THE END OF LIFE

1. Chapter 19 THE END OF LIFE

2. The Quest for “Healthy Dying” • Thanatology: The Study of Death and Dying

3. Living Will A legal document that states an individual’s wishes regarding medical care in case the person becomes incapacitated and unable to participate in decisions about his or her medical care.

4. The Right-to-Die Movement • Physician-Assisted Suicide • Trend: basing decisions less on legalistic interpretations regarding specific treatments and more on balancing benefits on a case-by-case basis • Euthanasia: Mercy killing

5. Suicide • Three concepts: (NIMH) 1. Suicide ideas 2. Suicide attempts 3. Completed suicide • Who Commits Suicide and Why? Females attempt more suicides, but males complete most.

7. The Hospice Movement • Provides comfort and care but with the knowledge that the recipients are nearing the end of their life’s journey--that they’re dying

8. The Dying Process • Defining Death Brain Death occurs when the brain receives insufficient oxygen to function.

9. Confronting One’s Own Death • A Life Review • Elderly person takes stock of his life, reflecting and reminiscing about it

10. Changes Before Death • Death drop • Near-Death Experiences • Dying individuals feel themselves leave their bodies and watch as spectators, the resuscitation efforts. Then they pass through a tunnel and enter a spiritual realm.

11. Near-Death Experiences Other views: • (Siegel) Arousal of nervous system and disorganization of brain • (Alkon) Anoxia induces such mental states • (Kastenbaum) Some heart-attack victims: no recollection of experience

12. Religious Beliefs • Christian: Book of Revelation Jewish: Speculation about afterlife is pointless Buddhists: Detailed account

13. Stages of Dying (Elisabeth Kubler-Ross) 1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance

15. Kastenbaum’s Trajectories of Death It is the nature of the disease that determines pain, mobility and length of terminal period. • Other factors: • Gender, ethnic group, personality, developmental level and death environment

16. Causes of Death • National Mortality Followback Survey: 1993 • Data on 23,000 records of death in 1993. • All states except South Dakota

18. Grief, Bereavement, and Mourning • Adjusting to the Death of a Loved One • Bereavement: state in which a person has been deprived of a relative or friend by death

19. Grief: keen mental anguish and sorrow over the death of a loved one Mourning: socially established manner of displaying signs of sorrow over death

20. Expressing Anguished Feelings • Support groups to help people through grief work • Culture and Grief Work • Cultural variability in expressing grief

21. Consequences of Grief • Survivor vulnerable to physical and mental illness and death • Adjusting to Violent and Premature Death • Most severe grief reaction

22. Adjusting to the Death of a Parent Stages of bereavement for healthy adults who have lost a parent 1. Going back to the origins 2. Reevaluation phase 3. Assuming leadership

23. Phases in the Bereavement Process 1. Shock, numbness, denial, disbelief 2. Pining, yearning, and depression 3. Emancipation from loved one and adjustment to new circumstances 4. Identity reconstruction

24. Individual Variations • People handle grief differently • Widows and Widowers • Death rate for widowers higher • Difficulty expressing emotion

25. Types of Widows • Three types (Lopata) 1. Better educated, middle class, strongly identifying with role of wife 2. Women who led multidimensional lives; husband only one part of total set of relations 3. Lower-or working-class women in sex-segregated worlds immersed in kin, neighboring or friendship relationships with other women

27. Death of a Child • Loss by Miscarriage • Sometimes receive no recognition of loss • Support Groups • Loss by Murder or Violence • Bereavement process can go on indefinitely