THE END OF LIFE

The Quest for “Healthy Dying” n Thanatology: The Study of Death and Dying

Living Will A legal document that states an individual’s wishes regarding medical care in case the person becomes incapacitated and unable to participate in decisions about his or her medical care.

The Right-to-Die Movement n Physician-Assisted Suicide n Trend: basing decisions less on legalistic interpretations regarding specific treatments and more on balancing benefits on a case- by-case basis n Euthanasia: Mercy killing

n Three concepts: (NIMH) 1. Suicide ideas 2. Suicide attempts 3. Completed suicide n Who Commits Suicide and Why? Females attempt more suicides, but males complete most. Suicide

n Provides comfort and care but with the knowledge that the recipients are nearing the end of their life’s journey--that they’re dying The Hospice Movement

The Dying Process n Defining Death Brain Death occurs when the brain receives insufficient oxygen to function.

n A Life Review n Elderly person takes stock of his life, reflecting and reminiscing about it Confronting One’s Own Death

n Death drop n Near-Death Experiences –Dying individuals feel themselves leave their bodies and watch as spectators, the resuscitation efforts. Then they pass through a tunnel and enter a spiritual realm. Changes Before Death

Other views: –(Siegel) Arousal of nervous system and disorganization of brain –(Alkon) Anoxia induces such mental states –(Kastenbaum) Some heart-attack victims: no recollection of experience Near-Death Experiences

n Christian: Book of Revelation Jewish: Speculation about afterlife is pointless Buddhists: Detailed account Religious Beliefs

(Elisabeth Kubler-Ross) 1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance Stages of Dying

It is the nature of the disease that determines pain, mobility and length of terminal period. n Other factors: –Gender, ethnic group, personality, developmental level and death environment Kastenbaum’s Trajectories of Death

n National Mortality Followback Survey: 1993 n Data on 23,000 records of death in n All states except South Dakota Causes of Death

Grief, Bereavement, and Mourning n Adjusting to the Death of a Loved One n Bereavement: state in which a person has been deprived of a relative or friend by death

Grief: keen mental anguish and sorrow over the death of a loved one Mourning: socially established manner of displaying signs of sorrow over death

n Support groups to help people through grief work n Culture and Grief Work –Cultural variability in expressing grief Expressing Anguished Feelings

n Survivor vulnerable to physical and mental illness and death n Adjusting to Violent and Premature Death –Most severe grief reaction Consequences of Grief

Stages of bereavement for healthy adults who have lost a parent 1. Going back to the origins 2. Reevaluation phase 3. Assuming leadership Adjusting to the Death of a Parent

1. Shock, numbness, denial, disbelief 2. Pining, yearning, and depression 3. Emancipation from loved one and adjustment to new circumstances 4. Identity reconstruction Phases in the Bereavement Process

n People handle grief differently n Widows and Widowers –Death rate for widowers higher –Difficulty expressing emotion Individual Variations

n Three types (Lopata) 1. Better educated, middle class, strongly identifying with role of wife 2. Women who led multidimensional lives; husband only one part of total set of relations 3. Lower-or working-class women in sex- segregated worlds immersed in kin, neighboring or friendship relationships with other women Types of Widows

n Loss by Miscarriage –Sometimes receive no recognition of loss –Support Groups n Loss by Murder or Violence n Bereavement process can go on indefinitely Death of a Child