, Dying, and Bereavement"— Presentation transcript:
1Chapter 19 Death, Dying, and Bereavement Today, most people in industrialized nations die in hospitals.For 20% of people, death is a gentle and relatively painless process. For the rest, it is not.An adult brain starved of oxygen for 2 to 4 minutes or more is irreversibly damaged.More people have long and drawn out deaths today than in the past because of medicaion and medical technology.
2Phases of Dying Agonal phase Clinical death Mortality Gasps and muscle spasms during first moments in which regular heartbeat disintegratesClinical deathInterval in which heartbeat, circulation, breathing, brain functioning stop, but resuscitation still possibleMortalityPermanent death
3Persistent vegetative state Defining DeathBrain deathirreversible cessation of all activity in brain and brain stemstandard for death in most industrialized nationsPersistent vegetative statecerebral cortex no longer registers electrical activitybrain stem remains activeThe use of brain death as the definition of death may not be sufficient. For example, it does not tell us what to do in the case of a persistent vegetative state. Approximately 10,000 Americans are in a persistent vegetative state.
4Death with DignityIntegrity of person’s life is fostered by the quality of communication with and care for dying person:assurance of supportcompassionate careesteem and respectcandidness about death’s certaintyinformation to make reasoned end-of-life choicesA century ago, most deaths occurred at home and people of all ages shared in the care of the dying. Also, because childhood and infant mortality rates were high, most people knew someone younger than themselves who had died. Today, most people (with the exception of those living in particularly violent neighborhoods) are insulated from the process of death. This makes people feel more distant from death and more likely to deny it.Young children may believe that certain people (those like them or close to them) do not die. They also tend to think that dead things still have some capabilities of living things, such as thinking, feeling, and dreaming.An understanding of death can help children accept it – and adults should not use cliches or misleading statements to help children understand.
5Death Anxiety Cultural variations influenced by religious teachings for Westerners, spirituality, meaning of life more important than religious commitmentIndividual variationswomen more anxious than menlow among adults with deep faith in higher beingreduced by sense of symbolic immortalityWomen have more death anxiety.Death anxiety can be reduced by:Spirituality (a sense of life’s meaning; rather than religious commitment per se)A well-developed personal philosophy of deathFaith in some form of higher force or beingGrowing older (death anxiety declines with age)Ego integritySymbolic immortality: sense that a person will continue to live on through her children, work, or personal influence
6Age, Gender, and Death Anxiety Figure Relationship of age and gender to death anxietyFigure 19.1(Adapted from Tomer, Eliason, & Smith, 2000.)
9Appropriate DeathMakes sense in terms of person’s pattern of living, valuesPreserves or restores significant relationshipsAs free of suffering as possibleAlso includesachieving a sense of controlconfronting and preparing for deathAppropriate death: one that makes sense in terms of the individual’s pattern of living and values, restores significant relationships, and is as free of suffering as possible.
11Traditional Places of Death Home:most preferred option: intimacy, loving careonly about 25% die at homeneed for adequate caregiver supportHospital:intensive care unit can be depersonalizingcomprehensive treatment programs optimalNursing home:focus usually not on terminal careimproves greatly when combined with hospice careHome: May be difficult because medical improvements allow older and sicker people to die at home. ½ of all AIDS patients die at home. Support for the caregiver is essential. Relationships may be conflict ridden and most homes lack adequate equipment to care for a dying person.Hospital: 80% of deaths take place in the hospital. May depersonalize the death experience the patient and family.
13Forms of Euthanasia Passive withdrawal of treatment advance medical directive: living will, durable power of attorneyVoluntary activemedical staff or others act to end life at patient’s requestAssisted suicidemedical staff provide means for patient to end own liferemains controversialInvoluntary activemedical staff end life without patient’s consent
14International Public Opinion on Voluntary Active Euthanasia Figure Public opinion favoring voluntary active euthanasia in five nationsFigure 19.2(From Harris Interactive, 2011; Pew Research Center, 2006.)
15Advance Medical Directives Written statement of desired medical treatment in case of incurable illnessLiving will: specifies desired treatmentsDurable power of attorney:authorizes another person to make health-care decisions on one’s behalfmore flexible than living willcan ensure partner’s role in decision making even in relationships not sanctioned by law
16Assisted Suicide Doctor provides drugs for patient to use Legal in few nations, tacitly accepted in manyLegal in only four U.S. statesFew choose this optionHighly controversial:opposed by many, including AMAsome find option comforting
18Grieving Sudden or Prolonged Deaths Sudden, unanticipatedAvoidance from shock and disbeliefSurvivor may not understand reasonsSuicide especially hard to bearProlonged, expectedAnticipatory grieving: allows emotional preparationReasons for death usually known
20Bereavement Interventions General supportsympathy, understandingpatient listening, “being there”Interventionssupport groupshelp with reorganizing daily lifeChildren and adolescentsafter violent death, prevent unnecessary reexposureDifficult situationssudden, violent, unexplainable, or ambiguous deathsgrief therapy, individual counseling
21Resolving Grief Give yourself permission to feel loss. Accept social support.Be realistic about course of grieving.Remember the deceased.When ready, invest in new activities and relationships.Master new tasks of daily living.
22Death EducationCourses in death and dying offered at many educational levelsLecture format: imparts knowledge but may increase discomfortExperiential format:role playing, discussions, guests, field tripsmay reduce death anxiety
23Goals of Death Education Increase understanding of physical, psychological changes in dyingHelp students learn to cope with death of loved onesPrepare informed consumers of medical, funeral servicesPromote understanding of social, ethical issues
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