2. Thanatology Thanatology
The study of death and dying, especially of the social and emotional aspects
Thanatology is not morbid or gloomy.
It reveals the reality of hope in death, acceptance of dying, and reaffirmation of life.

4. Death in Childhood Perceptions vary by age.
Children have a different perspective of death.
Older children turn into more concrete operational thinkers; they seek specific facts and become less anxious about death and dying.
Children have a different perspective of death.
They are more impulsive and may seem happy one day and morbidly sad the next.
They do not “get over” the death of a parent, nor do they dwell on it.
They may take certain explanations (e.g. Grandma is sleeping, Grandpa went on a trip) literally.
Fatally ill children typically fear abandonment  frequent and caring contact is more important than logic.

5. Death in Adolescence and Emerging Adulthood
Teenagers have little fear of death (they take risks, place a high value on appearance, and seek thrills).
Adolescents often predict that they will die at an early age and their developmental tendency toward risk taking can be deadly (e.g., suicides, homicides, car accidents).
Romanticizing death makes young people vulnerable to cluster suicides, foolish dares, fatal gang fights, and drunk driving.

7. Death in Adulthood
When adults become responsible for work and family death is to be avoided or at least postponed.
Many adults quit taking addictive drugs, start wearing seat belts, and adopt other precautions.
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.

8. Death in Late Adulthood
Death anxiety decreases and hope rises.
One sign of mental health among older adults is acceptance of their own mortality and altruistic concern about those who will live on after them.
Many older adults accept death (e.g. they write their wills, designate health care proxies, reconcile with estranged family members, plan their funeral).
The acceptance of death does not mean that the elderly give up on living!

9. Is a Toothache Worse Than Death?
A cohort of young adults(average age 21) and old adults (average age 74) were divided into three groups. One group wrote about death (so that they had overt thoughts about it), another did a puzzle with some words about death (so that their thoughts about death were unconscious), and the third wrote about dental pain (so that they served as the control group). Then they all judged how harshly people should be punished for various moral transgressions. Those who wrote about dental pain are represented by the zero point on this graph. Compared with them, those older adults who thought about death were less punitive, but younger adults were more so. The difference in the ratings of the young and old was more pronounced if their thoughts were unconscious than if they were overt.

10. Religions and Hope
People who think they might die soon are more likely than others to believe in life after death.
Virtually every world religion provides rites and customs to honor the dead and comfort the living.
Although not everyone observes religious customs, those who care for the dying and their families need extraordinary sensitivity to cultural traditions.

11. Near-Death Experience
An episode in which a person comes close to dying but survives and reports having left his or her body and having moved toward a bright white light while feeling peacefulness and joy.
Near-death experiences often include religious elements.
Survivors often adopt a more spiritual, less materialistic view of life.
To some, near-death experiences prove that there is a heaven but scientists are more skeptical.

12. Dying and Acceptance Good death Bad death
A death that is peaceful, quick, and painless and that occurs after a long life, in the company of family and friends, and in familiar surroundings.
People in all religious and cultural contexts hope for a good death.
Bad death
Lacks these six characteristics and is dreaded, particularly by the elderly

13. Stages of Dying: Kübler-Ross
Elisabeth Kübler-Ross identified emotions and stages experienced by dying people.
Denial “I am not really dying.”
Anger “I blame my doctors, or my family, or God for my death.”
Bargaining “I will be good from now on if I can live.”
Depression “I don't care about anything; nothing matters anymore.”
Acceptance “I accept my death as part of life.”

14. Stage Model Based on Maslow's Hierarchy of Needs
Physiological needs (freedom from pain)
Safety (no abandonment)
Love and acceptance (from close family and friends)
Respect (from caregivers)
Self-actualization (spiritual transcendence)

15. Telling the Truth
Most dying people want to spend time with loved ones and to talk honestly with medical and religious professionals.
It is unethical to withhold information if the patient asks for it although some people do not want the whole truth.
Hospital personnel need to respond to each dying person as an individual, not merely as someone who must understand that death is near.

16. Hospice Hospice Two principles for hospice care
Institution or program in which terminally ill patients receive palliative care
Hospice caregivers provide skilled treatment to relieve pain and discomfort; they avoid measures to delay death and their focus is to make dying easier
Two principles for hospice care
Each patient's autonomy and decisions are respected.
Family members and friends are counseled before the death, shown how to provide care, and helped after the death.

18. Palliative Medicine Palliative care Double effect
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.
Double effect
An ethical situation in which an action (such as administering opiates) has both a positive effect, which is intended (relieving a terminally ill person's pain), and a negative effect, which is foreseen but not intended (hastening death by suppressing respiration).

19. Deciding When Death Occurs
Brain death
Prolonged cessation of all brain activity with complete absence of voluntary movements; no spontaneous breathing; no response to pain, noise, and other stimuli.
Brain waves have ceased; the EEG is flat; the person is dead.
Locked-in syndrome
Person cannot move, except for the eyes, but brain waves are still apparent.
Person is not dead.

20. Deciding When Death Occurs
Coma
State of deep unconsciousness from which the person cannot be aroused.
Some people awaken spontaneously from a coma; others enter a vegetative state; the person is not dead.
Vegetative state
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.
This state can be transient, persistent, or permanent.
No one has ever recovered after two years; most who recover (about 15 percent) improve within three weeks.
After time has elapsed, the person may, effectively, be dead.

21. Hastening or Postponing Death
Longer life
Average person lived twice as long in 2010 as in 1910.
Later death due to drugs, surgery, and other interventions (e.g., respirators, defibrillators, stomach tubes, and antibiotics).
Many adults under age 50 once died of causes that now kill relatively few adults in developed nations, such as complications of childbirth and epidemic diseases.

22. Allowing Death Passive euthanasia DNR (do not resuscitate)
Situation in which a seriously ill person is allowed to die naturally, through the cessation of medical intervention.
DNR (do not resuscitate)
Written order from a physician (sometimes initiated by a patient's advance directive or by a health care proxy's request) that no attempt should be made to revive a patient if he or she suffers cardiac or respiratory arrest.

23. Allowing Death Active euthanasia Physician-assisted suicide
Situation in which someone takes action to bring about another person's death, with the intention of ending that person's suffering.
Legal under some circumstances in the Netherlands, Belgium, Luxembourg, and Switzerland, but it is illegal (yet rarely prosecuted) in most other nations.
Physician-assisted suicide
Form of active euthanasia in which a doctor provides the means for someone to end his or her own life.

25. Slippery Slope Definition Slippery slope relating to death
A given action will start a chain of events that will culminate in an undesirable outcome.
Slippery slope relating to death
Hastening death when terminally ill people request may cause a society to slide into killing sick people who are not ready to die—especially the old and the poor.

26. Advance Directives Advance directive Living will Health care proxy
Document that contains an individual's instructions for end-of-life medical care, written before such care is needed.
Living will
Document that indicates what kinds of medical intervention an individual wants or does not want if he or she becomes incapable of expressing those wishes.
Health care proxy
Person chosen by another person to make medical decisions if the second person becomes unable to do so.

27. Normal Grief Bereavement Grief Mourning
Sense of loss following a death
Grief
Powerful sorrow that an individual feels at the death of another
Mourning
Ceremonies and behaviors that a religion or culture prescribes for people to employ in expressing their bereavement after a death

28. Complicated Grief Absent grief Disenfranchised grief
Situation in which overly private people cut themselves off from the community and customs that allow and expect grief; can lead to social isolation.
Disenfranchised grief
Situation in which certain people, although they are bereaved, are prevented from mourning publicly by cultural customs or social restrictions.

29. Incomplete Grief Incomplete grief
Situation in which circumstances, such as a police investigation or an autopsy, interfere with the process of grieving.
Grief process may be incomplete if mourning is cut short or if other people are distracted from their role in recovery.

30. Mourning
Mourning
Ceremonies and behaviors that a religion or culture prescribes for people to employ in expressing their bereavement after a death
Mourning customs designed to move grief from loss toward reaffirmation

31. Placing Blame And Seeking Meaning
Common impulse after death for the survivors (e.g., for medical measures not taken, laws not enforced, unhealthy habits not changed)
Bereaved sometimes blame the dead person, sometimes themselves, and sometimes distant others
Nations may blame one another for public tragedies
Blame is not necessarily rational

32. Placing Blame And Seeking Meaning
Often starts with preserving memories (e.g., displaying photographs, telling anecdotes)
Support groups offer help when friends are unlikely to understand (e.g., groups for parents of murdered children).
Organizations devoted to causes such as fighting cancer and banning handguns often find supporters among people who have lost a loved one to that particular circumstance.
Close family members may start a charity.

33. Diversity of Reactions
Reactions to death are varied.
Other people need to be especially responsive to whatever needs a grieving person may have.
Most bereaved people recover within a year.
A feeling of having an ongoing bond with the deceased is no longer thought to be pathological.