1. Life-Span Development Twelfth Edition Chapter 20: Death, Dying and Grieving ©2009 The McGraw-Hill Companies, Inc. All rights reserved.

2. T HE D EATH S YSTEM  In most societies, death is not viewed as the end of existence because the spiritual body is believed to live on  People in the U.S. tend to be death avoiders and death deniers  Changing Historical Circumstances:  The age group in which death most often strikes  Life expectancy has increased from 47 to 78 years  Location of death

3. ©2009 The McGraw-Hill Companies, Inc. All rights reserved. I SSUES IN D ETERMINING D EATH  Brain Death: a person is brain dead when all electrical activity of the brain has ceased for a specified period of time  Includes both the higher cortical functions and the lower brain-stem functions Terri Schiavo

4. ©2009 The McGraw-Hill Companies, Inc. All rights reserved. L IFE, D EATH, AND H EALTH C ARE  Advance directive & living wills are designed to be filled in while the individual can still think clearly  Designed for situations in which the individual is in a coma and cannot express his or her desires  Many states have natural death legislation  People engaged in end-of-life planning are more likely to:  Have been hospitalized in the year prior  Believe that patients rather than physicians should make health-care decisions  Have less death anxiety  Have survived the painful death of a loved one

5. ©2009 The McGraw-Hill Companies, Inc. All rights reserved. A DVANCE D IRECTIVE & L IVING W ILLS LIVING WILL I, __________, of __________, being of sound mind, do hereby willfully and voluntarily make known my desire that my life not be prolonged under any of the following conditions, and do hereby further declare: 1. If I should, at any time, have an incurable condition caused by any disease or illness, or by any accident or injury, and be determined by any two or more physicians to be in a terminal condition whereby the use of "heroic measures” or the application of life-sustaining procedures would only serve to delay the moment of my death, and where my attending physician has determined that my death is imminent whether or not such "heroic measures" or life-sustaining measures are employed, I direct that such measures and procedures be withheld or withdrawn and that I be permitted to die naturally. 2. In the event of my inability to give directions regarding the application of life-sustaining procedures or the use of "heroic measures", it is my intention that this directive shall be honored by my family and physicians as my final expression of my right to refuse medical and surgical treatment, and my acceptance of the consequences of such refusal. 3. I am mentally, emotionally and legally competent to make this directive and I fully understand its import. 4. I reserve the right to revoke this directive at any time. 5. This directive shall remain in force until revoked. IN WITNESS WHEREOF, I have hereto set my hand and seal this _____ day of __________, 20___. Signed: __________ Declaration of Witnesses The declarant is personally known to me and I believe him to be of sound mind and emotionally and legally competent to make the herein contined Directive to Physicians. I am not related to the declarant by blood or marriage, nor would I be entitled to any portion of the declarant's estate upon his decease, nor am I an attending physician of the declarant, nor an employee of the attending physician, nor an employee of a health care facility in which the declarant is a patient, nor a patient in a health care facility in which the declarant is a patient, nor am I a person who has any claim against any portion of the estate of the declarant upon his death. Signed: _____________ https://www.texaslivingwill.org/

6. ©2009 The McGraw-Hill Companies, Inc. All rights reserved. L IFE, D EATH, AND H EALTH C ARE  Euthanasia: the act of painlessly ending the lives of individuals who are suffering from an incurable disease or severe disability  Passive euthanasia: treatment is withheld  Active euthanasia: death deliberately induced  Trend is toward acceptance of passive euthanasia in the case of terminally ill patients  Experts do not agree on the boundaries or mechanisms by which treatment decisions should be implemented  Active euthanasia was made famous by Dr. Jack Kevorkian in the U.S. as “assisted suicide”  Active euthanasia is a crime in most countries and in the U.S. (except Oregon)  Patients who have a desire for euthanasia are often:  Less religious  Have been diagnosed with depression  Have a lower functional living status

7. ©2009 The McGraw-Hill Companies, Inc. All rights reserved. L IFE, D EATH, AND H EALTH C ARE  Hospice: a program committed to making the end of life as free from pain, anxiety, and depression as possible  Palliative care: reducing pain and suffering, helping individuals die with dignity  Makes every effort to include the dying patient’s family members  Includes home-based programs today, supplemented with care for medical needs and staff  Family members report better psychological adjustment to the death of a loved one when hospice care is used A “good death” involves physical comfort, support from loved ones, acceptance, and appropriate medical care.

8. ©2009 The McGraw-Hill Companies, Inc. All rights reserved. C AUSES OF D EATH  Causes of death vary across the life span:  Prenatal death through miscarriage  Death during birth or shortly afterwards  Accidents or illness cause most childhood deaths  Most adolescent and young adult deaths result from suicide, homicide, or motor vehicle accidents  Middle-age and older adult deaths usually result from chronic diseases

9. ©2009 The McGraw-Hill Companies, Inc. All rights reserved. A TTITUDES T OWARD D EATH  Death of a parent is especially difficult for children  Most psychologists believe that honesty is the best strategy in discussing death with children  Depends on the child’s maturity level  Terminally ill children may distance themselves from their parents as death approaches  Most adolescents:  Avoid the subject of death until a loved one or close friend dies  Describe death in abstract terms and have religious or philosophical views about it  Often think that they are somehow immune to death

10. ©2009 The McGraw-Hill Companies, Inc. All rights reserved. A TTITUDES T OWARD D EATH  Concerns about death increase as one ages:  Awareness usually intensifies in middle age Middle-aged adults often fear death more than young adults or older adults  Older adults are more often preoccupied by it and want to talk about it more  One’s own death usually seems more appropriate in old age, possibly a welcomed event, and there is an increased sense of urgency to attend to unfinished business

11. ©2009 The McGraw-Hill Companies, Inc. All rights reserved. KÜBLER-ROSS’S STAGES OF DYING  Denial and Isolation: “It can’t be!”  Anger: “Why me?”  Bargaining: “Just let me do this first!”  Depression: withdrawal, crying, and grieving  Acceptance: a sense of peace comes

12. ©2009 The McGraw-Hill Companies, Inc. All rights reserved. P ERCEIVED C ONTROL AND D ENIAL  Perceived control may be an adaptive strategy for remaining alert and cheerful  Denial insulates and allows one to avoid coping with intense feelings of anger and hurt  Can be maladaptive depending on extent

13. ©2009 The McGraw-Hill Companies, Inc. All rights reserved. C ONTEXTS IN W HICH P EOPLE D IE  More than 50% of Americans die in hospitals  Nearly 20% die in nursing homes  Hospitals offer many important advantages:  Professional staff members  Technology may prolong life  Most individuals say they would rather die at home

14. ©2009 The McGraw-Hill Companies, Inc. All rights reserved. G RIEVING  Grief: emotional numbness, disbelief, separation anxiety, despair, sadness, and loneliness that accompany the loss of someone we love  Grief is a complex, evolving process with multiple dimensions  More like a roller-coaster ride than an orderly progression of stages  Cognitive factors are involved in the severity of grief  Good family communications and grief counselors can help grievers cope with feelings of separation and loss  Prolonged Grief: approximately 10%–20% of survivors have difficulty moving on with their life after 6 months have passed  Disenfranchised Grief: an individual’s grief involving a deceased person that is a socially ambiguous loss that can’t be openly mourned or supported  Examples: ex-spouse, abortion, stigmatized death (such as AIDS)

15. ©2009 The McGraw-Hill Companies, Inc. All rights reserved. G RIEVING  Dual-Process Model:  Loss-oriented stressors: focus on the deceased individual Can include grief work and both positive and negative reappraisal of the loss  Restoration-oriented stressors: secondary stressors that emerge as indirect outcomes of bereavement Changing identity and mastering new skills  Effective coping involves cycling between coping with loss and coping with restoration

16. ©2009 The McGraw-Hill Companies, Inc. All rights reserved. G RIEVING  Impact of death on surviving individuals is strongly influenced by the circumstances under which the death occurs  Traumatic, violent, or sudden deaths are likely to have more intense and prolonged effects Can be accompanied by PTSD-like symptoms

17. ©2009 The McGraw-Hill Companies, Inc. All rights reserved. G RIEVING  Cultural Diversity:  Some cultures emphasize the importance of breaking bonds with the deceased and returning quickly to autonomous lifestyles  Beliefs about continuing bonds with the deceased vary extensively  There is no one right, ideal way to grieve

18. ©2009 The McGraw-Hill Companies, Inc. All rights reserved. L OSING A L IFE P ARTNER  Widows outnumber widowers 5 to 1  Women live longer than men  A widowed man is more likely to remarry  Widows usually marry older men  Widowed women are probably the poorest group in America  Women tend to do better than men because women typically have better networks of friends and relatives  Older women do better than younger women  Religiosity and coping skills are related to well-being following the loss of a spouse in late adulthood

19. ©2009 The McGraw-Hill Companies, Inc. All rights reserved. F ORMS OF M OURNING  Approximately 80% are buried; 20% are cremated  Funerals are an important aspect of mourning in many cultures  Cultures vary in how they practice mourning