DEATH AND DYINGChapter 19

Learning Objectives

DYING AND DEATH ACROSS THE LIFESPAN

What is death?

Although the question seems straightforward, defining the point at which life ceases and death occurs is surprisingly complex•Functional death

•Brain death

•Legal death

Death across the Life Span: Causes and Reactions

• Despite its economic wealth, the United States has a relatively high infant mortality rate

• In 48 other countries infants died less often in the first year of birth than in the United States (World Fact Book, 2012)

• Infancy and childhood– Miscarriage– Still birth– Sudden infant death– Accidents– Homicides

Death across the Life Span: Causes and Reactions

Childhood•No concept of death until around the age of 5•Around the age of 5, better understanding of finality and irreversibility of death•By about age 9, acceptance of universality and finality of death •By middle childhood, understanding of some customs involved with death (e.g., funerals, cremation, and cemeteries)

Death across the Life Span: Causes and Reactions

Adolescence•View of death are often unrealistic • Sense of invincibility•Personal fable•Imaginary audience

Terminal Illness •Denial•Depression

Death across the Life Span: Causes and Reactions

Young Adulthood•Prime time of life•Death seems unthinkable•Creates feelings of anger and impatience

Concerns•Desire to develop intimate relationships and express sexuality •Future planning

Death across the Life Span: Causes and Reactions

Middle Adulthood•Life-threatening disease not surprising•Fear of death often greatest

Causes•Heart attack or stroke

Death across the Life Span: Causes and Reactions

Late adulthood•Realize death is imminent•Face an increasing number of deaths in their environment •Less anxious about dying

Causes•Cancer, stroke, and heart disease•Terminal death

Terminal Decline

• Suffering

• Burden to loved ones

• Decrease in value to society

Adding Years

Suicide in Later Life

• Rate for men climbs steadily during late adulthood

• No age group has a higher rate of suicide than white men over the age of 85– Severe depression– Some form of dementia– Loss of a spouse

Differing Conceptions of Death

Has one person died a better death than the other?•Depends on values related to cultural and subcultural teachings

Differing views•Death as punishment•Death as judgment about contributions to society•Death as start of redemption or start of eternal life

Religious influence•Christian and Jewish•Sunni Muslim•Druze

Do you agree?

Death education should be mandated for all college students

What is death education?

Death education encompasses programs that teach about death, dying, and grief•Crisis intervention education

•Routine death education

•Education for members of the helping professions

Feldman Concludes

Although no single form of death education will be sufficient to demystify death, the kinds of programs just described

may help people come to grips more effectively with what is, along with birth, the most universal—and certain—of all

human experiences

Review and Apply

Review and Apply

Review and Apply

CONFRONTING DEATH

Are there steps toward death?

Kübler-Ross •Developed a theory of death and dying

•Built on extensive interviews with people who were dying

•With input from those who cared for them

Kübler-Ross Theory

Evaluating Kübler-Ross’ Theory

Other Theorists

Edwin Shneidman •“Themes” in people's reactions to dying that occur—and recur—in any order throughout the dying process

Charles Corr •People who are dying face a set of psychological tasks

Should people be free to select the nature of their own death?

Choosing the Nature of Death

DNR•Issues

– Differentiates of “extreme” and “extraordinary” measures from those that are simply routine

– Determines of individual's current quality of life and whether it will be improved or diminished by a particular medical intervention

– Determines of decision-maker role

Doctors and Decisions

• Medical personnel are reluctant to suspend aggressive treatment.

• Physicians often claim to be unaware of patients’ wishes

• Physicians and other health care providers may be reluctant to act on DNR requests – Trained to save patients– To avoid legal liability issues

Living Wills

To gain more control over decisions regarding the nature of their death, people are increasingly signing living wills•Living will

•Health care proxy

•Durable power of attorney

Dying Hard: Experiences of 4,301 Patients with End-of-Life Care

Euthanasia and Assisted Suicide

Euthanasia•Passive•Voluntary active

Assisted suicide•Kevorkian

What are the arguments?

How Long Do “Terminal” Patients Really Live?

According to the large SUPPORT study, a significant percentage of a group of 3,693 patients given no more than a 50 percent chance of living for six months survived well beyond that period.

Why do you think this happened?

(Source: Based on Lynn et al., 1997.)

Caring for the Terminally Ill

Place of Death•Home care

•Hospice care

•Hospital care

Review and Apply

Review and Apply

Review and Apply

GRIEF AND BEREAVEMENT

Mourning and Funerals: Final Rites

Costs•Average funeral and burial costs $7,000

•Survivors are susceptible to suggestions to “provide the best” for deceased

•Determined by social norms and customs

Cultural Differences in Grieving

Western societal rituals (some variations)•Body preparation

•Celebration of a religious rite

•Military customs

Cultural Differences in Grieving

Non-Western rituals different from Western•Examples:

– Shave heads, let hair and beard grow– Noisy celebration and silence– High emotional display of emotion and no display of

emotion

Feldman concludes that all funerals basically serve the same underlying function.

What is this function?

Bereavement and Grief: Adjusting to the Death of a Loved One

What is the difference?

• Bereavement

• Grief

Grieving in the Western World

• 1st stage: grief typically entails shock, numbness, disbelief, or outright denial

• 2nd stage: people begin to confront the death and realize extent of their loss

• 3rd stage: people reach accommodation stage

Death of Long-term Spouse

Death of spouse•Strength of relationship with can have effect on grieving process

•Almost always traumatic experience that is usually followed by intense grief and anguish

What other factors besides interpersonal closeness might affect the duration of grief

after losing a long-time spouse?

When Grief Goes Awry

How long do you think grief lasts?

Consequences of Grief and Bereavement

How Helpful Is Grief Counseling?

Effectiveness and the necessity of grief counseling services has recently been called into question•Meta-analysis of more than 60 studies of therapeutic interventions for bereaved people concluded that these grief counseling did not help significantly more than the mere passage of time

•There are many variations on how people react to the death of a loved one, friend, or acquaintance

•Care should be taken about applying preconceptions about the course of grief as people cope with death

Helping a Child Cope with Grief

• Be honest

• Encourage expressions of grief

• Reassure children that they are not to blame for the death

• Understand that children's grief may surface in unanticipated ways

• Children may respond to books for young persons about death

Consider this…

• What are some policy issues affecting children and adolescents that are currently being debated nationally?

• Despite the existence of research data that might inform policy about development, politicians rarely discuss such data in their speeches.

Why do you think that is the case?

Review and Apply

Review and Apply

EPILOGUE

Before you close the book, return to the chapter prologue, about Adrian Carsini's approach toward death. Based on your understanding of death and dying, answer the following questions.

•How did Adrian seem to cope with his impending death? Was his initial reaction consistent with Kubler-Ross's theory?

•How might Adrian's pre-adolescent great-grandchildren have understood what was happening to Adrian?

•How might staying by Adrian's side during his last days have affected the grieving process for his family?

•How might Adrian's final days have been different if he elected to continue his cancer treatment in the hospital?