1. Chapter 17 The Final Challenge: Death and Dying

2. Biological Definitions of Death Harvard: Total Brain Death –Unresponsive to stimuli –No movement or breathing –No reflexes –Flat EEG

3. Euthanasia: “happy” or “good” death –Hastening death of someone suffering incurable illness or injury 1) Active euthanasia 2) Passive euthanasia 3) Assisted suicide Death with dignityTerry Schiavo

4. Social Meanings of Death Modern American –Medical failure More traditional societies –Natural part of life cycle Grieving practices vary –By culture: weeping/partying –By ethnicity: wake/Shiva

5. Life Expectancy Expected age at death –U.S.: 78 years –White females: 81 years –White males: 76 years –Black females: 76.5 years –Black males: 70 years –Ancient Rome: 30 years Japan, China, Sweden: 80 years

6. Figure 17.1

7. What Kills Us and When? Leading cause of death –Preschool and school children: unintentional injuries (car accidents) –Adolescence and early adulthood: accidents (especially car accidents), homicides, and suicides –45–64 age group: cancers –65 years and older: heart disease © 2015. Cengage Learning. All rights reserved.

8. What Kills Us and When? © 2015. Cengage Learning. All rights reserved.

9. Progeria

10. Perspectives on Dying Kübler-Ross’s five stages of dying –Denial Defense mechanism; anxiety- provoking thoughts are kept out of conscious awareness –Anger Why me? –Bargaining Bargainer begs for some concession from G-d, the medical staff, or family members

11. Perspectives on Dying Kübler-Ross’s five stages of dying –Depression Depression, despair, and a sense of hopelessness become the predominant emotional responses –Acceptance Accept the inevitability of death in a calm and peaceful manner

12. Perspectives on Dying Criticisms of Kübler-Ross’s five stages of dying –Emotional responses to dying are not stage-like –The nature and course of an illness affects reactions to it –Individuals differ widely in their responses –Dying people focus on living, not just dying

13. Perspectives on Dying One study (Nissim et al., 2012) found dying patients have the goals of: –Controlling dying –Valuing life in the present –Creating a living legacy

14. Attachment Model of Bereavement Bereavement: the state of loss Grieving: emotional expressions –Anticipatory grief Mourning: culturally approved reactions Parks/Bowlby Model –Reaction to separation from a loved one –Numbness, yearning, despair, reorganization (not stages)

15. Perspectives on Bereavement

16. The dual-process model of bereavement –Bereaved oscillate between coping with: Emotional blow of the loss Practical challenges of living –Loss-oriented coping –Restoration-oriented coping

17. The Dual-Process Model

18. Figure 17.2

19. The Infant Object permanence – “all gone” Attachment by 6-8 months –Separation anxiety at loss –Protest, yearning, searching despair –Behavioral: eating, sleeping, regression Less distress if attached to other parent Eventual new attachments and recovery

20. Grasping the Concept of Death Young children are: –Highly curious about death –Think about it with some frequency –Build it into their play –Can talk about it

21. The Child The mature concept of death –Finality, irreversibility, universality, biological causality Age 3-5: universality –Dead live under altered circumstances (hunger pangs, wishes, beliefs) –Reversible - like sleep Age 5-7: finality, irreversibility, universality (death caused by an external agent) Age 10: biological causality is understood Level of cognitive development, experience determine understanding

22. Grasping the Concept of Death

23. The Dying Child Young child aware of impending death Adults often secretive Same range of emotions as dying adults Anxiety revealed in behavior Control is helpful Need support of important others

24. The Bereaved Child Children do grieve Express grief differently than adults do –Misbehavior, strike out, rage Lack adult coping skills –Will use denial, avoidance Most adjust successfully

25. The Adolescent Higher levels of understanding Concerns of adolescence –Body image, identity, independence May carry on internal dialogue with dead Devastated at death of close friend Adult-like grieving

26. The Adult Death of family member difficult Death of spouse more expected with age –More difficult when young (non-normative) Elevated levels of stress Risk increases for illness and death Signs of recovery in 2 nd year Complicated grief

27. Loss of a Child No loss more difficult Experienced as untimely, unjust Broken attachments Guilt at failure to protect child May continue relationship w/dead child Marital problems often increase afterward

28. The Loss of a Parent Lasting problems may occur if young Less tragic than unexpected death Adjustment not as difficult Guilt: not doing enough for parent

29. Grief Work Perspective Emotions must be confronted: detachment Psychoanalytic, also popular view May be a culturally biased belief Grief work may actually cause more distress Delayed grief reaction predicted w/out it –Not supported by research Detachment not necessary Continuing bonds (Bo

30. Who Copes and Who Succumbs Secure infant attachment related to coping Low self-esteem related to more difficulty Cause of death influences bereavement Support system essential Additional life stressors detrimental Positive outcomes often found

31. Hospice Dying person decides what is needed De-emphasize prolonging life Pain control emphasized Normal setting (if possible) Bereavement counseling for entire family Research shows positive outcomes