1. Copyright © 2014, 2011, 2008 by Pearson Education, Inc. All Rights Reserved. Exploring Lifespan Development Third Edition  Laura E. Berk Chapter 19 Death, Dying, and Bereavement

2. Copyright © 2014, 2011, 2008 by Pearson Education, Inc. All Rights Reserved. Exploring Lifespan Development Third Edition  Laura E. Berk Death, Dying, and Bereavement I.How We Die A.Three phases preceding death B.Defining death C.Death with dignity D.Attitudes toward death (death anxiety) II.Thinking and Emotions of Dying People (Kübler-Ross, personality and coping style) A.A Place to Die (home, hospital, nursing home, hospice) B.The Right to Die (Types of euthanasia) C.Terri Schiavo case: Legal instruments (advanced medical directive, living will, durable power of attorney) III.Reactions to death of a loved one A.Bereavement B.Grief C.Personal and Situational Variations

3. Copyright © 2014, 2011, 2008 by Pearson Education, Inc. All Rights Reserved. Exploring Lifespan Development Third Edition  Laura E. Berk Agonal phase Gasps and muscle spasms during first moments in which regular heartbeat disintegrates Clinical death Interval in which heartbeat, circulation, breathing, brain functioning stop, but resuscitation still possible Mortality Permanent death I. How We Die: The Phases of Death

4. Copyright © 2014, 2011, 2008 by Pearson Education, Inc. All Rights Reserved. Exploring Lifespan Development Third Edition  Laura E. Berk Defining Death Brain death  irreversible cessation of all activity in brain and brain stem  standard for death in most industrialized nations Clinical death  heartbeat and breathing stop Persistent vegetative state  cerebral cortex no longer registers electrical activity  brain stem remains active

5. Copyright © 2014, 2011, 2008 by Pearson Education, Inc. All Rights Reserved. Exploring Lifespan Development Third Edition  Laura E. Berk Integrity of person’s life is fostered by the quality of communication with and care for dying person:  assurance of support  compassionate care  esteem and respect  candidness about death’s certainty  information to make reasoned end-of-life choices II. Thinking and Emotions of Dying People: Death with Dignity

6. Copyright © 2014, 2011, 2008 by Pearson Education, Inc. All Rights Reserved. Exploring Lifespan Development Third Edition  Laura E. Berk Cultural variations  influenced by religious teachings  for Westerners, spirituality, meaning of life more important than religious commitment Individual variations  women more anxious than men  low among adults with deep faith in higher being  reduced by sense of symbolic immortality Death Anxiety

7. Copyright © 2014, 2011, 2008 by Pearson Education, Inc. All Rights Reserved. Exploring Lifespan Development Third Edition  Laura E. Berk Age, Gender, and Death Anxiety Figure 19.1 (Adapted from Tomer, Eliason, & Smith, 2000.)

8. Copyright © 2014, 2011, 2008 by Pearson Education, Inc. All Rights Reserved. Exploring Lifespan Development Third Edition  Laura E. Berk  Denial  Anger  Bargaining  Depression  Acceptance © Lesley Rigg/Shutterstock Kübler-Ross’s Theory

9. Copyright © 2014, 2011, 2008 by Pearson Education, Inc. All Rights Reserved. Exploring Lifespan Development Third Edition  Laura E. Berk  Bargaining  Denial  Anger  Depression  Acceptance  Anger © Lesley Rigg/Shutterstock Kübler-Ross’s Theory

10. Copyright © 2014, 2011, 2008 by Pearson Education, Inc. All Rights Reserved. Exploring Lifespan Development Third Edition  Laura E. Berk  Acceptance  Denial  Acceptance  Depression  Acceptance © Lesley Rigg/Shutterstock Kübler-Ross’s Theory

11. Copyright © 2014, 2011, 2008 by Pearson Education, Inc. All Rights Reserved. Exploring Lifespan Development Third Edition  Laura E. Berk  Stages are not a fixed sequence, not universal  Does not allow for context  May lead to caregiver insensitivity  Best seen as coping strategies © Monkey Business Images/Shutterstock Evaluating Kübler-Ross

12. Copyright © 2014, 2011, 2008 by Pearson Education, Inc. All Rights Reserved. Exploring Lifespan Development Third Edition  Laura E. Berk  Makes sense in terms of person’s pattern of living, values  Preserves or restores significant relationships  As free of suffering as possible  Also includes  achieving a sense of control  confronting and preparing for death Appropriate Death

13. Copyright © 2014, 2011, 2008 by Pearson Education, Inc. All Rights Reserved. Exploring Lifespan Development Third Edition  Laura E. Berk  Nature and course of illness  Personality and coping style  Behavior of family members and health professionals  Spirituality, religion, culture Factors That Influence Thoughts About Dying © Alexander Raths/Shutterstock

14. Copyright © 2014, 2011, 2008 by Pearson Education, Inc. All Rights Reserved. Exploring Lifespan Development Third Edition  Laura E. Berk  Home:  most preferred option: intimacy, loving care  only about 25% die at home  need for adequate caregiver support  Hospital:  intensive care unit can be depersonalizing  comprehensive treatment programs optimal  Nursing home:  focus usually not on terminal care  improves greatly when combined with hospice care continued… Traditional Places of Death

15. Copyright © 2014, 2011, 2008 by Pearson Education, Inc. All Rights Reserved. Exploring Lifespan Development Third Edition  Laura E. Berk Comprehensive program of support for dying and their families:  patient and family as unit of care  interdisciplinary team  palliative (comfort) care  home or homelike setting  bereavement services © James Steidl/Shutterstock Hospice Approach

16. Copyright © 2014, 2011, 2008 by Pearson Education, Inc. All Rights Reserved. Exploring Lifespan Development Third Edition  Laura E. Berk The Right to Die: Forms of Euthanasia Passive euthanasia  withdrawal of treatment  advance medical directive: living will, durable power of attorney Voluntary active euthanasia  medical staff or others act to end life at patient’s request Assisted suicide  medical staff provide means for patient to end own life  remains controversial Involuntary active euthanasia  medical staff end life without patient’s consent

17. Copyright © 2014, 2011, 2008 by Pearson Education, Inc. All Rights Reserved. Exploring Lifespan Development Third Edition  Laura E. Berk International Public Opinion on Voluntary Active Euthanasia Figure 19.2 (From Harris Interactive, 2011; Pew Research Center, 2006.)

18. Copyright © 2014, 2011, 2008 by Pearson Education, Inc. All Rights Reserved. Exploring Lifespan Development Third Edition  Laura E. Berk Advance Medical Directives  Written statement of desired medical treatment in case of incurable illness  Living will: specifies desired treatments  Durable power of attorney:  authorizes another person to make health-care decisions on one’s behalf  more flexible than living will  can ensure partner’s role in decision making even in relationships not sanctioned by law

19. Copyright © 2014, 2011, 2008 by Pearson Education, Inc. All Rights Reserved. Exploring Lifespan Development Third Edition  Laura E. Berk The Terri Schiavo Case 1990: Heart attack. No advance directive 1990-2000: Husband attempts to have her revived 2000: Husband wins court case to remove feeding tube. 2000-2005: Court battles between hus- band and Terri’s parents. Feeding tube removed and replaced. Governor, Florida legislature, Florida Supreme Court and, President Bush, US Congress involved 2005: Feeding tube removed. Terri Schiavo dies. Autopsy reveals brain death without possibility of revival.

20. Copyright © 2014, 2011, 2008 by Pearson Education, Inc. All Rights Reserved. Exploring Lifespan Development Third Edition  Laura E. Berk “How Doctors Die” “It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently. Dr. Ken Murray, clinical assistant professor of family medicine at the Keck School of Medicine at USCKeck School of Medicine

21. Copyright © 2014, 2011, 2008 by Pearson Education, Inc. All Rights Reserved. Exploring Lifespan Development Third Edition  Laura E. Berk Dr. Ken Murray, clinical assistant professor of family medicine at the Keck School of Medicine at USCKeck School of Medicine “Many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor. I’ve had hundreds of people brought to me in the emergency room after getting CPR. Exactly one, a healthy man who’d had no heart troubles … walked out of the hospital. If a patient suffers from severe illness, old age, or a terminal disease, the odds of a good outcome from CPR are infinitesimal, while the odds of suffering are overwhelming. Poor knowledge and misguided expectations lead to a lot of bad decisions.” “How Doctors Die” http://think.usc.edu/2012/03/08/how-doctors-die /

22. Copyright © 2014, 2011, 2008 by Pearson Education, Inc. All Rights Reserved. Exploring Lifespan Development Third Edition  Laura E. Berk  Doctor provides drugs for patient to use  Legal in few nations, tacitly accepted in many  Legal in only four U.S. states  Few choose this option  Highly controversial:  opposed by many, including AMA  some find option comforting Assisted Suicide

23. Copyright © 2014, 2011, 2008 by Pearson Education, Inc. All Rights Reserved. Exploring Lifespan Development Third Edition  Laura E. Berk California End of Life Option Act Luther Cobb, MD President, CMA California Medical Association (CMA) ends its opposition to doctor- assisted suicide: "As physicians, we want to provide the best care possible for our patients. However, despite the remarkable medical break- throughs we've made and the world-class hospice or palliative care we can provide, it isn't always enough. The decision to parti- cipate in the End of Life Option Act is a very personal one between a doctor and their patient, which is why CMA has removed policy that outright objects to physicians aiding terminally ill patients in end of life options."

24. Copyright © 2014, 2011, 2008 by Pearson Education, Inc. All Rights Reserved. Exploring Lifespan Development Third Edition  Laura E. Berk Avoidance  “emotional anesthesia” Confrontation  most intense grief Restoration  dual-process model of coping with loss  alternate between dealing with emotions and with life changes © Cris Kelly/Shutterstock Grief Process

25. Copyright © 2014, 2011, 2008 by Pearson Education, Inc. All Rights Reserved. Exploring Lifespan Development Third Edition  Laura E. Berk Sudden, unanticipated  Avoidance from shock and disbelief  Survivor may not understand reasons  Suicide especially hard to bear Prolonged, expected  Anticipatory grieving: allows emotional preparation  Reasons for death usually known Grieving Sudden or Prolonged Deaths

26. Copyright © 2014, 2011, 2008 by Pearson Education, Inc. All Rights Reserved. Exploring Lifespan Development Third Edition  Laura E. Berk  Parents losing a child  Children or adolescents losing a parent or sibling  Adults losing an intimate partner  Bereavement overload © Giideon/Shutterstock Difficult Grief Situations

27. Copyright © 2014, 2011, 2008 by Pearson Education, Inc. All Rights Reserved. Exploring Lifespan Development Third Edition  Laura E. Berk Bereavement Interventions General support  sympathy, understanding  patient listening, “being there” Interventions  support groups  help with reorganizing daily life Children and adolescents  after violent death, prevent unnecessary reexposure Difficult situations  sudden, violent, unexplainable, or ambiguous deaths  grief therapy, individual counseling

28. Copyright © 2014, 2011, 2008 by Pearson Education, Inc. All Rights Reserved. Exploring Lifespan Development Third Edition  Laura E. Berk  Give yourself permission to feel loss.  Accept social support.  Be realistic about course of grieving.  Remember the deceased.  When ready, invest in new activities and relationships.  Master new tasks of daily living. Resolving Grief

29. Copyright © 2014, 2011, 2008 by Pearson Education, Inc. All Rights Reserved. Exploring Lifespan Development Third Edition  Laura E. Berk  Courses in death and dying offered at many educational levels  Lecture format: imparts knowledge but may increase discomfort  Experiential format:  role playing, discussions, guests, field trips  may reduce death anxiety Death Education

30. Copyright © 2014, 2011, 2008 by Pearson Education, Inc. All Rights Reserved. Exploring Lifespan Development Third Edition  Laura E. Berk  Increase understanding of physical, psychological changes in dying  Help students learn to cope with death of loved ones  Prepare informed consumers of medical, funeral services  Promote understanding of social, ethical issues Goals of Death Education

31. Copyright © 2014, 2011, 2008 by Pearson Education, Inc. All Rights Reserved. Exploring Lifespan Development Third Edition  Laura E. Berk Readers may view, browse, and/or download material for temporary copying purposes only, provided these uses are for noncommercial personal purposes. Except as provided by law, this material may not be further reproduced, distributed, transmitted, modified, adapted, performed, displayed, published, or sold in whole or in part, without prior written permission from the publisher.