Epilogue: Death and Dying

T HANATOLOGY Thanatology The study of death and dying

D EATH AND H OPE – U NDERSTANDING D EATH T HROUGHOUT THE L IFE S PAN Death in Childhood Children have a different perspective of death.

D EATH IN A DOLESCENCE AND E MERGING A DULTHOOD Teenagers have little fear of death Adolescents often predict that they will die at an early age

D EATH IN A DULTHOOD When adults become responsible for work and family death is to be avoided or at least postponed. 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.

D EATH IN L ATE A DULTHOOD Death anxiety decreases and hope rises. Mental health Many older adults accept death

D YING AND A CCEPTANCE Good death Bad death

H ONEST C ONVERSATION Stages of Dying I. Kübler-Ross: Identified emotions experienced by dying people, which she divided into a sequence of five stages: 1. Denial (“I am not really dying.”) 2. Anger (“I blame my doctors, or my family, or God for my death.”) 3. Bargaining (“I will be good from now on if I can live.”) 4. Depression (“I don’t care about anything; nothing matters anymore.”) 5. Acceptance (“I accept my death as part of life.”)

H ONEST C ONVERSATION II. Stage Model based on Maslow’s hierarchy of needs : 1. Physiological needs (freedom from pain) 2. Safety (no abandonment) 3. Love and acceptance (from close family and friends) 4. Respect (from caregivers) 5. Self-actualization (spiritual transcendence)

T HE H OSPICE Hospice An institution or program in which terminally ill patients receive palliative care Two principles for hospice care: 1. Each patient’s autonomy and decisions are respected. 2. Family members and friends are counseled before the death, shown how to provide care, and helped after the death.

P ALLIATIVE M EDICINE 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.

C HOICES AND C ONTROVERSIES WHEN IS A PERSON DEAD? Brain death: Prolonged cessation of all brain activity with complete absence of voluntary movements Locked-in syndrome: The person cannot move, except for the eyes, but brain waves are still apparent; the person is not dead.

C HOICES AND C ONTROVERSIES Coma: A state of deep unconsciousness from which the person cannot be aroused. Vegetative state: A state of deep unconsciousness in which all cognitive functions are absent, although eyes may open, sounds may be emitted, and breathing may continue; the person is not yet dead.

HASTENING OR POSTPONING DEATH Longer Life The average person lived twice as long in 2010 as in Later death due to drugs, surgery, and other interventions (e.g., respirators, defibrillators, stomach tubes, and antibiotics).

ALLOWING DEATH Passive Euthanasia DNR (do not resuscitate)

ALLOWING DEATH Active Euthanasia Physician-Assisted Suicide

A DVANCE D IRECTIVES Advance Directive Living Will Health Care Proxy

B EREAVEMENT 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