1. Ch:20 Lecture Prepared by: Dr. M. Sawhney

2. The Death System and Cultural Contexts Components comprising the death system: People Places or contexts Times Objects Symbols Cultural variations in the death system

3. Changing Historical Circumstances The age group in which death most often occurs Life expectancy has increased Location of death

4. Issues in Determining Death Brain death A flat EEG reading for a specified period of time is one criterion of brain death Includes both the higher cortical functions and the lower brain-stem functions https://www.youtube.com/wat ch?v=Ffqz-vKZO5Q

5. Decisions Regarding Life, Death, & Health Care Advanced Care Planning: Process of patients thinking about and communicating their preferences about end-of-life care “Choice in Dying” Advance Directive Physician order for life sustaining treatment

6. Euthanasia The act of painlessly ending the lives of individuals who are suffering from an incurable disease or severe disability Passive euthanasia Active euthanasia Recent cases - Terri Schiavo and Jack Kevorkian https://www.youtube.com/ watch?v=htZagt1Szcw https://www.youtube.com/ watch?v=htZagt1Szcw https://www.youtube.com/ watch?v=EQmyo6EvUY8

7. Needed: Better care for dying individuals Death in America is lonely, prolonged, and painful Fail-safe measures for avoiding pain at the end of life Make a living will Give someone power of attorney Give doctors specific instructions Discuss with the family whether or not you want to die at home Check insurance to see if it covers home care or hospice care

8. Decisions Regarding Life, Death, & Health Care Hospice: A program committed to making the end of life as free from pain, anxiety, and depression as possible Emphasizes palliative care

9. Causes of Death Causes of death: Prenatal death Birth defects SIDS is the leading cause of infant death in the U.S. Childhood deaths Death in adolescents Middle-age Older adult deaths

10. Attitudes Toward Death at Different Points in the Life Span Childhood Young children (3 -5 years) believe the dead can be brought back to life Around 9 years of age, children view death as universal and irreversible Honesty is the best strategy in discussing death with children

11. Attitudes Toward Death at Different Points in the Life Span Adolescence Death regarded as remote and may be avoided, glossed over, or kidded about. Develop more abstract conceptions about death than children Adulthood Middle-aged adults fear death more than young adults Older adults are forced to examine the meanings of life and death more frequently than younger adults

12. Facing one’s own death Knowledge of death’s inevitability permits us to establish priorities and structure our time Three areas of concern: Privacy and autonomy in regard to their families Inadequate information about physical changes and medication as death approached Motivation to shorten their life

13. Kübler-Ross’ stages of dying Kübler-Ross’ stages of dying: Denial and isolation: “It can’t be!” Anger: “Why me?” Bargaining: “Just let me do this first!” Depression: withdrawal, crying, and grieving Acceptance: a sense of peace comes Criticism

14. Coping with the death of someone else Communicating with a dying person: They can close their lives in accord with their own ideas about proper dying They may be able to complete plans and projects, and make arrangements and decisions They have the opportunity to reminisce and converse with others They have more understanding of what is happening to them

15. Grieving Dimensions of Grieving Grief Pining or yearning Separation anxiety Cognitive factors are involved in the severity of grief Prolonged grief disorder Disenfranchised grief

16. Dual-Process model Dual-Process model of Coping & Bereavement Oscillation between coping with loss and coping with restoration Loss Oriented Stressors Emotional and reactive processing of the loss Restoration Oriented Stressors Dealing with new roles and changes in life as a result of death of loved one

17. Grieving Coping and type of death: Depends on circumstances of death May lead to PTSD Difficult to deal with death of a child Cultural diversity in Healthy grieving: Some cultures emphasize the importance of breaking bonds with the deceased and returning quickly to autonomous lifestyles In Non-Western cultures beliefs vary extensively There is no one right, ideal way to grieve

18. Losing a life partner The death of an intimate partner brings profound grief 13 percent men and 40 percent of women are widowed. (U.S. Census Bureau, 2012) People cope with spouse death in different ways Social support is an important buffer for grieving

19. Forms of Mourning In 2012, 42 percent of deaths were followed by cremation Funerals are an important aspect of mourning in many cultures Cultures vary in how they practice mourning