Copyright © Allyn & Bacon 2007 Development Through the Lifespan Chapter 18 Death, Dying, and Bereavement This multimedia product and its contents are protected

Copyright © Allyn & Bacon 2007

Development Through the LifespanDevelopment Through the Lifespan

Chapter 18

Death, Dying, and Bereavement

This multimedia product and its contents are protected under copyright law. The following are prohibited by law:

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Chapter 18

Death, Dying, and Bereavement

This multimedia product and its contents are protected under copyright law. The following are prohibited by law:

Any public performance or display, including transmission of any image over a network;

Preparation of any derivative work, including the extraction, in whole or in part, of any images;

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Phases of DyingPhases of Dying

Agonal phase Suffering in first moments body can no

longer support life

Clinical death Heart, breathing, brain stopped,

but still can resuscitate

Mortality Permanent death

Agonal phase Suffering in first moments body can no

longer support life

Clinical death Heart, breathing, brain stopped,

but still can resuscitate

Mortality Permanent death


Defining DeathDefining Death

Brain death All activity in brain and brain stem stopped Irreversible

Persistent vegetative state Activity in cerebral cortex stopped Brain stem still active

Brain death All activity in brain and brain stem stopped Irreversible

Persistent vegetative state Activity in cerebral cortex stopped Brain stem still active


Death with DignityDeath with Dignity

Communication with and care of dying person: Assurance of support Humane, compassionate care Esteem and respect Candid about certainty of death Information to make end-of-life choices

Communication with and care of dying person: Assurance of support Humane, compassionate care Esteem and respect Candid about certainty of death Information to make end-of-life choices


Concept of DeathConcept of Death

Permanence Inevitability Cessation Applicability Causation

Permanence Inevitability Cessation Applicability Causation


Children’s Understanding of DeathChildren’s Understanding of Death

Most develop adultlike concept of death by middle childhood

Factors that affect understanding Experience with death Religious teachings Candid, sensitive

discussion with adults

Most develop adultlike concept of death by middle childhood

Factors that affect understanding Experience with death Religious teachings Candid, sensitive

discussion with adults


Adolescents’ Understanding of DeathAdolescents’ Understanding of Death

Logically understand death, but problems applying idea to their real lives High-risk activities

Conversations with parents promote understanding

Logically understand death, but problems applying idea to their real lives High-risk activities

Conversations with parents promote understanding


Discussing Death with Children and AdolescentsDiscussing Death with Children and Adolescents

Take the lead Listen perceptively Acknowledge feelings Provide facts

Be culturally sensitive

Joint problem solving

Take the lead Listen perceptively Acknowledge feelings Provide facts

Be culturally sensitive

Joint problem solving


Adulthood andUnderstanding of DeathAdulthood andUnderstanding of Death

Early Adulthood

Avoidance• Death anxiety• Death considered distant

Middle Adulthood

• Begin to think of death• Aware of limited time left to live

• Focus on tasks to be completed

Late Adulthood

• Think and talk more of death• Practical concern about how and when


Death AnxietyDeath Anxiety

Cultural Variations

Religious teachings Westerners -

spirituality, meaning of life

Cultural Variations

Religious teachings Westerners -

spirituality, meaning of life

Individual Variations

Personal philosophy of death

Consistency of religious beliefs and practice

Symbolic immortality Age Gender

Individual Variations

Personal philosophy of death

Consistency of religious beliefs and practice

Symbolic immortality Age Gender


Age, Gender, and Death AnxietyAge, Gender, and Death Anxiety


Kübler-Ross’s TheoryKübler-Ross’s Theory

Denial Anger Bargaining Depression Acceptance

Denial Anger Bargaining Depression Acceptance


Appropriate DeathAppropriate Death

Makes sense with person’s pattern of living, values

Preserves or restores significant relationships

Free of suffering As much as possible

Makes sense with person’s pattern of living, values

Preserves or restores significant relationships

Free of suffering As much as possible


Communicating withDying PeopleCommunicating withDying People

Be truthful Diagnosis Course of disease

Listen perceptively Acknowledge feelings Maintain realistic hope Assist final transition

Be truthful Diagnosis Course of disease

Listen perceptively Acknowledge feelings Maintain realistic hope Assist final transition


Factors That Influence Thoughts About DyingFactors That Influence Thoughts About Dying Cause of death

Nature of disease

Personality Coping style Family members’ behavior Health professionals’ behavior Spirituality and religion Culture

Cause of death Nature of disease

Personality Coping style Family members’ behavior Health professionals’ behavior Spirituality and religion Culture


Places of DeathPlaces of Death

Home Most preferred Only 20–25% die at home

Hospital Emergency room Intensive care unit Cancer care unit

Hospice

Home Most preferred Only 20–25% die at home

Hospital Emergency room Intensive care unit Cancer care unit

Hospice


Hospice ApproachHospice Approach

Comprehensive support for dying and their families Family and patient as a unit Team care Palliative (comfort) care Home or homelike Bereavement help

Comprehensive support for dying and their families Family and patient as a unit Team care Palliative (comfort) care Home or homelike Bereavement help


Forms of EuthanasiaForms of Euthanasia

Voluntary Passive

• Withdraw treatment• Advance medical directives

Voluntary Active

Medical staff or others act to end life at patient’s request

Assisted Suicide

• Medical staff provide means for patient to end own life• Controversial

Involuntary Active

Medical staff end life without patient’s consent


Advance Medical DirectivesAdvance Medical Directives

Living Will Specify unwanted treatments

Durable Power of Attorney for health care Appoint someone to make health

care decisions

Living Will Specify unwanted treatments

Durable Power of Attorney for health care Appoint someone to make health

care decisions


International Public Opinion onVoluntary Active EuthanasiaInternational Public Opinion onVoluntary Active Euthanasia


Assisted SuicideAssisted Suicide

Doctor provides drugs for patient to use Legal in few nations, only in Oregon in U.S. Few use

.1% in Oregon Highly controversial

About half disapprove Some find option comforting

Doctor provides drugs for patient to use Legal in few nations, only in Oregon in U.S. Few use

.1% in Oregon Highly controversial

About half disapprove Some find option comforting


Grief ProcessGrief Process

Avoidance “Emotional anesthesia”

Confrontation Most intense grief

Restoration Dual-process model of coping with loss

Alternate between dealing with emotions and with life changes

Avoidance “Emotional anesthesia”

Confrontation Most intense grief

Restoration Dual-process model of coping with loss

Alternate between dealing with emotions and with life changes


Grieving Sudden or Prolonged DeathsGrieving Sudden or Prolonged Deaths

Sudden, Unexpected

Avoidance from shock and disbelief

May not understand reasons

Suicide especially hard

Sudden, Unexpected

Avoidance from shock and disbelief

May not understand reasons

Suicide especially hard

Prolonged, Expected

Anticipatory grieving Allows emotional

preparation Reasons usually

known

Prolonged, Expected

Anticipatory grieving Allows emotional

preparation Reasons usually

known


Difficult Grief SituationsDifficult Grief Situations

Parents losing a child Children or adolescents

losing a parent Adults losing an

intimate partner Bereavement overload

Parents losing a child Children or adolescents

losing a parent Adults losing an

intimate partner Bereavement overload


Bereavement InterventionsBereavement Interventions

General Support

Sympathy, understanding Patient listening, “being there”

Interventions Self-help groups Daily living help

Children & Adolescents

After violent death, prevent unnecessary reexposure Help adults master own distress

Difficult situations

Sudden, violent, unexplained, ambiguous deaths Grief therapy, individual counseling


Resolving GriefResolving Grief

Give yourself permission to feel the loss

Accept social support

Be realistic about course of grieving

Remember the deceased

When ready: Engage in new activities, relationships Master tasks of daily living


Death EducationDeath Education

Courses in death and dying Offered at many educational levels

Lecture format Increases discomfort

Experiential format Role playing, discussions,

guests, field trips May reduce death anxiety

Courses in death and dying Offered at many educational levels

Lecture format Increases discomfort

Experiential format Role playing, discussions,

guests, field trips May reduce death anxiety


Goals of Death EducationGoals of Death Education

Understand physical, psychological changes in dying

Learn to cope with death of loved ones Inform consumers of medical, funeral

services Understand social, ethical issues

Understand physical, psychological changes in dying

Learn to cope with death of loved ones Inform consumers of medical, funeral

services Understand social, ethical issues

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Copyright © Allyn & Bacon 2007 Development Through the Lifespan Chapter 18 Death, Dying, and Bereavement This multimedia product and its contents are protected