Epilogue: Death and Dying

1. Epilogue: Death and Dying Thanatology • The study of death and dying • Especially the social and emotional aspects. • Neither morbid or gloomy, it reveals: • The reality of hope in death • Acceptance of dying • Reaffirmation of life

2. Death and Hope

3. Death and Hope Death in Childhood • Children have a different perspective of death. They: • are more impulsive and may seem happy one day and sad the next. • do not “get over” the death of a parent, nor dwell on it. • may take certain explanations literally. • Fatally ill children typically fear abandonment  frequent and caring contact is more important than logic. • Older children seek specific facts and become less anxious about death and dying.

4. Death in Childhood

5. Death in Adolescence and Emerging Adulthood • Teenagers seem to have little fear of death • Take risks, place a high value on appearance, and seek thrills • May be their way of controlling anxiety. • Terror management theory (TMT) • The idea that people adopt cultural values and moral principles in order to cope with their fear of death. • Adolescents often predict that they will die at an early age • Tendency toward risk taking can be deadly (e.g., suicides, homicides, car accidents).

6. Death in Adolescence and Emerging Adulthood

7. Death in Adulthood • When adults become responsible for work and family, death is to be avoided or at least postponed. • Many adults quit taking addictive drugs, start wearing seat belts, and adopt other precautions. • Death anxiety usually increases from one’s teens to one’s 20s and then gradually decreases. • Ages 25 to 60: Terminally ill adults worry about leaving something undone or leaving family members—especially children—alone.

8. Death in Late Adulthood • Death anxiety decreases and hope rises. • One sign of mental health among older adults is acceptance of their own mortality and altruistic concern about those who will live on after them. • Many older adults accept death (e.g., they write their wills, designate health care proxies, reconcile with estranged family members, plan their funeral). • The acceptance of death does not mean that the elderly give up on living!

9. Religions and Hope • People who think they might die soon are more likely than others to believe in life after death. • Virtually every world religion provides rites and customs to honor the dead and comfort the living. • Although not everyone observes religious customs, those who care for the dying and their families need extraordinary sensitivity to cultural traditions.

10. Near-Death Experience • An episode in which a person comes close to dying but survives and reports having left his or her body and having moved toward a bright white light while feeling peacefulness and joy. • Near-death experiences often include religious elements. • Survivors often adopt a more spiritual, less materialistic view of life. • To some, near-death experiences prove that there is a heaven but scientists are more skeptical.

11. Dying and Acceptance • Good death • A death that is peaceful, quick, and painless and that occurs after a long life, in the company of family and friends, and in familiar surroundings. • People in all religious and cultural contexts hope for a good death. • Bad death • Lacks these six characteristics and is dreaded, particularly by the elderly

12. Attending to the Needs of the Dying Kübler-Ross identified emotions experienced by dying people, which she divided into five stages: • Denial (“I am not really dying.”) • Anger (“I blame my doctors, or my family, or God for my death.”) • Bargaining (“I will be good from now on if I can live.”) • Depression (“I don’t care about anything; nothing matters anymore.”) • Acceptance (“I accept my death as part of life.”)

13. Honest Conversation Stage Model based on Maslow’s hierarchy of needs: • Physiological needs (freedom from pain) • Safety (no abandonment) • Love and acceptance (from close family and friends) • Respect (from caregivers) • Self-actualization (appreciating one’s past and present) • Self-transcendence (acceptance of death) • This stage was later suggested by Maslow. *Other researchers have not found sequential stages in this area.

14. Honest Conversation • Most dying people want to spend time with loved ones and talk honestly with medical and religious professionals. • Many thanologists find that the “stages” of death may not go in order and some may never occur. • Hospital personnel need to respond to each dying person as an individual. • Each person responds to death in their own way, some may not want the whole truth.

15. The Hospice Hospice • An institution or program in which terminally ill patients receive palliative care • Hospice caregivers provide skilled treatment to relieve pain and discomfort; they avoid measures to delay death and their focus is to make dying easier Two principles for hospice care: • Each patient’s autonomy and decisions are respected. • Family members and friends are counseled before the death, shown how to provide care, and helped after the death.

16. The Hospice

17. Palliative Medicine • Palliative care • Care designed not to treat an illness but to provide physical and emotional comfort to the patient and support and guidance to his or her family. • Double effect • An ethical situation in which an action (such as administering opiates) has both a positive effect (relieving a terminally ill person’s pain) and a negative effect (hastening death by suppressing respiration).

18. Choices and Controversies

19. Hastening or Postponing Death Longer Life • The average person lives twice as long in 2010 as in 1910. • Later death due to drugs, surgery, and other interventions (e.g., respirators, defibrillators, stomach tubes, and antibiotics) . • Many adults under age 50 once died of causes that now kill relatively few adults in developed nations, such as complications of childbirth and epidemic diseases.

20. Hastening or Postponing Death • Passive euthanasia • A situation in which a seriously ill person is allowed to die naturally, through the cessation of medical intervention. • DNR (do not resuscitate) • A written order from a physician (sometimes initiated by a patient’s advance directive or by a health care proxy’s request) that no attempt should be made to revive a patient during cardiac or respiratory arrest.

21. Hastening or Postponing Death • Active euthanasia • A situation in which someone takes action to bring about another person’s death, with the intention of ending that person’s suffering. • Legal under some circumstances in the Netherlands, Belgium, Luxembourg, and Switzerland, but it is illegal (yet rarely prosecuted) in most other nations. • Physician-assisted suicide • A form of active euthanasia in which a doctor provides the means for someone to end his or her own life.

22. When Physician-Assisted Suicide Is Legal

23. When Physician-Assisted Suicide Is Legal Slippery slope • The argument that a given action will start a chain of events that will culminate in an undesirable outcome. • Concern: Hastening death when terminally ill people request may cause a society to slide into killing sick people who are not ready to die—especially the old and the poor.

24. Advance Directives • An individual’s instructions for end-of-life medical care, written before such care is needed. • Living will • A document that indicates what kinds of medical intervention an individual wants or does not want if he or she becomes incapable of expressing those wishes. • Health care proxy • A person chosen by another person to make medical decisions if the second person becomes unable to do so.

25. Advance Directives

26. Bereavement Normal Grief • Bereavement • The sense of loss following a death. • Grief • The powerful sorrow that an individual feels at the death of another. • Mourning • The ceremonies and behaviors that a religion or culture prescribes for people to employ in expressing their bereavement after a death.

27. Placing Blame And Seeking Meaning Placing blame • Common impulse after death for the survivors (e.g., for medical measures not taken, laws not enforced, unhealthy habits not changed) • The bereaved sometimes blame the dead person, sometimes themselves, and sometimes distant others. • Nations may blame one another for public tragedies. • Blame is not necessarily rational.

28. Placing Blame And Seeking Meaning Seeking Meaning • Often starts with preserving memories (e.g., displaying photographs, telling anecdotes) • Support groups offer help when friends are unlikely to understand (e.g., groups for parents of murdered children). • Organizations devoted to causes such as fighting cancer and banning handguns often find supporters among people who have lost a loved one to that particular circumstance. • Close family members may start a charity.

29. Complicated Grief • Grief that impedes a person’s future life • Absent grief • A situation in which overly private people cut themselves off from the community and customs that allow and expect grief; can lead to social isolation. • Disenfranchised grief • A situation in which certain people, although they are bereaved, are prevented from mourning publicly by cultural customs or social restrictions.

30. Mourning That Does Not Heal Incomplete grief • A situation in which circumstances, such as a police investigation or an autopsy, interfere with the process of grieving. • The grief process may be incomplete if mourning is cut short or if other people are distracted from their role in recovery.

31. Diversity of Reactions • Reactions to death are varied • Other people need to be especially responsive to whatever needs a grieving person may have. • Most bereaved people recover within a year • A feeling of having an ongoing bond with the deceased is no longer thought to be pathological.

32. Diversity of Reactions