1. Chapter 19
Death and Grieving
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4. Issues in Determining Death
Defining Death and Life/Death Issues
Issues in Determining Death
Brain death – a neurological definition of death that states a person is brain dead when all electrical activity of the brain has ceased for a specified period of time.
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5. Issues in Determining Death
Defining Death and Life/Death Issues
Issues in Determining Death
The higher portions of the brain die first.
The brain’s lower portions monitor vital functions.
People whose higher brain areas have died may continue breathing & have a heartbeat.
The current definition of brain death (for most physicians) includes the death of both the higher cortical functions & lower brain stem functions.
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6. Decisions Regarding Life, Death, and Health Care
Defining Death and Life/Death Issues
Decisions Regarding Life, Death, and Health Care
Living Wills and DNRs
Euthanasia
Needed: Better Care for Dying Individuals
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7. Defining Death and Life/Death Issues
Living Will
Recognizing that terminally ill patients might prefer to die rather than linger in a painful or vegetative state, an organization called “Choice in Dying” created the Living Will.
The Living Will document is designed to be filled in while the individual can still think clearly & expresses their desire that extraordinary medical procedures not be used to sustain life when the medical situation becomes hopeless.
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8. Defining Death and Life/Death Issues
DNRs
DNR, or Do Not Resuscitate is an order preventing medical staff within a medical institution to use either specified or all means to prolong a person’s life or to resuscitate the person if their heart stops.
DNR can be arranged without a living will.
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9. Defining Death and Life/Death Issues
Euthanasia
Euthanasia is the act of painlessly ending the lives of individuals who are suffering from an incurable disease or severe disability.
Sometimes referred to as “mercy killing.”
Passive euthanasia – occurs when a person is allowed to die by withholding available treatment, such as withdrawing a life-sustaining device.
Active euthanasia – occurs when death is deliberately induced, as when a lethal dose of a drug is injected.
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10. Attitudes about Euthanasia
Defining Death and Life/Death Issues
Attitudes about Euthanasia
Passive euthanasia for terminally ill patients is accepted.
Precise boundaries for passive euthanasia & the exact mechanisms by which treatment decisions should be implemented are not entirely agreed upon.
Active euthanasia is a crime in most countries & in all U.S. states except Oregon.
Walker, Gruman & Blank’s (1999) recent survey of more than 900 physicians found most opposed active euthanasia & believed that adequate pain control eliminated the need for active euthanasia.
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11. Needed: Better Care for Dying Individuals
Defining Death and Life/Death Issues
Needed: Better Care for Dying Individuals
The Canadian Senate report on end-of-life found:
Only 1-in-10 Canadians received proper care as they die.
Dying individuals often get too little or too much care.
Many experience severe pain during their last days.
Regulations are needed that allow physicians flexibility in prescribing painkillers for dying patients who need them.
Many health-care professionals are not trained to provide adequate end-of-life care.
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12. Defining Death and Life/Death Issues
Palliative Care
Palliative care is a humanized program committed to making the end of life as free from pain, anxiety, & depression as possible.
Palliative care goals contrast with those of hospitals, which are to cure illness & prolong life.
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14. Changing Historical Circumstances
Death and Socio-historical Cultural Contexts
Changing Historical Circumstances
One historical change already presented is the increasing complexity of determining when someone is truly dead.
Another change is the age group death strikes most often—200 years ago it was children, now it is the elderly.
Life expectancy has increased by 50 years since 1900.
In the past, most people died at home.
80% of all deaths now occur in institutions, minimizing our exposure to death.
Care of the dying has shifted away from families.
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15. Death and Socio-historical Cultural Contexts
Perceptions of Death
In most societies, death is not viewed as the end of existence—though the biological body has died, the spiritual body is believed to live on.
Some cultures:
believe death is caused by magic and demons.
believe death is caused by natural forces.
focus on reincarnation.
view death as punishment, while for others it represents redemption.
fear death, while others embrace it.
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16. Death in Different Cultures
Death and Socio-historical Cultural Contexts
Death in Different Cultures
North Americans are death avoiders & death deniers.
People in many countries face death on a daily basis.
In some countries, the presence of dying family members & large funeral attendance are part of everyday cultural reality.
These aspects of life help prepare the young for death & provide them with guidelines on how to die.
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17. Evidence of the Denial of Death
Death and Socio-historical Cultural Contexts
Evidence of the Denial of Death
The funeral industry glosses over death & fashions lifelike qualities in the dead
Euphemistic language for death is used (passed away).
There is a persistent search for a fountain of youth
Rejection & isolation of the aged, who may remind us of death, is common.
Belief in the concept of a pleasant & rewarding afterlife, suggests that we are immortal
Medical practices emphasis prolonging biological life rather than an emphasizing diminishing human suffering
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19. Causes of Death and Expectations about Death
A Developmental Perspective on Death
Causes of Death and Expectations about Death
Death can occur at any point in the human life span.
Childhood deaths occur mostly due to accidents or illness.
Adolescent deaths are more likely to occur because of motor vehicle accidents, suicide, & homicide.
Younger adults are more likely to die from accidents.
Older adults are more likely to die from chronic diseases.
Younger adults who are dying feel cheated by death more than do older adults who are dying.
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20. Attitudes toward Death at Different Points in the Life Span
A Developmental Perspective on Death
Attitudes toward Death at Different Points in the Life Span
Childhood
Adolescence
Adulthood
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21. A Developmental Perspective on Death
Childhood
Infants have no concept of death, but once they develop an attachment, they can experience loss, separation & anxiety.
Children 3–5 years old don’t have a true idea of what death really means, often confusing death with sleep.
Young children believe death is reversible & the dead can be brought back to life spontaneously.
Cuddy-Casey & Orvaschel’s (1997) research found children don’t understand death is universal & irreversible until about age 9.
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22. Explaining Death to Children
A Developmental Perspective on Death
Explaining Death to Children
Psychologists recommend :
honesty in discussing death with children.
Answering children’s questions about death based on the child’s age & maturity level.
Death can be explained to preschool children in simple physical & biological terms.
Children need reassurance that they are loved & that they will not be abandoned.
Regardless of age, adults should be sensitive & sympathetic, encouraging children to express their own feelings & ideas.
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23. A Developmental Perspective on Death
Adolescence
The prospect of death is so remote for adolescents that it does not have much relevance.
Death may be avoided, glossed over, kidded about, neutralized, & controlled by a cool spectator-like orientation.
Adolescents have more abstract conceptions of death than children do.
Adolescents develop religious & philosophical views about the nature of death & whether there is life after death.
Adolescents are especially likely to think that they are invincible, unique & immune to death.
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24. A Developmental Perspective on Death
Adulthood
There is no evidence that a special orientation towards death develops in early adulthood.
An increase in consciousness about death accompanies individuals’ awareness that they are aging.
Kalish & Reynolds’ (1976) study found adults at midlife fear death more than do young adults or older adults.
Older adults think about death more & talk about it more than in previous adult stages.
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26. Kübler-Ross’s Stages of Dying
Facing One’s Own Death
Kübler-Ross’s Stages of Dying
Denial and Isolation
Anger
Bargaining
Depression
Acceptance
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27. Facing One’s Own Death
Denial and Isolation
Kübler-Ross (1969) divided the behaviour & thinking of dying persons into 5 stages.
In the first stage, denial & isolation, people refuse to believe that their condition is terminal.
People attempt to convince themselves that lab tests were inaccurate or that the disease will go into remission.
Dying individuals in this stage also seek isolation.
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28. Facing One’s Own Death
Anger
In the 2nd stage of dying, anger, the dying person recognizes that denial can no longer be maintained.
Denial gives way to anger, resentment, rage, & envy.
The dying person’s question is: “Why me?”
The dying person becomes increasingly difficult to care for, as anger may become displaced & projected onto physicians, nurses, family members, & God.
The realization of loss is great & those who represent life are targets of resentment
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29. Facing One’s Own Death
Bargaining
In the 3rd stage of dying, bargaining, Kübler-Ross states that the person develops the hope that death can somehow be postponed or delayed.
Some people enter into a bargaining or negotiation—often with God—as they try to delay their death.
In exchange for a few more days, weeks, or months of life, the person promises to lead a reformed life dedicated to God or to the service of others.
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30. Facing One’s Own Death
Depression
In Kübler-Ross’ 4th stage of dying, depression, the dying person accepts that death is certain.
At this point, a period of depression or preparatory grief may appear.
The dying person may become silent, refuse visitors, & spend time crying or grieving.
Attempts to cheer up the dying person at this stage should be discouraged because the person has a need to contemplate impending death.
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31. Facing One’s Own Death
Acceptance
In the 5th stage of dying, acceptance, the person develops a sense of peace; an acceptance of one’s fate; & in many cases, a desire to be left alone.
Feelings & physical pain may be virtually absent.
Kübler-Ross views this stage as the end of the dying struggle, the final resting stage before death.
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32. Criticisms of Kubler-Ross
Facing One’s Own Death
Criticisms of Kubler-Ross
Psychology death expert Robert Kastenbaum refutes the existence of Kübler-Ross’ 5 stage sequence.
Research has not demonstrated the process exists.
Kastenbaum (2000) believes the stage interpretation neglects the patients’ total life situations, including relationship support, specific effects of illness, family obligations, & the institutional climate in which they were interviewed.
Some psychologists prefer to describe the stages as reactions to dying.
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33. Contributions of Kubler-Ross
Facing One’s Own Death
Contributions of Kubler-Ross
Kübler-Ross made the important contribution of calling attention to people attempting to cope with life-threatening illnesses.
She did much to encourage needed attention to the quality of life for dying persons & their families.
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34. Perceived Control and Denial
Facing One’s Own Death
Perceived Control and Denial
Perceived control & denial may work together as an adaptive strategy for some older adults facing death.
Individuals who believe they can influence & control events, become more alert & cheerful.
Denial may be a useful way for some individuals to approach death.
Denial protects us from the tortuous feeling that we are going to die.
Denial can be maladaptive if it prevents treatment.
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35. The Contexts in Which People Die
Facing One’s Own Death
The Contexts in Which People Die
For dying individuals, the context in which they die is important.
75% of Canadians die in hospitals or long-term care facilities.
Hospitals offer important advantages in that professional staff members are readily available, & the medical technology may prolong life.
Kalish & Reynolds (1976) identified most individuals say they would rather die at home.
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37. Communicating with a Dying Person
Coping with the Death of Someone Else
Communicating with a Dying Person
Most psychologists believe that it is best for dying individuals to know that they are dying, & that significant others know they are dying.
Dying individuals can thus close their lives in accord with their own idea of proper dying.
They can complete plans and projects.
They can make arrangements for survivors.
They can participate in decisions about a funeral.
They will have the opportunity to reminisce.
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38. Grieving Dimensions of Grieving Cultural Diversity in Healthy Grieving
Coping with the Death of Someone Else
Grieving
Dimensions of Grieving
Cultural Diversity in Healthy Grieving
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39. Dimensions of Grieving
Coping with the Death of Someone Else
Dimensions of Grieving
Emotional numbness, disbelief, separation anxiety, despair, sadness, & loneliness accompany the loss of someone we love.
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40. Dimensions of Grieving
Coping with the Death of Someone Else
Dimensions of Grieving
Pining or yearning reflects a recurrent need to recover the lost loved one.
Separation anxiety includes pining but also focuses on places & things associated with the deceased, as well as crying.
Numbness, disbelief, & outbursts of panic are typical immediate reactions.
Despair, sadness, & hopelessness are part of grief.
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41. Cultural Diversity in Healthy Grieving
Coping with the Death of Someone Else
Cultural Diversity in Healthy Grieving
In contrast to Western beliefs, maintenance of ties with the deceased is accepted & sustained in the religious rituals of Japan.
In the Arizona Hopi, the deceased are forgotten as quickly as possible & life is carried on as usual.
In Egypt, the bereaved are encouraged to dwell at length on their grief.
In Bali, the bereaved are encouraged to laugh & be joyful, rather than be sad.
Diverse grieving patterns are culturally embedded.
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42. Making Sense of the World
Coping with the Death of Someone Else
Making Sense of the World
A beneficial aspect of grieving is that it stimulates many individuals to make sense of their world.
A common occurrence is to go over again & again all of the events that led up to the death.
When death is caused by an accident or disaster, the effort to make sense of it is pursued more vigorously.
The bereaved want to put the death in a perspective they can understand—divine intervention, a logical sequence of cause & effect, etc.
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43. Coping with the Death of Someone Else
Losing a Life Partner
Those left behind after the death of an intimate partner suffer profound grief & often endure financial loss, loneliness, increased physical & psychological problems.
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44. Coping with the Death of Someone Else
Losing a Life Partner
Those left behind after the death of an intimate partner suffer profound grief & often endure financial loss, loneliness, increased physical illness, & psychological disorders.
The bereaved are also at increased risk for many health problems, including death.
Optimal adjustment after a death depends on several factors.
Women do better than men in our society, due to their networks of friends & close relationships.
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45. Forms of Mourning and the Funeral
Coping with the Death of Someone Else
Forms of Mourning and the Funeral
Mourning varies cross-culturally.
Funeral rituals are an important aspect of mourning in many cultures.
One consideration is what to do with the body.
Approximately 80% of corpses are buried.
Studies showed that bereaved individuals who were religious derived more psychological benefits from a funeral, participated more actively in rituals, & adjusted more positively to the loss.
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