Presentation on theme: "AGEING AND SPIRITUALITY: Death, dying and bereavement"— Presentation transcript:
1 AGEING AND SPIRITUALITY: Death, dying and bereavement
2 QuotesDeath is not the greatest loss in life. The greatest loss is what dies inside us while we live. –Norman CousinsThe idea is to die young as late as possible. – Ashley Montague
3 We can deprive death of its fearfulness, strangeness, and power by getting used to it and learning about it. We also deprive death of its power by being ready for it. – Montaigne
4 Death takes many forms and occurs throughout the lifespan.
5 Definitions of Dying Clinical Death Brain Death Social Death Psychic Death
6 Clinical DeathHaving one’s heart and breathing cease spontaneously and there are no reflexes.Loss of consciousnessIrregular gaspingBrain activity stopped for few secondsAll tissues and organs accumulate ischemic injury (due to restricted blood supply; O2)Results in cardiac arrestFollowed by brain/biological death.If a person’s heartbeat has stopped but is restored through cardiopulmonary resuscitation (CPR), then a person who has technically died can be revived.
7 Brain Death Accepted by physicians as criteria for death. Definition: All electrical activity in the brain, as determined by an electroencephalogram (EEG), has ceased for a specified period of time
8 Brain Death Brain Damage Timeline: Within 4-6 minutes of clinical death, some brain damage is possible.Within 6-10 minutes of clinical death, brain damage is likely.After 10 minutes of clinical death, irreversible brain damage is certain.
9 Social DeathOccurs when a person is abandoned by or isolated from othersOften is expected to dies is talked about as if he or she were not presentCritically ill adults and older people who are severely impaired, social death reflects the fact that their lives are seen finished even though they quite alive by other criteria
10 Psychic DeathIndividuals accept their fate and regress, a very severe and personal form of withdrawalThe sense of being dead:Giving up fighting for lifeRejecting life
11 One might distinguish between sociological/ social death (people withdrawn from the dying), psychic death (the patient acquiesces), clinical death (the brain ceases to function) and physiological death (the body dies).
12 PERSONAL MEANINGS OF DEATH Death as lossDeath as punishment and releaseDeath as transitionDeath and the use of time
13 DEATH AS LOSS Loss of ability to have experiences As Kalish (1976, 1985) has observed, death may men losses of several kinds to different peopleLoss of ability to have experiencesLoss of ability to predict subsequent eventsLoss of our bodies
14 DEATH AS LOSSLoss of ability to care for people who are dependent on usLoss of a loving relationship with our familyLoss of opportunity to complete treasured plans and projectsLoss of being in a relatively painless state
15 DEATH AS PUNISHMENT AND RELEASE Punishment for one’s sinThis is presumably linked to one’s belief about an afterlifeReynolds and Kalish (1976) found that while older people generally equated moral goodness with a longer life span, a majority those surveyed saw, particularly accidental death as retribution rather then seeing a long life as a reward
16 DEATH AS TRANSITION The person sees death as a stopping-off point What may or may not happen afterwards is really more importantFeeling of death is also influenced by religious viewWhat is meaningful about life is highly subjective and varies by age
17 DEATH AND THE USE OF TIME Death is an event that makes the dimension of time meaningful, as well as helping us to order our livesOur goals and accomplishments, our sense of the past, present and future as well as our relationships with others become meaningful to the extent that we know we will not live forever
18 The meaning of deathIn studies of adults (e.g., Kalish, 1981; Kastenbaum & Herman, 1997; Ross & Pollio, 1991; Tamm, 1996), death has often been viewed as a personification (such as a grim reaper, gay seducer, or gentle comforter) or as a metaphor (e.g., a failing curtain).
19 Cultural meanings of death In studies of adults (e.g., Kalish, 1981; Kastenbaum & Herman, 1997; Ross & Pollio, 1991; Tamm, 1996), death has often been viewed as a personification (such as a grim reaper, gay seducer, or gentle comforter) or as a metaphor (e.g., a failing curtain).
21 THE DYING PROCESS Denial & Isolation Anger Bargaining Depression AcceptanceHope
22 Stages of grief for a dying person (Kubler Ross, 1969) So, are the 5 Stages without value? Not if they are used as originally intended, as The 5 Stages of Receiving Catastrophic News. One can even extrapolate to The 5 Stages of Coping With Trauma. Death need not be involved.As an example, apply the 5 stages to a traumatic event most all of us have experienced: The Dead Battery! You're going to be late to work so you rush out to your car, place the key in the ignition and turn it on. You hear nothing but a grind; the battery is dead.DENIAL --- What's the first thing you do? You try to start it again! And again. You may check to make sure the radio, heater, lights, etc. are off and then..., try again.ANGER --- car!", "I should have junked you years ago." Did you slam your hand on the steering wheel? I have. "I should just leave you out in the rain and let you rust."BARGAINING --- (realizing that you're going to be late for work)..., "Oh please car, if you will just start one more time I promise I'll buy you a brand new battery, get a tune up, new tires, belts and hoses, and keep you in perfect working condition.DEPRESSION --- "Oh God, what am I going to do. I'm going to be late for work. I give up. My job is at risk and I don't really care any more. What's the use".ACCEPTANCE --- "Ok. It's dead. Guess I had better call the Auto Club or find another way to work. Time to get on with my day; I'll deal with this later."
23 Denial and Isolation“This is not happening to me”
24 Anger “How dare ____ do this to me?” God/the person who died/anger directed at self
25 Bargaining“Just let me live to see my son graduate”
26 Depression“I can’t bear to face going through this, putting my family through this.”
27 Acceptance and Hope “I’m ready, I don’t want to struggle anymore.” “Without miracles, there are many, many ways of helping somebody, without a cure. So you have to be very careful how you word it. And you never, ever, ever take hope away from a dying patient. Without hope nobody can live. You are not God. You don't know what else is in store for them, what else can help them, or how meaningful, maybe, the last six months of a person's life are. Totally changed around.”(“On Death and Dying: An Interview with Elizabeth Kubler-Ross”, Redwood, 1995)
29 GRIEF AND BEREAVEMENTGrief is a response to bereavement. It’s how the survivors feel.Everyone can experience grief in different ways.
30 GRIEF AND BREAVEMENTMost bereaved individuals successfully overcome their grief without professional assistance.Grief refers to the sorrow hurt, anger, guilt, confusion and other feelings that arise after suffering a loss.
31 STAGES OF GRIEF Initial phase When death occurs and for a weeks afterwards.Survivor’s reaction is shock, disbelief and numbness
32 STAGES OF GRIEF Intermediate phase Several weeks after death Bereaved person thinks about the death a great dealSurvivors try to understand why the person diedPeople search for the deceased
33 STAGES OF GRIEF Recovery phase Often results from a conscious that continued dwelling on the past is pointless and that one’s life needs to move forward
34 HOSPICE CARE Pain and symptom control Alleviating isolation Hospice care for the terminally ill has emerged as viable alternative to hospital careCharacteristics of hospice care include:Pain and symptom controlAlleviating isolationPhysician-directed servicesTreatment on 24-hour-per-day basis, for both patient and family
35 Involvement of an interdisciplinary team Bereavement follow-up for the family after deathUse of volunteersOpportunities for staff support of one another, to lessen burnout and facilitate their own grief when a patient dies
36 EUTHANASIA Euthanasia means “good death” Comparatively recent advances in medical technology that allow for the extension of human life indefinitely
37 EuthanasiaActive euthanasia – defined as taking active measures to end someone’s life to relieve needless suffering or to preserve individual dignity.Passive euthanasia – defines as failing to use life saving measures that might prolog someone’s life, may be more acceptable