1. Death and Dying

2.  Three paths to death: 1. Death occurs without any warning.  Accident  Sudden, fatal, age-related event (heart attack, stroke) 2. People decline steadily as they approach death.  Dx with a fatal disease, possibly in the advanced stages 3. People have an erratic course; fatal disease takes years or decades with ups and downs.  Most common dying pattern  Typically helped by medical technology

3.  Death as a natural part of life (eighteenth and nineteenth century)  No medicine − People died quickly of infectious diseases.  Dying was familiar − It was routine event at every stage of life and a typical part of the community.  Later, due to fears of disease, death became more removed from the community.  Death is vigorously addressed by doctors (early twentieth century)  Modern medicine conquers infectious diseases, moving death to the end of the lifespan.  Dying moved to hospitals, far from view.  Result was that dying is a strange, frightening “health-care-managed” event.  Death awareness movement (late 1960s)  Talking about death becomes acceptable.  Thanatology (study of death and dying) classes became the rage on university campuses.  Doctors were more willing to talk about cancer.

4. ‘The aim of all life is death...inanimate things existed before living ones’ (Freud 1920)  Eros- (the life drive/instinct, libido [life energy])  Thanatos- (the death drive/instinct, mortido [death energy], aggression) According to Freud, these two forces fight each other, and their conflict and interaction determine the development of individual life and culture.

5.  Denial  Person may believe the diagnosis was a mistake.  May try to get several “second opinions”  Anger  Person may lash out, maybe even at the doctor.  Bargaining  Person may plead for more time, often to God.  Makes promises to be “good” if death is delayed  Depression  Person becomes distraught by the thought of his or her death.  Acceptance  Final stage where the person begins to accept his or her fate.

6.  A child’s death outweighs any other loss. It is more devastating than any other life event.  What can help parents deal with the death? Discussing death with a child can help parent avoid any regrets. Sharing in the hands-on care during the final days can be rewarding. Feeling health-care providers are caring and supportive can help relieve some of the pain.

7.  Guidelines for a good death: 1. Minimize physical distress to be free of possible debilitating pain. 2. Maximize psychological security, and reduce fear and anxiety, thus feeling in control of death. 3. Enhance relationships and be close as possible to loved ones. 4. Foster spirituality and have a sense of integrity and purpose in life.