1.  Study of Death: Thanatology (Thanatos: Greek God of Death) (Thanatos: Greek God of Death)  Pascal: man is the only animal that knows he will die some day  Fear of death uniquely human  Historically, death part of daily life, high mortality rate, took place at home  20 century: death in hospital death in hospital medical technology medical technology facilitated death denial facilitated death denial funeral parlours funeral parlours euphemisms euphemisms DEATH AND DYING

2.  About age 9-10 we realize that death is final, universal and inevitable  Adolescence: invulnerable, immortal “can’t happen to me”, risk taking, denial  Early adulthood: change when becoming parents  Middle age: death of parents, friends, siblings. Highest death anxiety  Old age: lowest anxiety, though facing death of spouse and peers  Role of religion: true believers and atheists lowest anxiety

3. What is death? 1. Determined by doctor (if available). Errors 2. Clinical death: heart and lungs stop. But nowadays resuscitation through technology: CPR, oxygen, defibrillation, etc. (NDEs) 3. Brain death: no EEG. New structures (cerebral cortex) die first, then midbrain, then medulla and spinal cord (vegetative functions and reflexes): is this person alive? Coma

4. Euthanasia: active or passive  Active: method used to terminate life, e.g. drug, asphyxia, etc. Special case: assisted suicide (Kevorkian) Special case: assisted suicide (Kevorkian)  Passive: withhold or remove life support Ethical issue: Nazis Ethical issue: Nazis Issue of longevity and economics Issue of longevity and economics Cultural variations, Netherlands Cultural variations, Netherlands  NDE: Near death experience, increase since resuscitations increased

5. First thanatologist: Elizabeth Kubler-Ross Process in 5 stages: 1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance  Not a typical stage process: individual differences, order of stages, return to earlier stages  Also observed in chronic illness, loss of body parts, loss of function

6. Schneidman: alternation of emotions instead of stages: grief grief anguish anguish anger anger anxiety anxiety denial denial NO acceptance NO acceptance

7.  Pattison: living-dying interval, prolonged by technology  3 phases: acute crisis: time of diagnosis acute crisis: time of diagnosis chronic: gradual deterioration, longest phase due to medical-technological advances chronic: gradual deterioration, longest phase due to medical-technological advances surrender: giving up, not a real acceptance surrender: giving up, not a real acceptance  Variables that affect process: age age cause of death cause of death personality personality religious beliefs religious beliefs ethnic background ethnic background hospital, home or hospice location hospital, home or hospice location

8.  Survivors: Grief: feelings Grief: feelings Mourning: behaviours that express grief Mourning: behaviours that express grief Rituals: e.g. Irish wake, sitting shiva Rituals: e.g. Irish wake, sitting shiva  Stages: 1. numbness 2. yearning, anger and denial 3. depression, apathy, disorganization 4. acceptance, adjustment, reorganization All 4 can coexist and alternate

9.  Varying time span, influence of culture  Child and spouse worst  Widows/widowers: longer grieving if bad marriage: sanctification of dead spouse (guilt)  Increase in morbidity and mortality (one study in text contradicts) Double whammy: 1. immune system weakens 2. self neglect (meals, exercise, sleep, smoking and drinking)

10.  Psychoneuroimmunology  Psycho: thoughts and feelings  Neuro: brain and nervous system  Immuno: immune system  Logy: study of  People who have supports fare better  Anticipatory grief helps (when death is expected)