Death and GrievingDeath and Grieving

Chapter 17Chapter 17

Issues in Determining DeathIssues in Determining Death

Brain deathBrain death —— neurological definition neurological definition of deathof death All electrical activity of brain has ceased All electrical activity of brain has ceased

for a specified period of timefor a specified period of time

Flat EEG recordingFlat EEG recording

Some medical experts argue criteria for Some medical experts argue criteria for death should include only higher cortical death should include only higher cortical functioningfunctioning

Death becoming increasingly Death becoming increasingly complexcomplex

1. When to determine death has 1. When to determine death has

occurred?occurred?

2. Life expectancy has increased2. Life expectancy has increased

3. Care for dying shifted away from 3. Care for dying shifted away from

familyfamily

4. Minimized exposure to death and its 4. Minimized exposure to death and its

painpain

Death in Different CulturesDeath in Different Cultures

Most societies haveMost societies have Philosophical or religious beliefs Philosophical or religious beliefs

about deathabout death

Rituals that deal with deathRituals that deal with death

View that death does not end View that death does not end existenceexistence

U.S. Denial and Avoidance of Death ?U.S. Denial and Avoidance of Death ?

Funeral industry emphasizes lifelike Funeral industry emphasizes lifelike qualitiesqualities

Euphemisms Euphemisms — softening— softening language language for deathfor death

Persistent search for “fountain of Persistent search for “fountain of youth”youth”

Rejection and isolation of agedRejection and isolation of agedHope that everyone goes to heavenHope that everyone goes to heavenMedical emphasis Medical emphasis —— prolonging life, prolonging life,

not easing sufferingnot easing suffering

Attitudes Toward Death at Different Attitudes Toward Death at Different Points in the Life SpanPoints in the Life Span

Childhood

Adolescence

Adulthood

Infant has no concept of death; perceptions of death develop in middle/late childhood; even very young children concerned about separation and loss

Develop more abstract concepts of death; common to think they are immune to death

Middle-aged adults fear death more than young adults or older adults; older adults think about death more

SuicideSuicideA Developmental Perspective of Death

Serious physical Serious physical illnessillness

Feelings of Feelings of disparity, isolation, disparity, isolation, failure, lossfailure, loss

Serious financial Serious financial problemsproblems

Drug use or prior Drug use or prior suicide attemptssuicide attempts

Antidepressant linksAntidepressant links

– Cultural and gender differences exist

– Rare in childhood, risk increase in adolescence

– Most adolescent attempts fail

– Linked to genetic and situational factors

– Gay or lesbian links not clear

Risk factors

Facing One’s Own DeathFacing One’s Own Death

Most dying individuals want to Most dying individuals want to make decisions regarding their make decisions regarding their life and deathlife and death

Complete unfinished businessComplete unfinished business

Resolve problems and conflictsResolve problems and conflicts

Put their affairs in orderPut their affairs in order

Kubler-Ross’ Stages of DyingKubler-Ross’ Stages of Dying

Denial and isolation

Anger

Bargaining

Denies s/he is going to die

Denial gives way to anger, resentment, rage, and envy

Develops hope that death can somehow be postponed

Depression

Acceptance

Comes to accept the certainty of her or his death

Develops sense of peace and may desire to be left alone

Perceived Control and DenialPerceived Control and Denial

When individuals believe they can When individuals believe they can influence and control events, they may influence and control events, they may become more alert and cheerfulbecome more alert and cheerful

Denial can be adaptive or maladaptiveDenial can be adaptive or maladaptive

Care for Dying IndividualsCare for Dying Individuals ? ?

Death in U.S.: often lonely, prolonged, Death in U.S.: often lonely, prolonged, painfulpainful

Plan for your deathPlan for your death Make a living willMake a living will

Give someone power of attorneyGive someone power of attorney

Give your doctor specific instructions Give your doctor specific instructions

Discuss desires with family and doctorDiscuss desires with family and doctor

Check insurance plan coverageCheck insurance plan coverage

The Contexts in Which People DieThe Contexts in Which People Die

Most would rather die at home but Most would rather die at home but worry overworry over

Burden at homeBurden at home

Limited spaceLimited space

May alter relationshipsMay alter relationships

Competency and availability of emergency Competency and availability of emergency medical treatment medical treatment

Communicating with the Dying PersonCommunicating with the Dying Person Establish your presenceEstablish your presence

Eliminate distractionEliminate distraction

Limit visit timeLimit visit time

DonDon’’t insist on t insist on acceptanceacceptance

Allow expressions of guilt Allow expressions of guilt or angeror anger

Discuss alternatives, Discuss alternatives, unfinished businessunfinished business

Ask if there is anyone s/he Ask if there is anyone s/he would like to seewould like to see

Encourage the dying Encourage the dying individual to reminisceindividual to reminisce

Talk with the individual Talk with the individual when s/he wishes to talkwhen s/he wishes to talk

Express your regard Express your regard

Decisions Regarding Life, Decisions Regarding Life, Death, and Health CareDeath, and Health Care

Natural Death Act and Advance Natural Death Act and Advance DirectiveDirective

Expresses person’s desires regarding Expresses person’s desires regarding extraordinary medical procedures that extraordinary medical procedures that might be used to sustain life when might be used to sustain life when medical situation becomes hopelessmedical situation becomes hopeless

EuthanasiaEuthanasia Painlessly ending lives of persons suffering from Painlessly ending lives of persons suffering from

incurable diseases or severe disabilitiesincurable diseases or severe disabilities

Passive euthanasiaPassive euthanasia —— withholding of withholding of available treatments, allowing the available treatments, allowing the person to dieperson to die

Active euthanasiaActive euthanasia —— death induced death induced deliberately, as by injecting a lethal deliberately, as by injecting a lethal dose of drugdose of drug

Publicized controversy: assisted suicidePublicized controversy: assisted suicide

Care for Dying IndividualsCare for Dying Individuals

Hospice Hospice — humanized program — humanized program committed to making the end of committed to making the end of life as free from pain, anxiety, and life as free from pain, anxiety, and depression as possibledepression as possible

Palliative care Palliative care — reducing pain — reducing pain and suffering and helping and suffering and helping individuals die with dignityindividuals die with dignity

When Others DecideWhen Others Decide

Remember Terry SchaivoRemember Terry Schaivo

What is a persistent vegetative What is a persistent vegetative state?state?

Who decides?Who decides?

What are their motives?What are their motives?

Should the government Should the government decide?decide?

Social security bankruptcy – worker-Social security bankruptcy – worker-pensioner imbalancepensioner imbalance

Medicare/Medicaid bankruptcyMedicare/Medicaid bankruptcy

Generational inequity – rationing of Generational inequity – rationing of carecare

GrievingGrievingGriefGrief: emotional numbness; a : emotional numbness; a

complex emotional state of…complex emotional state of… DisbeliefDisbelief Separation anxietySeparation anxiety DespairDespair SadnessSadness Loneliness Loneliness

……that accompanies loss of that accompanies loss of someone we lovesomeone we love

Cultural Diversity in Healthy GrievingCultural Diversity in Healthy Grieving

Contemporary western orientationContemporary western orientation

Breaking bonds with the deadBreaking bonds with the dead

Returning survivors to autonomous Returning survivors to autonomous

lifestylelifestyle

Non-Western culturesNon-Western cultures

Maintaining ties with deceased Maintaining ties with deceased

Influenced by religious beliefs and Influenced by religious beliefs and

lifestylelifestyle

Making Sense of GriefMaking Sense of Grief

Grieving stimulates many to try to Grieving stimulates many to try to make sense of their world make sense of their world —— positive positive themes linked to hopeful future and themes linked to hopeful future and better adjustmentbetter adjustment

Effort to make sense of it pursued Effort to make sense of it pursued more vigorously when caused by an more vigorously when caused by an accident or disasteraccident or disaster

Losing a Life PartnerLosing a Life PartnerThose left behind after the death of an Those left behind after the death of an

intimate partner suffer profound grief intimate partner suffer profound grief and often endureand often endure

Financial lossFinancial loss

Loneliness linked to poverty and Loneliness linked to poverty and

educationeducation

Increased physical illnessIncreased physical illness

Psychological disorders, including Psychological disorders, including

depressiondepression

Marital Quality and Marital Quality and Adjustment to WidowhoodAdjustment to Widowhood

Widowhood associated with Widowhood associated with increased anxiety among those increased anxiety among those highly dependent on their spouseshighly dependent on their spouses

Lower anxiety for those who did Lower anxiety for those who did not depend on their spouse very not depend on their spouse very muchmuch

Forms of MourningForms of Mourning

Approximately 80 percent of corpses are disposed Approximately 80 percent of corpses are disposed of by burial, the remaining 20 percent by of by burial, the remaining 20 percent by cremation cremation

Funeral industry is source of controversyFuneral industry is source of controversy

Funeral is important aspect of mourning in many Funeral is important aspect of mourning in many culturescultures

Cultures vary in how they practice mourningCultures vary in how they practice mourning

Amish MourningAmish Mourning

Conservative group; family-oriented Conservative group; family-oriented

societysociety Live same unhurried pace as ancestorsLive same unhurried pace as ancestors

Time of death met with calm acceptanceTime of death met with calm acceptance

Neighbors notify community; funeral atNeighbors notify community; funeral at homehome

High level of support to family for one yearHigh level of support to family for one year

Traditional Judaism and MourningTraditional Judaism and Mourning

Mourning in graduated time periods; Mourning in graduated time periods; each with appropriate practiceseach with appropriate practices

1st period: 1st period: AninutAninut —— between death between death and burialand burial

2nd period: 2nd period: AvelutAvelut period period —— mourning mourning properproperShivahShivah period period —— 7-day begins at burial 7-day begins at burialSheloshimSheloshim period period —— 30-day period after 30-day period after

burialburial

Mourning over for all but parents who Mourning over for all but parents who mourn another 11 monthsmourn another 11 months