Transcript Slide 1

CHAPTER 19
DEATH AND DYING
DYING AND DEATH ACROSS THE LIFESPAN
What is death?
Although the question seems straightforward, defining
the point at which life ceases and death occurs is
surprisingly complex
• Functional death: is defined by an absence of heartbeat
and breathing. Although this definition seems
unambiguous, it is not completely straightforward.
• Brain death: occurs when all signs of brain activity, as
measured by electrical brain waves, have ceased.
• Legal death: of death in most localities in the United
States relies on the absence of brain functioning,
although some laws still include a definition relating to
the absence of respiration and heartbeat.
Death across the Life Span: Causes and
Reactions
• Despite its economic wealth, the United States has a
relatively high infant mortality rate
• In 48 other countries infants died less often in the first year of
birth than in the United States (World Fact Book, 2012)
• Infancy and childhood
– Miscarriage
– Still birth
– Sudden infant death
– Accidents #1
– Homicides #4
Death across the Life Span: Causes and
Reactions
Childhood
• No concept of death until around the age of 5
• Around the age of 5, better understanding of finality and
irreversibility of death
• By about age 9, acceptance of universality and finality of
death
• By middle childhood, understanding of some customs
involved with death (e.g., funerals, cremation, and
cemeteries)
Death across the Life Span: Causes and
Reactions
Adolescence
• View of death are often unrealistic
• Sense of invincibility
• Personal fable
• Imaginary audience
Terminal Illness
• Denial
• Depression
Death across the Life Span: Causes and
Reactions
Young Adulthood
• Prime time of life
• Death seems unthinkable
• Creates feelings of anger and impatience
Concerns
• Desire to develop intimate relationships and express
sexuality
• Future planning
Death across the Life Span: Causes and
Reactions
Middle Adulthood
• Life-threatening disease not surprising
• Fear of death often greatest
Causes
• Heart attack or stroke
Death across the Life Span: Causes and
Reactions
Late adulthood
• Realize death is imminent
• Face an increasing number of deaths in their
environment
• Less anxious about dying
Causes
• Cancer, stroke, and heart disease
• Terminal death
• a significant drop in performance in cognitive areas such as
memory and reading may foreshadow death within the next few
years.
Terminal Decline
• Suffering
• Burden to loved ones
• Decrease in value to society
Adding Years
Suicide in Later Life
• Rate for men climbs steadily during late adulthood
• No age group has a higher rate of suicide than white
men over the age of 85
– Severe depression
– Some form of dementia
– Loss of a spouse
Differing Conceptions of Death
Has one person died a better death than the other?
• Depends on values related to cultural and subcultural teachings
Differing views
• Death as punishment
• Death as judgment about contributions to society
• Death as start of redemption or start of eternal life
Religious influence
• Christian and Jewish
• Sunni Muslim
• Druze
CONFRONTING DEATH
Are there steps toward death?
Kübler-Ross
•Developed a theory of death and dying
•Built on extensive interviews with people who were dying
•With input from those who cared for them
Kübler-Ross Theory
Evaluating Kübler-Ross’ Theory
PROS
CONS
• One of first people to observe
systematically how people
approach their own deaths
• Increased public awareness
and affected practices and
policies related to dying
• Largely limited to those who
are aware that they are dying
• Less applicable to people
who suffer from diseases in
which the prognosis is
uncertain
• Stage-like increments
questioned
• Anxiety levels not included
• Some people report feelings
of yearning rather than anger
or depression
Other Theorists
Edwin Shneidman
•“Themes” in people's reactions to dying that occur—and
recur—in any order throughout the dying process
–incredulity, a sense of unfairness, fear of pain or even
general terror, and fantasies of being rescued
Charles Corr
•People who are dying face a set of psychological tasks
–Tasks include minimizing physical stress, maintaining
the richness of life, continuing or deepening their
relationships with other people, and fostering hope,
often through spiritual searching.
Should people be free to select the nature of
their own death?
Choosing the Nature of Death
DNR
•Issues
– Differentiates of “extreme” and “extraordinary”
measures from those that are simply routine
– Determines of individual's current quality of life and
whether it will be improved or diminished by a
particular medical intervention
– Determines of decision-maker role
Doctors and Decisions
• Medical personnel are reluctant to suspend aggressive
treatment.
• Physicians often claim to be unaware of patients’ wishes
• Physicians and other health care providers may be
reluctant to act on DNR requests
– Trained to save patients
– To avoid legal liability issues
• Many became physicians in order to SAVE lives
Living Wills
To gain more control over decisions regarding the
nature of their death, people are increasingly signing
living wills
• Living will
• Health care proxy
• Durable power of attorney
Euthanasia and Assisted Suicide
Euthanasia
• Passive
• Voluntary active
Assisted suicide
• Kevorkian
• Issue of “informed consent”
• Very ill people make poor decisions
• Pain avoidance can lead to wishing for death
What are the arguments?
PROS
CONS
Pros
• Does the right belong solely to an individual, a person's
physicians, his or her dependents, the government, or
some deity?
• In the United States, it is assumed that all have the
absolute right to create lives by bringing children into the
world, some people argue that we should also have the
absolute right to end our lives.
Cons
• Practice is morally wrong.
• Prematurely ending someone's life, no matter how willing
that person may be, is the equivalent of murder.
• Physicians are often inaccurate in predicting how long a
person's life will last.
• Emotional state of the patient may be unstable.
How Long Do “Terminal” Patients Really Live?
According to the large
SUPPORT study, a
significant percentage of a
group of 3,693 patients
given no more than a 50
percent chance of living for
six months survived well
beyond that period.
Why do you think this
happened?
(Source: Based on Lynn et
al., 1997.)
Caring for the Terminally Ill
Place of Death
• Home care
• Hospice care
• Hospital care
GRIEF AND BEREAVEMENT
Mourning and Funerals: Final Rites
Costs
•Average funeral and burial costs $7,000
•Survivors are susceptible to suggestions to “provide the
best” for deceased
•Determined by social norms and customs
Cultural Differences in Grieving
Western societal rituals (some variations)
• Body preparation
• Celebration of a religious rite
• Military customs
• Other customs – like Masons, or family, or personal
wishes
Cultural Differences in Grieving
Non-Western rituals different from Western
• Examples:
– Shave heads, let hair and beard grow
– Noisy celebration and silence
– High emotional display of emotion and no display of
emotion
Feldman concludes that all funerals basically
serve the same underlying function.
They serve as a way to mark the endpoint for the life
of the person who has died—and provide a formal forum for
the feelings of the survivors, a place where they can come together
and share their grief and comfort one another.
Bereavement and Grief: Adjusting to the Death
of a Loved One
What is the difference?
• Bereavement is acknowledgment of the objective fact
that one has experienced a death
• Grief is the emotional response to one's loss.
Grieving in the Western World
• 1st stage: grief typically entails shock, numbness,
disbelief, or outright denial
• 2nd stage: people begin to confront the death and
realize extent of their loss
• 3rd stage: people reach accommodation stage
• Most people emerge from the grieving process and live
new lives, independent from the person who has died.
Form new relationships, and some even find that coping
with the death has helped them to grow as individuals.
They become more self-reliant and more appreciative of
life.
•
Death of Long-term Spouse
Death of spouse
• Strength of relationship with can have effect on grieving
process
• Almost always traumatic experience that is usually
followed by intense grief and anguish
Close Marriages
• Almost half of those who reported having satisfying
marriages were able to get past their grief within six
months of the death of their spouses
•
• People who enjoy close and happy marriages tend to
have strong interpersonal skills on which to rely during
their time of loss. They may be better equipped to call
upon friends, family, and even a professional counselor if
necessary to assist them through their grieving period.
Close Marriages
• Surviving spouses who enjoyed a close marriage are
more likely to have settled lingering issues and to have
talked through what would happen after either of them
died; they therefore are more likely to feel secure in
knowing what their departed would have wanted for
them in widowhood.
• Finally, spouses who have a close and secure
relationship may simply have a better opportunity to say
their final goodbyes as one of the partners’ heath fails.
Strained marriages
• Surviving partners of strained marriages might feel more
sadness over never having achieved a desired level of
closeness, or they might regret not having an opportunity
to resolve lingering conflicts, or they might feel guilty
about not working harder to make their marriage better
when they had the chance.
• Slower recovery
• Increased possibility of permanent personality and
relationship changes
When Grief Goes Awry
• No particular timetable for grieving
• For some people (but not all) grieving may take
considerably longer than a year
• Only 15 to 30 percent of people show relatively
deep depression following loss of loved one
• Those who show most intense distress
immediately after a death are most apt to have
adjustment difficulties and health problems later
on
Consequences of Grief and Bereavement
Negative
• Widowed people are
particularly at risk of death
• More negative
consequences if person is
already insecure, anxious,
or fearful, overly
dependent, or lacking in
social support
• Sudden death
Positive
• Remarriage lowers risk of
death for survivors,
especially for widowers
Survivor Risks
• risk of death is as much as seven times higher than
normal in the first year after the death of a spouse.
• At particular risk are men and younger women
• Those highly dependent on the person who died, and
who therefore feel more vulnerable without them, are apt
to suffer more after the death, as are those who spend a
great deal of time reflecting on a loved one's death and
their feelings of grief.
• Those lacking social support from family, friends, or a
connection to some other group, religious or otherwise,
are more likely to experience feelings of loneliness, and
therefore are more at risk.
• Those unable to make sense of the death or find
meaning in it show less overall adjustment.
How Helpful Is Grief Counseling?
Effectiveness and the necessity of grief counseling
services has recently been called into question
• Meta-analysis of more than 60 studies of therapeutic
interventions for bereaved people concluded that these
grief counseling did not help significantly more than the
mere passage of time
• There are many variations on how people react to the
death of a loved one, friend, or acquaintance
• Care should be taken about applying preconceptions
about the course of grief as people cope with death
Helping a Child Cope with Grief
• Be honest
• Encourage expressions of grief
• Reassure children that they are not to blame for the death
(But be careful NOT to introduce idea!)
• Understand children's grief may surface in unanticipated ways
• Children may respond to books for young persons about
death