1. Copyright © Allyn & Bacon 2004 Development Through the Lifespan 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; Preparation of any derivative work, including the extraction, in whole or in part, of any images; Any rental, lease, or lending of the program.

2. Copyright © Allyn & Bacon 2004 Phases of Dying Agonal phase Suffering in first moments body can no longer support life Clinical death Hear, breathing, brain stopped, but still can resuscitate Mortality Permanent death

3. Copyright © Allyn & Bacon 2004 Defining Death Brain death All activity in brain and brain stem stopped Irreversible Persistent vegetative state Activity in cerebral cortex stopped Brain stem still active

4. Copyright © Allyn & Bacon 2004 Death with Dignity Communication and care of dying person: Assurance of support and care Esteem and respect Candid about certainty of death Information to make end-of-life choices

5. Copyright © Allyn & Bacon 2004 Children’s Understanding of Death Most develop realistic concept of death by middle childhood Permanence Universality Nonfunctionality Factors that affect understanding Experience with death Religious teachings Candid and sensitive discussion with adults

6. Copyright © Allyn & Bacon 2004 Adolescents’ Understanding of Death Logically understand death, but problems applying idea to their real lives High-risk activities Talks with parents help understanding

7. Copyright © Allyn & Bacon 2004 Adulthood and Understanding of Death Early Adulthood Avoidance Death anxiety Considered distant Middle Adulthood Begin to think of death Aware of limited time left to live Late Adulthood Think and talk more of death Practical concern about how and when

8. Copyright © Allyn & Bacon 2004 Age, Gender and Death Anxiety

9. Copyright © Allyn & Bacon 2004 Kübler-Ross’s Theory Denial Anger Bargaining Depression Acceptance

10. Copyright © Allyn & Bacon 2004 Factors than Influence Thoughts About Dying Cause of Death Nature of disease Personality Coping Style Family Members Health Professionals Spirituality and Religion Culture

11. Copyright © Allyn & Bacon 2004 Places of Death Home Most preferred Only 20–25% Hospital Emergency room Intensive care unit Cancer care unit Hospice

12. Copyright © Allyn & Bacon 2004 Hospice Approach Comprehensive support for dying and their families Family and patient as a unit Team care Palliative (comfort) care Home or homelike Bereavement help

13. Copyright © Allyn & Bacon 2004 Forms of Euthanasia Voluntary Passive Withdraw treatment Advance medical directives Voluntary Active Medical staff or others act to end life at patient’s request Assisted Suicide Medical staff provide means for patient to end own life Controversial Involuntary Active Medical staff end life without patient’s consent

14. Copyright © Allyn & Bacon 2004 Advance Medical Directives Living Will Specify unwanted treatments Durable Power of Attorney for health care Appoint someone to make health care decisions

15. Copyright © Allyn & Bacon 2004 International Public Opinion on Voluntary Active Euthanasia

16. Copyright © Allyn & Bacon 2004 Grief Process Avoidance “Emotional anesthesia” Confrontation Most intense grief Restoration Dual-process model of coping with loss Alternate between dealing with emotions and with life changes

17. Copyright © Allyn & Bacon 2004 Grieving Sudden or Prolonged Deaths Sudden, Unexpected Avoidance from shock and disbelief May not understand reasons Suicide especially hard Prolonged, Expected Anticipatory grieving Allows emotional preparation Reasons usually known

18. Copyright © Allyn & Bacon 2004 Difficult Grief Situations Parents losing a child Children or adolescents losing a parent Adult losing an intimate partner Bereavement overload

19. Copyright © Allyn & Bacon 2004 Death Education Courses in death and dying Offered at many educational levels Lecture format Increases discomfort Experiential format Role playing, discussions, guests, field trips Can reduce death anxiety