Chapter 19- part 1: Death and Dying Module 9 Dying and Death Across the Life Span

DYING AND DEATH ACROSS THE LIFESPAN

What is death? Functional death Brain death Legal death 474 Define: Functional death is defined by an absence of heartbeat and breathing. Although this definition seems unambiguous, it is not completely straightforward. Brain death occurs when all signs of brain activity, as measured by electrical brain waves, have ceased. Legal definition of death in most localities in the United States relies on the absence of brain functioning, although some laws still include a definition relating to the absence of respiration and heartbeat. The difficulty in establishing legal and medical definitions of death may reflect some of the changes in understanding and attitudes about death that occur over the course of people’s lives. 474

Should children be shielded from death? Why or why not?

Death across the Life Span: Causes and Reactions Infancy and childhood Miscarriage Still birth Sudden infant death Accidents Homicides Infancy and childhood: Although the rate has declined since the mid-1960s, the United States ranks behind 35 other countries in the proportion of infants who die during the first year of life. During childhood, the most frequent cause of death is accidents, most of them due to motor vehicle crashes, fires, and drowning. However, a substantial number of children in the United States are victims of homicides, which have nearly tripled in number since 1960. By the early 1990s, death by homicide had become the fourth leading cause of death for children between the ages of 1 and 9 (Finkelhor, 1997; Centers for Disease Control, 2004). Parent reactions Death of a child produces the most profound sense of loss and grief. In fact, there is no worse death in the eyes of most parents, including the loss of a spouse or of one’s own parents. Parents’ extreme reaction is partly based on the sense that the natural order of the world, in which children “should” outlive their parents, has somehow collapsed. Their reaction is often coupled with the feeling that it is their primary responsibility to protect their children from any harm, and they may feel that they have failed in this task when a child dies (Gilbert, 1997; Strength, 1999). Parents are almost never well equipped to deal with the death of a child, and they may obsessively ask themselves afterward, over and over, why the death occurred. Because the bond between children and parents is so strong, parents sometimes feel that a part of themselves has died as well. The stress is so profound that the loss of a child significantly increases the chances of admission to a hospital for a mental disorder. 475

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) Childhood: Children themselves do not really begin to develop a concept of death until around the age of 5. Although they are well aware of death before that time, they are apt to think of it as a temporary state that involves a reduction in living, rather than a cessation. For children who believe this, death is not particularly fearsome; rather, it is something of a curiosity. If people merely tried hard enough—by administering medicine, providing food, or using magic—dead people might “return” (Lonetto, 1980). Cause of death Motor-vehicle accidents, child abuse and beatings, and pedestrian injuries are the leading causes of trauma-related deaths among preschool children According to reports from the National Pediatric Trauma Registry: Car accidents accounted for about 30 percent of the deaths, child abuse and beatings totaled 21 percent and pedestrian injuries -- caused, for instance, by a child running into a street and being struck by a car -- reached 18 percent. 476

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 Define: Personal fable, a set of beliefs that causes them to feel unique and special—so special, in fact, that they may believe they are invulnerable and that the bad things that happen to other people won’t happen to them. Most frequent cause of death among adolescents is accidents, most often involving motor vehicles. Other frequent causes include homicide, suicide, cancer, and AIDS. 476

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 at such a point in life seems close to unthinkable, its occurrence is particularly difficult. Because they are actively pursuing their goals for life, they are angry and impatient with any illness that threatens their future. Leading cause of death continues to be accidents, followed by suicide, homicide, AIDS, and cancer. By the end of early adulthood, however, disease becomes a more prevalent cause of death. Young adults who have a terminal illness face additional burdens. Should they marry, even though it is likely that the partner will soon end up widowed? Should a couple seek to conceive a child if the child is likely to be raised by only one parent? How soon should one’s employer be told about a terminal illness, when it is clear that employers sometimes discriminate against unhealthy workers? None of these questions is easily answered. 477

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 Fears about death are often greater in middle adulthood than at any time previously—or even in later life. These fears may lead people to look at life in terms of the number of years they have remaining as opposed to their earlier orientation toward the number of years they have already lived. Most frequent cause of death in middle adulthood is heart attack or stroke. Although the unexpectedness of such a death does not allow for preparation, in some ways it is easier than a slow and painful death from a disease such as cancer. 477

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 Terminal decline, a significant drop in performance in cognitive areas such as memory and reading may foreshadow death within the next few years. 477

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 477

Is life always worth living?

Terminal Decline Suffering Burden to loved ones Decrease in value to society 478

Differing Conceptions of Death Developmental Diversity Reactions to death are diverse Dependent on practices and values of culture and subculture Some societies view death as a punishment or as a judgment about one’s contributions to the world. Others see death as redemption from an earthly life of travail. Some view death as the start of an eternal life, while others believe that there is no heaven or hell and that an earthly life is all there is. Christian and Jewish 10-year-olds tended to view death from a more “scientific” vantage point (in terms of the cessation of physical activity in the body) than Sunni Moslem and Druze children of the same age, who are more likely to see death in spiritual terms. For members of Native American tribes, death is seen as a continuation of life. 478

Do you agree? Death education should be mandated for all college students? Thanatologists, people who study death and dying, have suggested that death education should be an important component of everyone’s schooling.

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 Death education encompasses programs that teach about death, dying, and grief. Death education is designed to help people of all ages deal better with death and dying—both others’ deaths and their own personal mortality. Most successful programs not only provide ways for providers to help patients deal with their own impending deaths and those of family members, but also allow students to explore their feelings about the topic. 479

Review and Apply REVIEW Functional death is defined as the cessation of heartbeat and respiration; brain death is defined by the absence of electrical brain waves. What defines death has changed as medical advances allow us to resuscitate people who would once have been considered dead. Some medical experts believe that a person is in fact dead when they can no longer think, reason, or feel, and can never again live anything resembling a human life. The death of an infant or young child can be particularly difficult for parents, and for an adolescent death appears to be unthinkable. 480

Review and Apply REVIEW Cultural differences in attitudes and beliefs about death strongly influence people’s reactions to it. Thanatologists recommend that death education become a normal part of learning. 480

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? 480