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DEATH AND DYING

Chapter 19. DEATH AND DYING. Learning Objectives. 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 Brain death Legal death.

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DEATH AND DYING

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  1. Chapter 19 DEATH AND DYING

  2. Learning Objectives

  3. DYING AND DEATH ACROSS THE LIFESPAN

  4. What is death? Although the question seems straightforward, defining the point at which life ceases and death occurs is surprisingly complex • Functional death • Brain death • Legal death

  5. 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 • Homicides

  6. 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)

  7. 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

  8. 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

  9. 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

  10. 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

  11. Terminal Decline • Suffering • Burden to loved ones • Decrease in value to society

  12. Adding Years

  13. 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

  14. 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

  15. Do you agree? Death education should be mandated for all college students

  16. What is death education? Death education encompasses programs that teach about death, dying, and grief • Crisis intervention education • Routine death education • Education for members of the helping professions

  17. Feldman Concludes Although no single form of death education will be sufficient to demystify death, the kinds of programs just described may help people come to grips more effectively with what is, along with birth, the most universal—and certain—of all human experiences

  18. Review and Apply

  19. Review and Apply

  20. Review and Apply

  21. CONFRONTING DEATH

  22. 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

  23. Kübler-Ross Theory

  24. Evaluating Kübler-Ross’ Theory

  25. Other Theorists Edwin Shneidman • “Themes” in people's reactions to dying that occur—and recur—in any order throughout the dying process Charles Corr • People who are dying face a set of psychological tasks

  26. Should people be free to select the nature of their own death?

  27. 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

  28. 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

  29. 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

  30. Dying Hard: Experiences of 4,301 Patients with End-of-Life Care

  31. Euthanasia and Assisted Suicide Euthanasia • Passive • Voluntary active Assisted suicide • Kevorkian

  32. What are the arguments?

  33. 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.)

  34. Caring for the Terminally Ill Place of Death • Home care • Hospice care • Hospital care

  35. Review and Apply

  36. Review and Apply

  37. Review and Apply

  38. GRIEF AND BEREAVEMENT

  39. 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

  40. Cultural Differences in Grieving Western societal rituals (some variations) • Body preparation • Celebration of a religious rite • Military customs

  41. 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

  42. Feldman concludes that all funerals basically serve the same underlying function. What is this function?

  43. Bereavement and Grief: Adjusting to the Death of a Loved One

  44. What is the difference? • Bereavement • Grief

  45. 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

  46. 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

  47. What other factors besides interpersonal closeness might affect the duration of grief after losing a long-time spouse?

  48. When Grief Goes Awry How long do you think grief lasts?

  49. Consequences of Grief and Bereavement

  50. How Helpful Is Grief Counseling? Effectiveness and the necessity of grief counseling serviceshas 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

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