Endings: Death and Dying

Chapter 19

Robert S. Feldman

What is death?

• Functional death-absence of heartbeat and breathing

• Brain death-all electrical brain waves have ceased

• Legal death-in most cases, considered the absence of brain functioning

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Death across the Life Span: Causes and Reactions

• Infancy and childhood– Miscarriage grief due to the– Still birth ‘unnatural’ order– Sudden infant death of things– Accidents

• Motor vehicles• Fires• Drowning

– Homicides639

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

(happens to everyone) and finality of death – By middle childhood, understanding of some

customs involved with death (e.g., funerals, cremation, and cemeteries)

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Death across the Life Span: Causes and Reactions

• Adolescence– View of death are often unrealistic-”can’t happen to

me” – Sense of invincibility Leading causes – Personal fable death-accidents– Imaginary audience homicide, suicide,

• Terminal Illness cancer and AIDS

– Denial– Depression

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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

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Death in young adulthood

• Leading cause of death continues to be accidents, followed by suicide, homicide, AIDS, and cancer.

• By the end of early adulthood, however, disease becomes a more prevalent cause of death.

Death across the Life Span: Causes and Reactions

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

• Causes– Most frequents cause: heart attack or stroke

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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 decline-decrease in cognitive and reading functions indicates death may

be imminent in the next few 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

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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

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Types of Depression in stage 4

• Reactive depression-

– Sadness at what has been lost

• Job• Ability to function• Relationships

• Preparatory depression-

– Sadness over the lack of a future

• Seeing children graduate/get married

• Inability to spend the rest of their life with spouse

Kübler-Ross Theory

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Evaluating Kübler-Ross’ Theory

PROS• One of first people to

observe systematically how people approach their own deaths

• Increased public awareness and affected practices and policies related to dying

CONS• Largely limited to those

who are aware that they are dying

• Less applicable to people who suffer from diseases in which the prognosis is uncertain

• Stage-like increments questioned

• Anxiety levels not included

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Choosing the Nature of Death

• DNR– Issues

• States that no ‘extraoridnary’ measures should be taken

• 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

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Doctors and Decisions

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• 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

• Health care proxy• Durable power of

attorney

• See figure 19-3 on page 651 for an example of a living will…

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Euthanasia and Assisted Suicide

• Euthanasia– Passive-removing any medical equipment that

may keep the person alive. Allows patient to die naturally.

– Voluntary active-when a caregiver or medical personnel decides to end a patient’s life before its time

• Assisted suicide– Kevorkian

Oregon-Right to die law650

Caring for the Terminally Ill

Place of Death– Home care– Hospice care– Hospital care

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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

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What is the difference?

• Bereavement-Acknowledging that one has experienced a loss

• Grief-emotional response that follows– Everyone handles grief differently– 3 stages to grief

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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. Starting their life over again or beginning to adjust to the change.

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When Grief Goes Awry

• No particular timetable for grieving• For some people (but not all) grieving may take

considerably longer than a year• Only 15 to 30 percent of people show relatively

deep depression following loss of loved one• Those who show most intense distress

immediately after a death are most apt to have adjustment difficulties and health problems later on

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Consequences of Grief and Bereavement

Negative– Widowed people are

particularly at risk of death

– More negative consequences if person is already insecure, anxious, or fearful, overly dependent, or lacking in social support

– Sudden death

Positive• Remarriage lowers risk of

death for survivors, especially for widowers

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Becoming an Informed Consumer of Development

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

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