Copyright © 2011 Pearson Education, Inc. All Rights Reserved. Exploring Lifespan Development Chapter 19 Death, Dying, and Bereavement This multimedia product and its contents are protected under copyright law. The following are prohibited by law: Any public performance or display, including transmission of any image over a network; Any public performance or display, including transmission of any image over a network; Preparation of any derivative work, including the extraction, in whole or in part, of any images; Preparation of any derivative work, including the extraction, in whole or in part, of any images; Any rental, lease, or lending of the program. Any rental, lease, or lending of the program.

Copyright © 2011 Pearson Education, Inc. All Rights Reserved. Phases of Dying Agonal phase Agonal phase suffering in first moments in which body can no longer support life suffering in first moments in which body can no longer support life Clinical death Clinical death heart, breathing, brain stopped, but still can resuscitate heart, breathing, brain stopped, but still can resuscitate Mortality Mortality permanent death permanent death

Cultural context Customs related to disposal and remembrance of the dead, transfer of possessions, expressions of grief; care of toward the dying Mortality Top cause for death are diseases.

Psychological Issues Confronting one’s own death Confronting one’s own death In absence of identifiable illness, at 100, tend to suffer functional declines, lose interest in eating and drinking, and die a natural death In absence of identifiable illness, at 100, tend to suffer functional declines, lose interest in eating and drinking, and die a natural death

Terminal drop or terminal decline- widely observed decline in cognitive abilities shortly before death; decline in verbal ability significant Near death experiences: sense of being out of body and visions of bright lights or mystical encounters May result from physiological changes or psychological responses to threat of death

Copyright © 2011 Pearson Education, Inc. All Rights Reserved. Defining Death Brain death Brain death all activity in brain and brain stem stopped all activity in brain and brain stem stopped irreversible irreversible Persistent vegetative state Persistent vegetative state activity in cerebral cortex stopped activity in cerebral cortex stopped brain stem still active brain stem still active

Copyright © 2011 Pearson Education, Inc. All Rights Reserved. Death with Dignity Communication with and care of dying person: Communication with and care of dying person: assurance of support assurance of support humane, compassionate care humane, compassionate care esteem and respect esteem and respect candid about certainty of death candid about certainty of death information to make end-of-life choices information to make end-of-life choices

Copyright © 2011 Pearson Education, Inc. All Rights Reserved. Cultural variations religious teachings religious teachings Westerners: spirituality, meaning of life Westerners: spirituality, meaning of life Individual variations personal philosophy of death personal philosophy of death consistency of religious beliefs, practice consistency of religious beliefs, practice symbolic immortality symbolic immortality age age gender gender Death Anxiety

Copyright © 2011 Pearson Education, Inc. All Rights Reserved. Kübler-Ross’s Theory DenialAngerBargainingDepressionAcceptance Senior Lifestyles

Copyright © 2011 Pearson Education, Inc. All Rights Reserved. Evaluating Kübler-Ross Stages are not fixed sequence Stages are not fixed sequence May cause insensitivity by caregivers May cause insensitivity by caregivers Best seen as coping strategies Best seen as coping strategies RubberBall Productions

Copyright © 2011 Pearson Education, Inc. All Rights Reserved. Appropriate Death Makes sense with person’s pattern of living, values Makes sense with person’s pattern of living, values Preserves or restores significant relationships Preserves or restores significant relationships Free of suffering (as much as possible) Free of suffering (as much as possible) Also includes achieving: Also includes achieving: sense of control sense of control confronting and preparing for death confronting and preparing for death

Copyright © 2011 Pearson Education, Inc. All Rights Reserved. Communicating with Dying People Be truthful. Be truthful. diagnosis diagnosis course of disease course of disease Listen perceptively. Listen perceptively. Acknowledge feelings. Acknowledge feelings. Maintain realistic hope. Maintain realistic hope. Assist with final transition. Assist with final transition. RubberBall Productions

Copyright © 2011 Pearson Education, Inc. All Rights Reserved. Factors That Influence Thoughts About Dying Cause of death Cause of death nature of disease nature of disease Personality Personality Coping style Coping style Family members’ behavior Family members’ behavior Health professionals’ behavior Health professionals’ behavior Spirituality and religion Spirituality and religion Culture Culture ©Nilesh Bhange/Dreamstime.com

Copyright © 2011 Pearson Education, Inc. All Rights Reserved. Hospice Approach Comprehensive support for dying and their families Comprehensive support for dying and their families family and patient as a unit family and patient as a unit team care team care palliative (comfort) care palliative (comfort) care home or homelike home or homelike bereavement help bereavement help many diverse options many diverse options ©mcherevan/Dreamstime.com

Copyright © 2011 Pearson Education, Inc. All Rights Reserved. Forms of Euthanasia Voluntary passive withdraw treatment withdraw treatment advance medical directives advance medical directives Voluntary active medical staff or others act to end life at patient’s request medical staff or others act to end life at patient’s request Assisted suicide medical staff provide means for patient to end own life medical staff provide means for patient to end own life controversial controversial Involuntary active medical staff end life without patient’s consent medical staff end life without patient’s consent

Copyright © 2011 Pearson Education, Inc. All Rights Reserved. Right to Die Euthanasia Euthanasia passive: life-sustaining treatment withheld or withdrawn passive: life-sustaining treatment withheld or withdrawn voluntary active: doctor-administered at patient’s request voluntary active: doctor-administered at patient’s request Advance medical directives Advance medical directives living will living will durable power of attorney for health care durable power of attorney for health care

Copyright © 2011 Pearson Education, Inc. All Rights Reserved. Assisted Suicide Doctor provides drugs for patient to use. Doctor provides drugs for patient to use. Legal in few nations, only in two states Legal in few nations, only in two states Few use Few use 0.1% in Oregon 0.1% in Oregon Highly controversial Highly controversial many, including AMA, disapprove many, including AMA, disapprove some find option comforting some find option comforting

Copyright © 2011 Pearson Education, Inc. All Rights Reserved. Grief Process Avoidance Avoidance “emotional anesthesia” “emotional anesthesia” Confrontation Confrontation most intense grief most intense grief Restoration Restoration dual-process model of coping with loss dual-process model of coping with loss alternate between dealing with emotions and with life changes alternate between dealing with emotions and with life changes ©Cheryl Casey/Dreamstime.com

Copyright © 2011 Pearson Education, Inc. All Rights Reserved. Sudden, unexpected Prolonged, expected Grieving: Sudden or Prolonged Deaths avoidance from shock and disbelief avoidance from shock and disbelief may not understand reasons may not understand reasons suicide especially hard suicide especially hard anticipatory grieving anticipatory grieving allows emotional preparation allows emotional preparation reasons usually known reasons usually known

Copyright © 2011 Pearson Education, Inc. All Rights Reserved. Difficult Grief Situations Parents losing a child Parents losing a child Children or adolescents losing a parent Children or adolescents losing a parent Adults losing an intimate partner Adults losing an intimate partner Bereavement overload Bereavement overload ©Elena Elisseeva/Dreamstime.com

Childhood and Adolescence Ages 5-7, begins to understand death as irreversible; Ages 5-7, begins to understand death as irreversible; Also that it is universal (all things must die) and therefore inevitable; and a dead person is nonfunctional (all life functions end at death) Also that it is universal (all things must die) and therefore inevitable; and a dead person is nonfunctional (all life functions end at death) Pre-5, difficult to grasp Pre-5, difficult to grasp Table 19-2 (page ) Table 19-2 (page )

How children show grief depends on cognitive and emotional ability. Some express through anger, acting out, refusal to acknowledge death; Help children understand death and bereavement process; make as few changes to routines, household as possible

Adulthood May experience little or major problems with death. Surviving Loss of Spouse Women: difficult when structured life pleasing or caring for husband; not only loose companion but important, central role. Men may experience similar

Quality of marital relationship affects degree to which widowhood affects mental health If have become high dependent on spouse, tended to become more anxious and more difficult time grieving- longer mourning

Men who lost their wives within 5 year period, 21% died if not remarried; women 10% more likely to die Loss of spouse may be loss of the protective shield- the one who reminded to take pills, care for, etc Practical problems of care, poverty

Women- can be catalyst for growth, discovering submerged aspects of self, learning to be more independent; search for personal meaning May seek new companion, some seek new marriage- though not necessary- only companionship

Losing parent in adulthood Experience emotional distress. Experience emotional distress. Helps to force resolution of important developmental issues; achieving stronger sense of self; more realistic goals and awareness of own mortality; greater responsibility, commitment, and attachment to others Helps to force resolution of important developmental issues; achieving stronger sense of self; more realistic goals and awareness of own mortality; greater responsibility, commitment, and attachment to others May have to assume responsibility for surviving parent and in keeping family together May have to assume responsibility for surviving parent and in keeping family together

Losing a child Unprepared; comes as a cruel, unnatural shock; an untimely event that should not have happened Unprepared; comes as a cruel, unnatural shock; an untimely event that should not have happened Parents may blame themselves; may hasten parent’s death Parents may blame themselves; may hasten parent’s death If terminally ill, parents who discuss openly the impending death tend to achieve a sense of closure that helps to cope with the loss If terminally ill, parents who discuss openly the impending death tend to achieve a sense of closure that helps to cope with the loss

Mourning a miscarriage Most end to avoid talking about it; grief becomes more intense and wrenching without support Often overcome with frustration and helplessness; often found support by supporting spouse.

Copyright © 2011 Pearson Education, Inc. All Rights Reserved. Bereavement Interventions General support sympathy, understanding sympathy, understanding patient listening, “being there” patient listening, “being there” Interventions self-help groups self-help groups daily living help daily living help Children and adolescents after violent death, prevent unnecessary reexposure after violent death, prevent unnecessary reexposure help adults master own distress help adults master own distress Difficult situations sudden, violent, unexplained, ambiguous deaths sudden, violent, unexplained, ambiguous deaths grief therapy, individual counseling grief therapy, individual counseling

Copyright © 2011 Pearson Education, Inc. All Rights Reserved. Resolving Grief Give yourself permission to feel the loss. Give yourself permission to feel the loss. Accept social support. Accept social support. Be realistic about the course of grieving. Be realistic about the course of grieving. Remember the deceased. Remember the deceased. When ready, engage in new activities and relationships. When ready, engage in new activities and relationships. Master tasks of daily living. Master tasks of daily living.

Copyright © 2011 Pearson Education, Inc. All Rights Reserved. Death Education Courses in death and dying Courses in death and dying offered at many educational levels offered at many educational levels Lecture format Lecture format increases discomfort increases discomfort Experiential format Experiential format role playing, discussions, guests, field trips role playing, discussions, guests, field trips may reduce death anxiety may reduce death anxiety

Advance directives Constitutional right to refuse or discontinue life-sustaining treatment- to request passive euthanasia. Must be mentally competent. This is a written document; contains instructions. Living will is one type. Constitutional right to refuse or discontinue life-sustaining treatment- to request passive euthanasia. Must be mentally competent. This is a written document; contains instructions. Living will is one type. Durable power of attorney- appoints someone to make decisions when person unable to make their own decisions

Copyright © 2011 Pearson Education, Inc. All Rights Reserved. Goals of Death Education Understand physical, psychological changes in dying Understand physical, psychological changes in dying Learn to cope with death of loved ones Learn to cope with death of loved ones Inform consumers of medical, funeral services Inform consumers of medical, funeral services Understand social, ethical issues Understand social, ethical issues