Transcript Death, Dying, and Bereavement PS277 – Lecture 19 – Chapter 13 Literary Commentary on the Great Mystery: Shakespeare vs.

Death, Dying, and
Bereavement
PS277 – Lecture 19 – Chapter 13
Literary Commentary on the Great
Mystery: Shakespeare vs. Dylan Thomas
 Julius Caesar: “Of all the wonders that I have
yet heard, It seems to me most strange that
men should fear;
 Seeing that death, a necessary end,
 Will come when it comes.”
 Dylan Thomas: “Do not go gentle into that
good night. Old age should burn and rave at
close of day; rage, rage against the dying of
the light.”
Outline
 Euthanasia and Death
 Cultural and Historical Context of Death
 Experiencing Death Personally
 Dying as a Process
 Death Anxiety
 Grieving: Process and Causes
Medical - Legal Definitions of
Death
 Modern medical definitions focus on concept of “brain
death”
 Strong definition = absence of both cortical and brain
stem functions and reflexes, total unconsciousness
 Other conditions which might produce this state must be
ruled out
 Inability to live on own, without use of supportive
technology for cardiovascular function
Various States of Awareness
after Injury and Their Relations
Euthanasia Issues: Ending
Life
 Active vs. Passive Euthanasia – actively inducing death vs.
withholding treatment. More of an issue as life sustaining
technology has developed to more sophisticated levels
 Terri Schiavo case (March, 2005) – withholding of
nourishment from a woman in persistent vegetative state for
15 years – US Supreme Court upheld husband’s right to have
feeding tube removed
 Legal issues – some countries and jurisdictions allow active
euthanasia under medical supervision (e.g., the Netherlands)
 Canadians can leave a DNR document to prevent use of
extraordinary measures, but active euthanasia is illegal – Sue
Rodriguez case, ALS
 Hitler’s “euthanasia” programs for undesirable persons!
Historical Context of Death and Dying
 Death occurs primarily away from home and from our
everyday life
 60 years ago, fewer than 50% of all deaths occurred at
hospital, now over 80% do
 Philippe Aries, a French historian, notes how much this
has led to the “hiding” of death: “Our senses can no
longer tolerate the sights and smells that in the early 19th
century were part of daily life, along with suffering and
illness. The physiological effects have passed from daily
life to the aseptic world of hygiene, medicine and
morality…The hospital has become the place of solitary
death.”
My Grandparents
 Both died at home in
1958
 Very quickly and
within two weeks of
one another
Some Issues for Person and Society
of Our Modern Technological Context
 Personal: Dying alone more common today
 Personal: Dying with little dignity or control
 Society: Avoidance of contemplation of death
and dying
 Society: Difficulty in accepting death as a
natural process
Sherwin Nuland: How We Die
Immediate Causes and
Experience of Death
 Nuland’s 23 cases of autopsy of people in 80’s & 90’s: 7 heart
attacks, 4 strokes, 3 pneumonias, 5 “severe infections”, 4
advanced cancers – these are the most common ends
 All of these 23 cases had serious atherosclerosis diseases of
heart or brain associated with aging, plus many other incidental
diseases – “wear and tear” for every one of them
 Lack of oxygen is most direct cause of death, however
 Sequence of death: shock due to oxygen loss to organs,
agonal moments (gasping, etc.), clinical death, irretrievable
mortality
 Common for the brain to secrete endorphins during these final
moments, makes people more tranquil than we might expect
Famous African Explorer, David
Livingstone’s Lion Attack – 1844, Age 30
 Later description of the attack, which almost killed him:
 “Growling horribly close to my ear, he shook me as a dog
does a rat. The shock produced a stupor similar to that
which seems to be felt by a mouse after the first shake of
the cat. It caused a sort of dreaminess, in which there
was no sense of pain nor feeling of terror, though quite
conscious of all that was happening. The shake
annihilated fear, and allowed no sense of horror in
looking round at the beast. This peculiar state is
probably produced in all animals killed by carnivores;
and if so, is a merciful provision by our benevolent
Creator for lessening the pain of death.”
Kubler-Ross: Stages of Death
and Dying
Stages of Dying and the
Process Itself
 Kubler-Ross’s 5 stages:
 Shock and Denial
 Anger (“Why me?”)
 Bargaining
 Depression, sadness
 Acceptance/accommodation
 Not likely that these represent stages or that everyone
experiences all of them
 Cultural variations may shape these, etc.
Fear of Death and Some of Its
Correlates
 What do you fear most about death?
 Generally, people fear most the process of dying and
the unknown
 Religiosity can be an important factor in moderating fear
of unknown
 Previous experience with death of a loved one can affect
 Feelings of purpose and accomplishment can help lower
fear
Age Differences in Fear of
Death
Coping with the Fear and
Avoidance of Death
 Exercises: Doing a personal obituary
 Decide on final scenarios – end state care,
hospice care, funeral choices, burial or
cremation, etc.
 Thich Nhat Han: Contemplating being dead:
Buddhist meditation exercises – imaging
yourself as a corpse and meditating on what will
happen to it…not fun, but important to
integrating one’s death and life with
equanimity?
My Parents
My Father’s Death
 Non-Hodgkin’s lymphoma – cancer of the blood
 Recurrence led to very low red blood counts and heavy
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stress on heart, many other health problems w/ treatment
Last 2 years – in and out of hospital many times
Hospice care at home, but limited time permitted in US
Several times convinced he was dying, angina symptoms
End: had a fall, high fever, etc. – had to go to hospital
Last phase was short, massive pneumonia - led to death
in a few days
Very clear that wanted to die
Able to say good-bye to family + strong religious beliefs
Last evening- not completely lucid, but very gentle ending
Funeral was a positive process, community celebration of
his life
Bereavement and Grief
 Grief work: Freud’s theory of the need to “work through”
attachment to lost person and resolve negative emotions over
time, important to talk through the loss
 Recent research questions – those who do more early “grief
work” actually seem to have more problems later on
 Wortman & Silver found much variability in grieving, not the
case that failure to grieve necessarily means problems –
several patterns are normal
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typical (high initial, fairly quick recovery) = 35%
chronic (high over several years) = 30%-35%
delayed (low then increases) = 5%
absent (person shows and feels little distress at all) = 25%
Loss of Parents
 Loss of parents is the most expectable
bereavement, but still very difficult
 Has much symbolic meaning about
one’s generational place
 Context is everything – my father’s
parents and his grief
Darwin’s Father Robert
 Darwin’s father, Robert,
died in 1848, age 82, of
heart failure
 Darwin’s illness during
these months was much
worse, he visited often
but could not attend
funeral
 Darwin had a very
difficult relationship as
child, but was closer to
father as adult
Loss of a Spouse
 Disrupts immune function, strong rise in
depression for some time, 1-2 years as typical
for older adult spouses
 Quality of bond, social support available, other
factors can moderate these effects – Emma
Darwin
 Seems to be worse in some ways for men, who
may have less social support, harder time
talking about this
Losing a Child
 Seems most “unnatural,” probably hardest to fully resolve
 Historical Context: Many parents in past generations
lost children to illness, etc. Some people have suggested
that attachments to infants were less – these claims are
strongly disputed, certainly grief occurred nonetheless
 My cousin’s daughters - sudden, shocking, more difficult
to handle immediately, some research suggests stronger
health effects for sudden deaths
 Overall, grieving is highly individual, variable, personal –
takes time
Darwin’s First Daughter, Annie
 Parents’ favourite, died at
age 10 in 1851 of TB
 Darwin did not attend this
funeral either, overcome
with grief
 Lost what little faith he
had left at this point,
though his wife continued
to believe
 Annie’s box