1. Chapter 15: Dying and Bereavement “I am not afraid of death – I just don’t want to be there when it happens!” Woody Allen

2. The Many Faces of Death Death as an image Tombstone Hearse Death as a statistic Mortality rates Life expectancy tables Death as an event Funeral Memorial Service

3. Faces of Death (cont.) Death as a state of being Nonthingness Being with God Death as an analogy Dead meat Dead as a doornail Death as a mystery What is it like to die? What happens after death?

4. Faces of Death, contd. Death as a boundary You’ll never get out of this world alive How many years do I have left? Death as a thief of meaning I have much left to do I feel so cheated Death as fear/anxiety I’m afraid to die I worry about my family Death as a reward or punishment The wicked go to Hell Heaven awaits the just

5. Brain Death No spontaneous movement No spontaneous respiration/1 hour Total lack of responsiveness No eye movement (blinking/pupil) No postural activity – swallowing, yawning, vocalizing No motor reflexes Flat EEG - 10 minutes No change in any of these if tested again in 24 hours

6. Issues about Death Persistent Vegetative State Cortical functions cease Brain stem activities continue Euthanasia Active Passive Dr. Kevorkian

7. Ideas about Death Childhood Death of a pet Lack of abstractive abilities Adolescence Sensitive – still no real restriction until personal experience Young Adulthood Cheated of future Middle Age Most people confront death at this time Late Adulthood Imminent

8. Death Anxiety Elisabeth Kübler-Ross Stage Theory Denial Anger Bargaining Depression Acceptance

9. Alternate Theory Phase Theory (Pattison) Acute – become aware that condition is terminal High anxiety, denial, anger, and bargaining Chronic Living Dying Phases Adjusts to idea of terminal illness Anxiety declines Terminal phase - withdrawal

10. Task Based Approach 1. Satisfy physical needs – minimize physical stress 2. Maximize psychological security – live life to fullest 3. Sustain/enhance interpersonal Commitments 4. Develop/reaffirm spiritual energy; fosters hope.

11. Hospice - dying with dignity - Grief Process Acknowledge reality of loss Work through emotional turmoil Adjust to environment where deceased is absent Loosen ties to deceased.

12. Death expectations Expected vs. unexpected death Grief over time Abnormal grief reactions Death of loved ones Death of parent Death of child Death of partner