1. Death and Grieving Chapter 17

2. Issues in Determining Death Brain death — neurological definition of death Brain death — neurological definition of death All electrical activity of brain has ceased for a specified period of time All electrical activity of brain has ceased for a specified period of time Flat EEG recording Flat EEG recording Some medical experts argue criteria for death should include only higher cortical functioning Some medical experts argue criteria for death should include only higher cortical functioning

3. Death becoming increasingly complex 1. When to determine death has occurred? 2. Life expectancy has increased 3. Care for dying shifted away from family 4. Minimized exposure to death and its pain

4. Death in Different Cultures Most societies have Most societies have Philosophical or religious beliefs about death Philosophical or religious beliefs about death Rituals that deal with death Rituals that deal with death View that death does not end existence View that death does not end existence

5. U.S. Denial and Avoidance of Death ? Funeral industry emphasizes lifelike qualities Funeral industry emphasizes lifelike qualities Euphemisms — softening language for death Euphemisms — softening language for death Persistent search for “fountain of youth” Persistent search for “fountain of youth” Rejection and isolation of aged Rejection and isolation of aged Hope that everyone goes to heaven Hope that everyone goes to heaven Medical emphasis — prolonging life, not easing suffering Medical emphasis — prolonging life, not easing suffering

6. Attitudes Toward Death at Different Points in the Life Span Childhood Adolescence Adulthood Infant has no concept of death; perceptions of death develop in middle/late childhood; even very young children concerned about separation and loss Develop more abstract concepts of death; common to think they are immune to death Middle-aged adults fear death more than young adults or older adults; older adults think about death more

7. Suicide A Developmental Perspective of Death Serious physical illness Serious physical illness Feelings of disparity, isolation, failure, loss Feelings of disparity, isolation, failure, loss Serious financial problems Serious financial problems Drug use or prior suicide attempts Drug use or prior suicide attempts Antidepressant links Antidepressant links –Cultural and gender differences exist –Rare in childhood, risk increase in adolescence –Most adolescent attempts fail –Linked to genetic and situational factors –Gay or lesbian links not clear Risk factors

8. Facing One’s Own Death Most dying individuals want to make decisions regarding their life and death Most dying individuals want to make decisions regarding their life and death Complete unfinished business Complete unfinished business Resolve problems and conflicts Resolve problems and conflicts Put their affairs in order Put their affairs in order

9. Kubler-Ross’ Stages of Dying Denial and isolation Anger Bargaining Denies s/he is going to die Denial gives way to anger, resentment, rage, and envy Develops hope that death can somehow be postponed Depression Acceptance Comes to accept the certainty of her or his death Develops sense of peace and may desire to be left alone

10. Perceived Control and Denial When individuals believe they can influence and control events, they may become more alert and cheerful When individuals believe they can influence and control events, they may become more alert and cheerful Denial can be adaptive or maladaptive Denial can be adaptive or maladaptive

11. Care for Dying Individuals ? Death in U.S.: often lonely, prolonged, painful Death in U.S.: often lonely, prolonged, painful Plan for your death Plan for your death Make a living will Make a living will Give someone power of attorney Give someone power of attorney Give your doctor specific instructions Give your doctor specific instructions Discuss desires with family and doctor Discuss desires with family and doctor Check insurance plan coverage Check insurance plan coverage

12. The Contexts in Which People Die Most would rather die at home but worry over Most would rather die at home but worry over Burden at home Burden at home Limited space Limited space May alter relationships May alter relationships Competency and availability of emergency Competency and availability of emergency medical treatment medical treatment

13. Communicating with the Dying Person Establish your presence Establish your presence Eliminate distraction Eliminate distraction Limit visit time Limit visit time Don ’ t insist on acceptance Don ’ t insist on acceptance Allow expressions of guilt or anger Allow expressions of guilt or anger Discuss alternatives, unfinished business Discuss alternatives, unfinished business Ask if there is anyone s/he would like to see Ask if there is anyone s/he would like to see Encourage the dying individual to reminisce Encourage the dying individual to reminisce Talk with the individual when s/he wishes to talk Talk with the individual when s/he wishes to talk Express your regard Express your regard

14. Decisions Regarding Life, Death, and Health Care Natural Death Act and Advance Directive Natural Death Act and Advance Directive Expresses person’s desires regarding extraordinary medical procedures that might be used to sustain life when medical situation becomes hopeless Expresses person’s desires regarding extraordinary medical procedures that might be used to sustain life when medical situation becomes hopeless

15. Euthanasia Painlessly ending lives of persons suffering from incurable diseases or severe disabilities Painlessly ending lives of persons suffering from incurable diseases or severe disabilities Passive euthanasia — withholding of available treatments, allowing the person to die Passive euthanasia — withholding of available treatments, allowing the person to die Active euthanasia — death induced deliberately, as by injecting a lethal dose of drug Active euthanasia — death induced deliberately, as by injecting a lethal dose of drug Publicized controversy: assisted suicide Publicized controversy: assisted suicide

16. Care for Dying Individuals Hospice — humanized program committed to making the end of life as free from pain, anxiety, and depression as possible Hospice — humanized program committed to making the end of life as free from pain, anxiety, and depression as possible Palliative care — reducing pain and suffering and helping individuals die with dignity Palliative care — reducing pain and suffering and helping individuals die with dignity

17. When Others Decide Remember Terry Schaivo Remember Terry Schaivo What is a persistent vegetative state? What is a persistent vegetative state? Who decides? Who decides? What are their motives? What are their motives?

18. Should the government decide? Social security bankruptcy – worker- pensioner imbalance Social security bankruptcy – worker- pensioner imbalance Medicare/Medicaid bankruptcy Medicare/Medicaid bankruptcy Generational inequity – rationing of care Generational inequity – rationing of care

19. Grieving Grief: emotional numbness; a complex emotional state of… Grief: emotional numbness; a complex emotional state of… Disbelief Disbelief Separation anxiety Separation anxiety Despair Despair Sadness Sadness Loneliness Loneliness …that accompanies loss of someone we love

20. Cultural Diversity in Healthy Grieving Contemporary western orientation Contemporary western orientation Breaking bonds with the dead Breaking bonds with the dead Returning survivors to autonomous lifestyle Returning survivors to autonomous lifestyle Non-Western cultures Non-Western cultures Maintaining ties with deceased Maintaining ties with deceased Influenced by religious beliefs and lifestyle Influenced by religious beliefs and lifestyle

21. Making Sense of Grief Grieving stimulates many to try to make sense of their world — positive themes linked to hopeful future and better adjustment Grieving stimulates many to try to make sense of their world — positive themes linked to hopeful future and better adjustment Effort to make sense of it pursued more vigorously when caused by an accident or disaster Effort to make sense of it pursued more vigorously when caused by an accident or disaster

22. Losing a Life Partner Those left behind after the death of an intimate partner suffer profound grief and often endure Those left behind after the death of an intimate partner suffer profound grief and often endure Financial loss Financial loss Loneliness linked to poverty and education Loneliness linked to poverty and education Increased physical illness Increased physical illness Psychological disorders, including depression Psychological disorders, including depression

23. Marital Quality and Adjustment to Widowhood Widowhood associated with increased anxiety among those highly dependent on their spouses Widowhood associated with increased anxiety among those highly dependent on their spouses Lower anxiety for those who did not depend on their spouse very much Lower anxiety for those who did not depend on their spouse very much

24. Forms of Mourning Approximately 80 percent of corpses are disposed of by burial, the remaining 20 percent by cremation Approximately 80 percent of corpses are disposed of by burial, the remaining 20 percent by cremation Funeral industry is source of controversy Funeral industry is source of controversy Funeral is important aspect of mourning in many cultures Funeral is important aspect of mourning in many cultures Cultures vary in how they practice mourning Cultures vary in how they practice mourning

25. Amish Mourning Conservative group; family-oriented society Live same unhurried pace as ancestors Live same unhurried pace as ancestors Time of death met with calm acceptance Time of death met with calm acceptance Neighbors notify community; funeral at home Neighbors notify community; funeral at home High level of support to family for one year High level of support to family for one year

26. Traditional Judaism and Mourning Mourning in graduated time periods; each with appropriate practices Mourning in graduated time periods; each with appropriate practices 1st period: Aninut — between death and burial 2nd period: Avelut period — mourning proper Shivah period — 7-day begins at burial Shivah period — 7-day begins at burial Sheloshim period — 30-day period after burial Sheloshim period — 30-day period after burial Mourning over for all but parents who mourn another 11 months