Death and Grieving

1. Death and Grieving Chapter 17

2. Issues in Determining Death • Brain death— neurological definition of death • All electrical activity of brain has ceased for a specified period of time • Flat EEG recording • Some medical experts argue criteria for death should include only higher cortical functioning

3. Death becoming increasingly complex 1. When to determine death has occurred? 2. Life expectancy has increased 3. Care for dying shifted away from family 4. Minimized exposure to death and its pain

4. Death in Different Cultures • Most societies have • Philosophical or religious beliefs about death • Rituals that deal with death • View that death does not end existence

5. U.S. Denial and Avoidance of Death ? • Funeral industry emphasizes lifelike qualities • Euphemisms — softening language for death • Persistent search for “fountain of youth” • Rejection and isolation of aged • Hope that everyone goes to heaven • Medical emphasis — prolonging life, not easing suffering

6. Attitudes Toward Death at Different Points in the Life Span Infant has no concept of death; perceptions of death develop in middle/late childhood; even very young children concerned about separation and loss Childhood Develop more abstract concepts of death; common to think they are immune to death Adolescence Middle-aged adults fear death more than young adults or older adults; older adults think about death more Adulthood

7. A Developmental Perspective of Death Suicide Risk factors • 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 • Serious physical illness • Feelings of disparity, isolation, failure, loss • Serious financial problems • Drug use or prior suicide attempts • Antidepressant links

8. Facing One’s Own Death • Most dying individuals want to make decisions regarding their life and death • Complete unfinished business • Resolve problems and conflicts • Put their affairs in order

9. Kubler-Ross’ Stages of Dying Denial and isolation Denies s/he is going to die Denial gives way to anger, resentment, rage, and envy Anger Develops hope that death can somehow be postponed Bargaining Comes to accept the certainty of her or his death Depression Develops sense of peace and may desire to be left alone Acceptance

10. Perceived Control and Denial • When individuals believe they can influence and control events, they may become more alert and cheerful • Denial can be adaptive or maladaptive

11. Care for Dying Individuals ? • Death in U.S.: often lonely, prolonged, painful • Plan for your death • Make a living will • Give someone power of attorney • Give your doctor specific instructions • Discuss desires with family and doctor • Check insurance plan coverage

12. The Contexts in Which People Die • Most would rather die at home but worry over • Burden at home • Limited space • May alter relationships • Competency and availability of emergency medical treatment

13. Communicating with the Dying Person • Establish your presence • Eliminate distraction • Limit visit time • Don’t insist on acceptance • Allow expressions of guilt or anger • Discuss alternatives, unfinished business • Ask if there is anyone s/he would like to see • Encourage the dying individual to reminisce • Talk with the individual when s/he wishes to talk • Express your regard

14. Decisions Regarding Life, Death, and Health Care • Natural Death Act and Advance Directive • Expresses person’s desires regarding extraordinary medical procedures that might be used to sustain life when medical situation becomes hopeless

15. Euthanasia • Painlessly ending lives of persons suffering from incurable diseases or severe disabilities • Passive euthanasia— withholding of available treatments, allowing the person to die • Active euthanasia— death induced deliberately, as by injecting a lethal dose of drug • Publicized controversy: assisted suicide

16. Care for Dying Individuals • Hospice — humanized program committed to making the end of life as free from pain, anxiety, and depression as possible • Palliative care — reducing pain and suffering and helping individuals die with dignity

17. When Others Decide • Remember Terry Schaivo • What is a persistent vegetative state? • Who decides? • What are their motives?

18. Should the government decide? • Social security bankruptcy – worker-pensioner imbalance • Medicare/Medicaid bankruptcy • Generational inequity – rationing of care

19. Grieving • Grief: emotional numbness; a complex emotional state of… • Disbelief • Separation anxiety • Despair • Sadness • Loneliness …that accompanies loss of someone we love

20. Cultural Diversity in Healthy Grieving • Contemporary western orientation • Breaking bonds with the dead • Returning survivors to autonomous lifestyle • Non-Western cultures • Maintaining ties with deceased • Influenced by religious beliefs and lifestyle

21. Making Sense of Grief • Grieving stimulates many to try to make sense of their world — positive themes linked to hopeful future and better adjustment • Effort to make sense of it pursued more vigorously when caused by an accident or disaster

22. Losing a Life Partner • Those left behind after the death of an intimate partner suffer profound grief and often endure • Financial loss • Loneliness linked to poverty and education • Increased physical illness • Psychological disorders, including depression

23. Marital Quality and Adjustment to Widowhood • Widowhood associated with increased anxiety among those highly dependent on their spouses • Lower anxiety for those who did not depend on their spouse very much

24. Forms of Mourning • Approximately 80 percent of corpses are disposed of by burial, the remaining 20 percent by cremation • Funeral industry is source of controversy • Funeral is important aspect of mourning in many cultures • Cultures vary in how they practice mourning

25. Amish Mourning Conservative group; family-oriented society • Live same unhurried pace as ancestors • Time of death met with calm acceptance • Neighbors notify community; funeral athome • High level of support to family for one year

26. Traditional Judaism and Mourning • Mourning in graduated time periods; each with appropriate practices 1st period: Aninut— between death and burial 2nd period: Avelut period — mourning proper • Shivah period — 7-day begins at burial • Sheloshim period — 30-day period after burial Mourning over for all but parents who mourn another 11 months