Endings: Death and Dying Chapter 19 Robert S. Feldman Copyright © 2011 Pearson Education, Inc. All rights reserved.

DYING AND DEATH ACROSS THE LIFESPAN

Looking Forward What is death? What does death mean at different stages of the life span? In what ways do people face the prospect of their own death? How do survivors react to and cope with death?

What is death? Functional death Brain death Legal death

Should children be shielded from death?

Death across the Life Span: Causes and Reactions Infancy and childhood Miscarriage Still birth Sudden infant death Accidents Homicides

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)

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

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

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

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

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

Is life always worth living?

A Closer Look at Patient Choices

Terminal Decline Suffering Burden to loved ones Decrease in value to society

Copyright © 2011 Pearson Education, Inc. All rights reserved. Differing Conceptions of Death Developmental Diversity Reactions to death are diverse Dependent on practices and values of culture and subculture

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

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

Review and Apply REVIEW Death has been defined as the cessation of heartbeat and respiration (____ ____), the absence of electrical brain waves (____ ____), and the loss of human qualities. The ____ of an infant or young child can be particularly difficult for parents, and for an adolescent death appears to be ____. Death in young adulthood can appear ____, while people in middle adulthood have begun to understand the ____ of death.

Review and Apply REVIEW By the time they reach ____ ____, people know they will die and begin to make preparations. Cultural differences in ____ and ____ about death strongly influence people’s reactions to it. Thanatologists recommend that ____ education become a normal part of learning.

Review and Apply APPLY Do you think people who are going to die should be told? Does your response depend on the person’s age? Given their developmental level and understanding of death, how do you think preschool children react to the death of a parent?

CONFRONTING DEATH

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

Kübler-Ross Theory

Copyright © 2011 Pearson Education, Inc. All rights reserved. Evaluating Kübler-Ross’ Theory PROS One of first people to observe systematically how people approach their own deaths Increased public awareness and affected practices and policies related to dying CONS Largely limited to those who are aware that they are dying Less applicable to people who suffer from diseases in which the prognosis is uncertain Stage-like increments questioned Anxiety levels not included

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

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

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

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

Copyright © 2011 Pearson Education, Inc. All rights reserved. Living Wills Health care proxy Durable power of attorney See Figure 19-3 for an example of a living will

Euthanasia and Assisted Suicide Euthanasia Passive Voluntary active Assisted suicide Kevorkian

Copyright © 2011 Pearson Education, Inc. All rights reserved. What are the arguments? PROSCONS

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

Review and Apply REVIEW Elisabeth Kübler-Ross has identified five steps toward dying: ____, ____, ____, ____, and ____. The stage nature of her theory been criticized as too ____, and other theorists have suggested alternatives. Issues surrounding dying are highly controversial, including the ____ of measures that physicians should apply to keep dying patients alive and who should make the ____ about those measures.

Review and Apply REVIEW ____ ____ are a way for people to take some control over the decision. Assisted suicide and, more generally, ____ are highly controversial and are illegal in most of the United States, although many people believe they should be ____ if they are regulated. Although most people in the United States die in ____, increasing numbers are choosing ____ care or ____ care for their final days.

Review and Apply APPLY Do you think assisted suicide should be permissible? Other forms of euthanasia? Why or why not? Do you think Kübler-Ross’s five steps of dying might be subject to cultural influences? Age differences? Why or why not?

GRIEF AND BEREAVEMENT

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

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

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

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

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

What is the difference? Bereavement Grief

Grieving in the Western World 1 st stage: grief typically entails shock, numbness, disbelief, or outright denial 2 nd stage: people begin to confront the death and realize extent of their loss 3 rd stage: people reach accommodation stage

Death of Long-term Spouse Strength of relationship with can have effect on grieving process Almost always traumatic experience that is usually followed by intense grief and anguish

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

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

Copyright © 2011 Pearson Education, Inc. All rights reserved. Consequences of Grief and Bereavement Negative Widowed people are particularly at risk of death More negative consequences if person is already insecure, anxious, or fearful, overly dependent, or lacking in social support Sudden death Positive Remarriage lowers risk of death for survivors, especially for widowers

Becoming an Informed Consumer of Development Helping a Child Cope with Grief Be honest Encourage expressions of grief Reassure children that they are not to blame for the death Understand that children’s grief may surface in unanticipated ways Children may respond to books for young persons about death

Consider this… What are some policy issues affecting children and adolescents that are currently being debated nationally? Despite the existence of research data that might inform policy about development, politicians rarely discuss such data in their speeches. Why do you think that is the case?

Review and Apply REVIEW ____ refers to the loss of a loved one; ____ refers to the emotional response to that loss. ____ ____play a significant role in helping people acknowledge the death of a loved one, recognize their own mortality, and proceed with their lives. For many people, ____ passes through denial, sorrow, and accommodation. ____ need special help coping with grief.

Review and Apply APPLY Why do so many people in U.S. society feel reluctant to think and talk about death? Why do you think the risk of death is so high for people who have recently lost a spouse? Why might remarriage lower the risk?

EPILOGUE Before you close the book, return to the chapter prologue, about Archie Walker’s positive approach toward death. Based on your understanding of death and dying, answer the following questions: To what extent do you think Walker went through the stages described by Kübler-Ross? How might Walker have reacted differently to his impending death if he were a young man in his early 20s? How might Walker’s celebratory and jocular attitude toward the ending of his life affected the bereavement process for his family? How might Walker’s final days been different if he had elected to receive cancer treatment in the hospital? How might they have been different if he had required hospice care?