Lifespan Development Chapter 20: Death and Grieving

1. Lifespan Development Chapter 20: Death and Grieving Defining death has gotten more complicated. It used to be dependent on the end of certain biological functions like breathing and blood pressure and the signs of rigor mortis. Defining death has gotten more complicated. It used to be dependent on the end of certain biological functions like breathing and blood pressure and the signs of rigor mortis.

2. Brain death occurs when all electrical activity in the brain ceases Higher portions of the brain die sooner than the lower portions There is controversy over what medical experts should use as criteria for death When do intelligence and personality end? Defining Death and Life/Death Issues A person’s lower brain portions can continue to keep the person alive even when coritcal function has ended. Some people argue that the cessation of cortical functioning should constitute brain death, because all of the qualities we associate with being human are housed in the higher portions of the brain.A person’s lower brain portions can continue to keep the person alive even when coritcal function has ended. Some people argue that the cessation of cortical functioning should constitute brain death, because all of the qualities we associate with being human are housed in the higher portions of the brain.

3. Termination of medical treatments is controversial Unconscious dying patients need living wills Physicians have concerns over malpractice suits in the absence living wills or defining laws Euthanasia is often called mercy killing Passive euthanasia – treatment is withheld Active euthanasia – death deliberately induced Euthanasia evokes a variety of emotions among health-care professionals and family members The organization “Choice in Dying,” created the living will. California’s Natural Death Act allows a person who has been diagnosed by 2 physicians as terminally ill to sign an advanced directive, which states that life sustaining procedures shall not be used to prolong their lives when death is imminent. Must be signed while the person is still able to think clearly. Euthanasia means “easy death.” The organization “Choice in Dying,” created the living will. California’s Natural Death Act allows a person who has been diagnosed by 2 physicians as terminally ill to sign an advanced directive, which states that life sustaining procedures shall not be used to prolong their lives when death is imminent. Must be signed while the person is still able to think clearly. Euthanasia means “easy death.”

4. Euthanasia in the Courts Case of Terry Schiavo who had suffered brain damage related to cardiac arrest and a lack of oxygen to the brain. She spent 15 years in a vegetative state until a court ordered that her feeding tube be removed. Appeals led to 2 reinsertions of the tube, but she died on 3/18/05 13 days after it had been removed for the 3rd time. Jack Kevorkian was convicted of 2nd degree murder for his assistance in active euthanasia for a number of patients.

5. Active euthanasia is a crime in most countries and in every state in the U.S. except for Oregon Oregon passed the Death with Dignity Act in 1994. By 2001, 91 individuals were known to have died by active euthanasia in Oregon. Most physicians surveyed oppose active euthanasia Better care is needed for dying persons, as death is often lonely, prolonged, and painful

6. The hospice movement Is a new kind of medical institution Began in London at the end of the 1960s Is dedicated to reducing pain and helping patients die with dignity Makes every effort to include the dying patient’s family members Includes home-based programs today, supplemented with care for medical needs and staff Hospices are more likely to serve patients with cancer than with other terminal illnesses. Hospice advocates suggest that it is possible to control pain for almost any dying individual. Today most hospices are home-based.Hospice advocates suggest that it is possible to control pain for almost any dying individual. Today most hospices are home-based.

7. Death has changed historically 200 years ago, 1 out of every 2 children died before age 10, and one parent usually died before a child grew up Today, death occurs mostly among the elderly Life expectancy has increased from 47 years for a person born in 1900 to 77 years for a person born today Over 80% of all U.S. deaths occur in hospitals Death and Cultural Contexts In the modern US, we are generally not exposed to the process of death and is not uncommon for an adult in the US to have never seen a person die.In the modern US, we are generally not exposed to the process of death and is not uncommon for an adult in the US to have never seen a person die.

8. Culture affects how death is experienced Americans live as if they are immortal India and Africa have many young children and infants dying of malnutrition and disease Most societies throughout history have had religious or philosophical beliefs about death and rituals surrounding it Some societies welcome death while others fear it In most societies, death is not an end to existence

9. Causes of death vary across the life span: Prenatal death through miscarriage Death during birth or shortly afterwards Accidents or illness cause most childhood deaths Most adolescent deaths result from suicide, homicide, or motor vehicle accident Deaths among young adults are increasing due to AIDS Middle-age and older adult deaths usually result from chronic diseases A Developmental Perspective on Death

10. Young children use illogical reasoning to explain death, believing magic or treatment can return life Others claim separation anxiety is an indicator of a child’s awareness of separation and loss Those in middle and late childhood have more realistic perceptions of death – that it is a finality Attitudes toward death vary at different points in the life span Infants do not have a concept of death and may experience brief separations as total losses. However, loss of a parent can lead to bereavement which can affect the infant’s health. Kids 3 to 5 have little or no idea what death means and generally do not get upset if they see a dead animal or by being told that a person has died. Young children may also believe that only people who want to die or who are bad or careless may die, and they may blame themselves for the death of someone they know well – thinking that the death happened because they disobeyed the person.Infants do not have a concept of death and may experience brief separations as total losses. However, loss of a parent can lead to bereavement which can affect the infant’s health. Kids 3 to 5 have little or no idea what death means and generally do not get upset if they see a dead animal or by being told that a person has died. Young children may also believe that only people who want to die or who are bad or careless may die, and they may blame themselves for the death of someone they know well – thinking that the death happened because they disobeyed the person.

11. Children and youth can reexperience grief as they age, and it may affect future relationships Hypersensitivity about death and fear of losing others close to the person. Many strategies, including honesty, should be adopted when discussing death with children Extent of explanations will vary according to a child’s age Most adolescents Avoid the subject of death until a loved one or close friend dies Describe death in abstract terms and have religious or philosophical views about it Many adolescents still think that they are somehow immune to death.

12. Concerns about death increase as one ages Awareness usually intensifies in middle age and middle-aged adults fear death more than younger or older adults. Older adults are more often preoccupied with death and want to talk about it more One’s own death usually seems more appropriate in old age. For younger adults, there may be an increased sense of urgency to attend to unfinished business Older adults are more likely to have directly experienced death than younger adults.Older adults are more likely to have directly experienced death than younger adults.

13. Knowledge of death’s approach forces the dying person to change her attitudes and behaviors Kübler-Ross identified 5 stages in dying: Denial and isolation – “It can’t be!” Anger – “Why me?” Bargaining – “Just let me do this first!” Depression – withdrawal, crying, and grieving Acceptance – a sense of peace comes Research does not support the idea that dying people go through these stages or go through any stages in any predictable order. In facing their own deaths, some people struggle desperately until the end Facing One’s Own Death What Kubler-Ross contributed is appreciation for the process of the dying person and attention to the needs of people attempting to cope with terminal illnesses.What Kubler-Ross contributed is appreciation for the process of the dying person and attention to the needs of people attempting to cope with terminal illnesses.

14. The quality of one’s life is linked to how death will be approached Meaning and purpose bring peaceful acceptance An unfulfilled life brings distress and despair Perceived control and denial may be adaptive strategies for remaining alert and cheerful Denial can actually be adaptive if it insulates and allows a dying person to avoid coping with intense feelings of anger and hurt In the U.S., 50% of people die in hospitals, and 20% die in nursing homes or a hospice When people are lead to believe they can influence and control events – such as prolonging their lives – they become more alert and cheerful. Most people say that they would like to die at home, although a home setting does compromise the availability of emergency medical treatment.When people are lead to believe they can influence and control events – such as prolonging their lives – they become more alert and cheerful. Most people say that they would like to die at home, although a home setting does compromise the availability of emergency medical treatment.

15. No loss is greater than that of a loved one Open communication with a dying person is very important because it gives them A chance to plan activities for the time left An opportunity to reminisce A chance to examine what is happening to them Effective strategies for open communication vary and should be directed toward internal growth Coping with the Death of Someone Else

16. Grief is not a simple emotional process and may not end anytime soon after the loss Process is more of a roller coaster rather than orderly progression of clear-cut stages with clear-cut time frames. Complicated grief: involves enduring despair and is still unresolved over an extended period of time. Good family communications and grief counselors can help grievers cope with feelings of separation and loss Cross-culturally, people in some societies forget the deceased as quickly as possible, while in others they try to hold on Dimensions of Grieving Someone who loses someone they were emotionally dependent upon is at risk for complicated grief.Someone who loses someone they were emotionally dependent upon is at risk for complicated grief.

17. Dual Process Model of Coping with Bereavement 1) Loss-oriented stressors Which focus on the deceased person and can include grief work and finding the positive aspects of the loss (relief from suffering) and experiencing the negative (yearning and rumination) 2) Restoration-oriented stressors Involve secondary stressors that emerge as indirect outcomes of bereavement. Examples include developing a new identity and learning new skills (such as managing finances). Coping with loss can involve an oscillation between loss oriented and restoration-oriented stressors.xCoping with loss can involve an oscillation between loss oriented and restoration-oriented stressors.x

18. Grieving forces one to try and make sense of the world – reliving one or more events over and over Finding meaning may enhance or ease the ability to cope Researchers have identified 3 types of meaning-making coping Personal – cognitive acceptance is sought Family – members search for common factors Community – a broader level of loss

19. Women feel the loss of a life partner more than men because They live longer than men A widowed man is more likely to remarry They usually marry older men Cross-culturally, many widows fall into poverty after the loss of a life partner Impact on one’s physical and psychological health is linked to how long one grieves and remains widowed

20. Funerals are an important aspect of mourning and a source of closure in many cultures Forms of mourning include Making some type of funeral arrangement Deciding on burial or cremation for the body Holding ceremonies after the funeral – in some cultures Being supported as a family by the community Dividing the mourning into time periods Designating one time frame for mourning