1. CHAPTER THIRTEEN CHAPTER THIRTEEN Dying and Bereavement

2. Sociocultural Definitions of Death All cultures have their own ideas about death, mourning rituals and states of bereavement

3. Legal and Medical Definitions Clinical death ( accepted for hundreds of years) –Lack of heart beat and respiration Whole-Brain death (most widely accepted today) –Includes eight specific criteria, all of which must be met No spontaneous responses to any stimuli No spontaneous respiration for at least 1 hour Total lack of responsiveness to even the most painful stimuli No eye movements, blinking, or pupil responsiveness No postural activity, swallowing, yawning, or vocalizing No motor reflexes A flat EEG for at least 10 minutes No change in any of these when tested again 24 hours later

4. Legal and Medical Definitions Persistent vegetative state: a person does not recover following –Disruption of the blood flow to the brain –Severe head injury –Drug overdose –Abby Dorn case

5. Ethical Issues Bioethics –Examines the interaction between human values and technological advances Euthanasia –The practice of ending life for reasons of mercy

6. Euthanasia Two types of euthanasia –Active euthanasia Deliberately ending someone’s life through some sort of intervention or action –Passive euthanasia Ending someone’s life by withholding treatment Oregon Death with Dignity Law – 1994 –Provides for people to obtain prescriptions for self- administered lethal doses of medication –Terri Schiavo case

7. The Price of Life-Sustaining Care A growing debate concerns the costs for keeping someone alive through technology and includes financial, personal, and moral costs.

8. A Life Course Approach to Dying Young adults report a sense of being cheated by death. Middle-aged adults begin to confront their own mortality and undergo a change in their sense of time lived and time until death. –When their parents die, people realize they are the oldest generation. Older adults are more accepting of death.

9. Coping with Death: Kübler-Ross’s 5-Stage Theory DENIAL: Often first reaction; likely to be shock and disbelief ANGER: At some point people express anger (hostility, resentment, frustration, envy) BARGAINING: Looking for a way out; setting a timetable DEPRESSION: Occurs when one can no longer deny the illness ACCEPTANCE: Realizing that death is inevitable; often results in detachment from the world and sense of peace.

10. Coping with Death: Kübler-Ross’s 5-Stage Theory Movement through the stages: –Some people do not progress through all of these stages, and people move through them at different rates. –People may be in more than one stage at a time and do not necessarily go through them in order.

11. Coping with Death: A Contextual Theory of Dying Stage theories of dying: assume some sort of underlying process for moving from one stage to another do not clearly state what a person must do to move from one stage to another Contextual theories of dying emphasize: –Tasks and issues that a dying person must face –No right way to die (but there are better or worse ways of coping with death) –Corr identified four dimensions of tasks that must be faced. –Bodily needs, psychological security, interpersonal attachments, and spiritual energy and hope

12. Death Anxiety Death anxiety is widespread in Western culture. Several components have been identified: –Anxiety about pain –Body malfunction –Humiliation –Rejection –Nonbeing –Punishment –Interruption of goals –Negative impact on survivors These components can be expressed at public, private, and unconscious levels.

13. Death Anxiety Death anxiety is demonstrated in many different ways, including: –Avoidance of things connected with death Such as refusing to go to funerals –Directly challenging death Such as engaging in dangerous sports Less common ways to express death anxiety: –Daydreaming –Changing one’s lifestyle –Using humor –Displacing anxiety onto work –Becoming a professional who deals with death

14. Creating a Final Scenario End-of-life issues –Managing the final aspects of life –After-death disposition of the body and how one is memorialized— cremation or burial? –Distribution of assets

15. Creating a Final Scenario Making choices about what people do and do not want done –A crucial aspect of the final scenario is the process of separation from family and friends. Bringing closure to relationships –One’s final scenario helps family and friends interpret one’s death, especially when the scenario is constructed jointly.

16. The Hospice Option An approach to assisting dying people that emphasizes pain management (palliative care) and death with dignity Emphasizes quality of life rather than quantity of life The goal is a de-emphasis on the prolongation of death for terminally ill patients Both inpatient and outpatient hospices exist. The role of the staff is to be with patients, not to do things for patients.

17. Making Your End-of-Life Intentions Known Decisions regarding end-of-life issues are complex –Legal, Political, and Ethical Living will and durable power of attorney for health care –Personal preferences for medical intervention –The purpose of both is to make one’s wishes about the use of life support known in the event one is unconscious or otherwise incapable of expressing them. Do Not Resuscitate (DNR): medical order which is used when cardiopulmonary resuscitation is not desired.

18. Survivors: The Grieving Process Bereavement –The state or condition caused by loss through death Grief –The sorrow, hurt, anger, guilt, confusion, or other feelings that arise after a loss Mourning –The way we express our grief Mourning is heavily influenced by cultural norms.

19. The Grief Process Unlike bereavement, over which we have no control, grief is a process that involves choices. A person must: –Acknowledge the reality of the loss –Work through the emotional turmoil –Adjust to the environment where the deceased is absent –Loosen ties to the deceased Grief is an active coping process. Grief is complicated and personal Anniversary reaction –Grief that often returns around the anniversary of the death Grief Over Time –Grief tends to peak within the first six months. –People can grieve many years after the loss.

20. Normal Grief Reactions Disbelief Denial Shock Sadness Anger Hatred Guilt Fear Anxiety Confusion Helplessness Emptiness Loneliness Acceptance Relief Happiness Lack of enthusiasm Absence of emotion

21. News Report: Green Burials