1. Slide 1 © 2008 The McGraw-Hill Companies, Inc. All rights reserved. LIFE-SPAN DEVELOPMENT 17 A Topical Approach to John W. Santrock Death and Grieving

2. Slide 2 © 2008 The McGraw-Hill Companies, Inc. All rights reserved. Death in Different Cultures Perceptions of death vary; reflect diverse values and philosophies Individuals more conscious of death in times and places of war, poverty, disease. Most societies have – Philosophical or religious beliefs about death – Rituals that deal with death – View that death does not end existence Death and Cultural Contexts

3. Slide 3 © 2008 The McGraw-Hill Companies, Inc. All rights reserved. U.S. Denial and Avoidance of Death Funeral industry emphasizes lifelike qualities Euphemisms — softening language for death Persistent search for “fountain of youth” Rejection and isolation of aged Concept of pleasant and rewarding afterlife Medical emphasis — prolonging life, not easing suffering Death and Cultural Contexts

4. Slide 4 © 2008 The McGraw-Hill Companies, Inc. All rights reserved. Changing Historical Circumstance Death becoming increasingly complex – When to determine death has occurred – Life expectancy has increased – Most die apart from families – Care for dying shifted away from family – Minimized exposure to death and its pain Death and Cultural Contexts

5. Slide 5 © 2008 The McGraw-Hill Companies, Inc. All rights reserved. Issues in Determining Death Brain death — neurological definition of death – All electrical activity of brain has ceased for a specified period of time – Flat EEG recording – Some medical experts argue criteria for death should include only higher cortical functioning Defining Death and Life/Death Issues

6. Slide 6 © 2008 The McGraw-Hill Companies, Inc. All rights reserved. Decisions Regarding Life, Death, and Health Care Natural Death Act and Advance Directive –Expresses person’s desires regarding extraordinary medical procedures that might be used to sustain life when medical situation becomes hopeless Defining Death and Life/Death Issues

7. Slide 7 © 2008 The McGraw-Hill Companies, Inc. All rights reserved. Euthanasia Painlessly ending lives of persons suffering from incurable diseases or severe disabilities –Passive euthanasia — withholding of available treatments, allowing the person to die –Active euthanasia — death induced deliberately, as by injecting a lethal dose of drug Publicized controversy: assisted suicide Defining Death and Life/Death Issues

8. Slide 8 © 2008 The McGraw-Hill Companies, Inc. All rights reserved. Needed: Better Care for Dying Individuals Death in U.S.: often lonely, prolonged, painful Plan for your death – Make a living will – Give someone power of attorney – Give your doctor specific instructions – Discuss desires with family and doctor – Check insurance plan coverage Defining Death and Life/Death Issues

9. Slide 9 © 2008 The McGraw-Hill Companies, Inc. All rights reserved. Needed: Better Care for Dying Individuals Hospice — humanized program committed to making the end of life as free from pain, anxiety, and depression as possible Palliative care — reducing pain and suffering and helping individuals die with dignity Defining Death and Life/Death Issues

10. Slide 10 © 2008 The McGraw-Hill Companies, Inc. All rights reserved. Causes of Death Death can occur at any point in human life span – Prenatal — miscarriage, stillborn – Childhood — accidents or illness – Adolescence — motor vehicle accidents, suicide, and homicide – Older adults — chronic diseases A Developmental Perspective of Death

11. Slide 11 © 2008 The McGraw-Hill Companies, Inc. All rights reserved. Death and Children Honesty may be best way to discuss death with children – Explained in simple physical or biological terms to preschool children – Be sensitive and sympathetic, encouraging feelings and questions – Not unusual for terminally ill children to distance themselves in final stages, may be a result of depression A Developmental Perspective of Death

12. Slide 12 © 2008 The McGraw-Hill Companies, Inc. All rights reserved. Attitudes Toward Death at Different Points in the Life Span Childhood Adolescence Adulthood Infant has no concept of death; perceptions of death develop in middle/late childhood; even very young children concerned about separation and loss Develop more abstract concepts of death; common to think they are immune to death Middle-aged adults fear death more than young adults or older adults; older adults think about death more A Developmental Perspective of Death

13. Slide 13 © 2008 The McGraw-Hill Companies, Inc. All rights reserved. Suicide A Developmental Perspective of Death –Serious physical illness –Feelings of disparity, isolation, failure, loss –Serious financial problems –Drug use or prior suicide attempts –Antidepressant links –Cultural and gender differences exist –Rare in childhood, risk increase in adolescence –Most adolescent attempts fail –Linked to genetic and situational factors –Gay or lesbian links not clear Risk factors

14. Slide 14 © 2008 The McGraw-Hill Companies, Inc. All rights reserved. Suicide in U.S. Adolescence 3rd leading cause of death in ages10-19 19% of high school students seriously considered or tried suicide in last 12 mos Adulthood and Aging Suicide rates increase in adulthood Older adults use more lethal ways, are more successful Racial and gender differences exist A Developmental Perspective of Death

15. Slide 15 © 2008 The McGraw-Hill Companies, Inc. All rights reserved. Facing One’s Own Death Most dying individuals want to make decisions regarding their life and death – Complete unfinished business – Resolve problems and conflicts – Put their affairs in order Facing One’s Own Death

16. Slide 16 © 2008 The McGraw-Hill Companies, Inc. All rights reserved. Kubler-Ross’ Stages of Dying Denial and isolation Anger Bargaining Denies s/he is going to die Denial gives way to anger, resentment, rage, and envy Develops hope that death can somehow be postponed Depression Acceptance Comes to accept the certainty of her or his death Develops sense of peace and may desire to be left alone Facing One’s Own Death

17. Slide 17 © 2008 The McGraw-Hill Companies, Inc. All rights reserved. Perceived Control and Denial When individuals believe they can influence and control events, they may become more alert and cheerful Denial can be adaptive or maladaptive Facing One’s Own Death

18. Slide 18 © 2008 The McGraw-Hill Companies, Inc. All rights reserved. The Contexts in Which People Die Context of dying is important for most Most would rather die at home but worry over Burden at home Limited space May alter relationships Competency and availability of emergency medical treatment Facing One’s Own Death

19. Slide 19 © 2008 The McGraw-Hill Companies, Inc. All rights reserved. Communicating with the Dying Person Establish your presence Eliminate distraction Limit visit time Don’t insist on acceptance Allow expressions of guilt or anger Discuss alternatives, unfinished business Ask if there is anyone s/he would like to see Encourage the dying individual to reminisce Talk with the individual when s/he wishes to talk Express your regard Coping with the Death of Someone Else

20. Slide 20 © 2008 The McGraw-Hill Companies, Inc. All rights reserved. Grieving Grief: emotional numbness; a complex emotional state of… Disbelief Separation anxiety Despair Sadness Loneliness –Complicated grief –Disenfranchised grief Coping with the Death of Someone Else

21. Slide 21 © 2008 The McGraw-Hill Companies, Inc. All rights reserved. Model of Grieving Dual-process model for effective coping –Loss-oriented stressors –Restoration-oriented stressors Coping and type of death –Sudden or violent deaths have more intense and prolonged effects –Many such deaths accompanied by PTSD

22. Slide 22 © 2008 The McGraw-Hill Companies, Inc. All rights reserved. Cultural Diversity in Healthy Grieving Persistent holding on to deceased may be therapeutic –Hopi of Arizona forget quickly –Egyptians dwell on grief –Netherlands: integrate loss into their lives Healthy coping involves – Growth – Flexibility – Appropriateness within the cultural context

23. Slide 23 © 2008 The McGraw-Hill Companies, Inc. All rights reserved. Making Sense of the World Grieving stimulates many to try to make sense of their world — positive themes linked to hopeful future and better adjustment Effort to make sense of it pursued more vigorously when caused by an accident or disaster Coping with the Death of Someone Else

24. Slide 24 © 2008 The McGraw-Hill Companies, Inc. All rights reserved. Losing a Life Partner Those left behind after the death of an intimate partner suffer profound grief and often endure – Financial loss – Loneliness linked to poverty and education – Increased physical illness – Psychological disorders, including depression Coping with the Death of Someone Else

25. Slide 25 © 2008 The McGraw-Hill Companies, Inc. All rights reserved. Adjustment to Widowhood Women live longer Widowed men more likely to remarry Measures of older women’s health –Physical and mental health –Health behaviors and outcomes Overall, women adjust better than men –Older widows do better than younger widows –Support programs aid adjustment Coping with the Death of Someone Else

26. Slide 26 © 2008 The McGraw-Hill Companies, Inc. All rights reserved. Forms of Mourning Approximately 80 percent of corpses are disposed of by burial, the remaining 20 percent by cremation Funeral industry is source of controversy Funeral is important aspect of mourning in many cultures Cultures vary in how they practice mourning Coping with the Death of Someone Else

27. Slide 27 © 2008 The McGraw-Hill Companies, Inc. All rights reserved. The End 17