Post on 14-Dec-2015
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Death and GrievingDeath and Grieving
Chapter 17Chapter 17
Issues in Determining DeathIssues in Determining Death
Brain deathBrain death —— neurological definition neurological definition of deathof death All electrical activity of brain has ceased All electrical activity of brain has ceased
for a specified period of timefor a specified period of time
Flat EEG recordingFlat EEG recording
Some medical experts argue criteria for Some medical experts argue criteria for death should include only higher cortical death should include only higher cortical functioningfunctioning
Death becoming increasingly Death becoming increasingly complexcomplex
1. When to determine death has 1. When to determine death has
occurred?occurred?
2. Life expectancy has increased2. Life expectancy has increased
3. Care for dying shifted away from 3. Care for dying shifted away from
familyfamily
4. Minimized exposure to death and its 4. Minimized exposure to death and its
painpain
Death in Different CulturesDeath in Different Cultures
Most societies haveMost societies have Philosophical or religious beliefs Philosophical or religious beliefs
about deathabout death
Rituals that deal with deathRituals that deal with death
View that death does not end View that death does not end existenceexistence
U.S. Denial and Avoidance of Death ?U.S. Denial and Avoidance of Death ?
Funeral industry emphasizes lifelike Funeral industry emphasizes lifelike qualitiesqualities
Euphemisms Euphemisms — softening— softening language language for deathfor death
Persistent search for “fountain of Persistent search for “fountain of youth”youth”
Rejection and isolation of agedRejection and isolation of agedHope that everyone goes to heavenHope that everyone goes to heavenMedical emphasis Medical emphasis —— prolonging life, prolonging life,
not easing sufferingnot easing suffering
Attitudes Toward Death at Different Attitudes Toward Death at Different Points in the Life SpanPoints 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
SuicideSuicideA Developmental Perspective of Death
Serious physical Serious physical illnessillness
Feelings of Feelings of disparity, isolation, disparity, isolation, failure, lossfailure, loss
Serious financial Serious financial problemsproblems
Drug use or prior Drug use or prior suicide attemptssuicide attempts
Antidepressant linksAntidepressant 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
Facing One’s Own DeathFacing One’s Own Death
Most dying individuals want to Most dying individuals want to make decisions regarding their make decisions regarding their life and deathlife and death
Complete unfinished businessComplete unfinished business
Resolve problems and conflictsResolve problems and conflicts
Put their affairs in orderPut their affairs in order
Kubler-Ross’ Stages of DyingKubler-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
Perceived Control and DenialPerceived Control and Denial
When individuals believe they can When individuals believe they can influence and control events, they may influence and control events, they may become more alert and cheerfulbecome more alert and cheerful
Denial can be adaptive or maladaptiveDenial can be adaptive or maladaptive
Care for Dying IndividualsCare for Dying Individuals ? ?
Death in U.S.: often lonely, prolonged, Death in U.S.: often lonely, prolonged, painfulpainful
Plan for your deathPlan for your death Make a living willMake a living will
Give someone power of attorneyGive someone power of attorney
Give your doctor specific instructions Give your doctor specific instructions
Discuss desires with family and doctorDiscuss desires with family and doctor
Check insurance plan coverageCheck insurance plan coverage
The Contexts in Which People DieThe Contexts in Which People Die
Most would rather die at home but Most would rather die at home but worry overworry over
Burden at homeBurden at home
Limited spaceLimited space
May alter relationshipsMay alter relationships
Competency and availability of emergency Competency and availability of emergency medical treatment medical treatment
Communicating with the Dying PersonCommunicating with the Dying Person Establish your presenceEstablish your presence
Eliminate distractionEliminate distraction
Limit visit timeLimit visit time
DonDon’’t insist on t insist on acceptanceacceptance
Allow expressions of guilt Allow expressions of guilt or angeror anger
Discuss alternatives, Discuss alternatives, unfinished businessunfinished business
Ask if there is anyone s/he Ask if there is anyone s/he would like to seewould like to see
Encourage the dying Encourage the dying individual to reminisceindividual to reminisce
Talk with the individual Talk with the individual when s/he wishes to talkwhen s/he wishes to talk
Express your regard Express your regard
Decisions Regarding Life, Decisions Regarding Life, Death, and Health CareDeath, and Health Care
Natural Death Act and Advance Natural Death Act and Advance DirectiveDirective
Expresses person’s desires regarding Expresses person’s desires regarding extraordinary medical procedures that extraordinary medical procedures that might be used to sustain life when might be used to sustain life when medical situation becomes hopelessmedical situation becomes hopeless
EuthanasiaEuthanasia Painlessly ending lives of persons suffering from Painlessly ending lives of persons suffering from
incurable diseases or severe disabilitiesincurable diseases or severe disabilities
Passive euthanasiaPassive euthanasia —— withholding of withholding of available treatments, allowing the available treatments, allowing the person to dieperson to die
Active euthanasiaActive euthanasia —— death induced death induced deliberately, as by injecting a lethal deliberately, as by injecting a lethal dose of drugdose of drug
Publicized controversy: assisted suicidePublicized controversy: assisted suicide
Care for Dying IndividualsCare for Dying Individuals
Hospice Hospice — humanized program — humanized program committed to making the end of committed to making the end of life as free from pain, anxiety, and life as free from pain, anxiety, and depression as possibledepression as possible
Palliative care Palliative care — reducing pain — reducing pain and suffering and helping and suffering and helping individuals die with dignityindividuals die with dignity
When Others DecideWhen Others Decide
Remember Terry SchaivoRemember Terry Schaivo
What is a persistent vegetative What is a persistent vegetative state?state?
Who decides?Who decides?
What are their motives?What are their motives?
Should the government Should the government decide?decide?
Social security bankruptcy – worker-Social security bankruptcy – worker-pensioner imbalancepensioner imbalance
Medicare/Medicaid bankruptcyMedicare/Medicaid bankruptcy
Generational inequity – rationing of Generational inequity – rationing of carecare
GrievingGrievingGriefGrief: emotional numbness; a : emotional numbness; a
complex emotional state of…complex emotional state of… DisbeliefDisbelief Separation anxietySeparation anxiety DespairDespair SadnessSadness Loneliness Loneliness
……that accompanies loss of that accompanies loss of someone we lovesomeone we love
Cultural Diversity in Healthy GrievingCultural Diversity in Healthy Grieving
Contemporary western orientationContemporary western orientation
Breaking bonds with the deadBreaking bonds with the dead
Returning survivors to autonomous Returning survivors to autonomous
lifestylelifestyle
Non-Western culturesNon-Western cultures
Maintaining ties with deceased Maintaining ties with deceased
Influenced by religious beliefs and Influenced by religious beliefs and
lifestylelifestyle
Making Sense of GriefMaking Sense of Grief
Grieving stimulates many to try to Grieving stimulates many to try to make sense of their world make sense of their world —— positive positive themes linked to hopeful future and themes linked to hopeful future and better adjustmentbetter adjustment
Effort to make sense of it pursued Effort to make sense of it pursued more vigorously when caused by an more vigorously when caused by an accident or disasteraccident or disaster
Losing a Life PartnerLosing a Life PartnerThose left behind after the death of an Those left behind after the death of an
intimate partner suffer profound grief intimate partner suffer profound grief and often endureand often endure
Financial lossFinancial loss
Loneliness linked to poverty and Loneliness linked to poverty and
educationeducation
Increased physical illnessIncreased physical illness
Psychological disorders, including Psychological disorders, including
depressiondepression
Marital Quality and Marital Quality and Adjustment to WidowhoodAdjustment to Widowhood
Widowhood associated with Widowhood associated with increased anxiety among those increased anxiety among those highly dependent on their spouseshighly dependent on their spouses
Lower anxiety for those who did Lower anxiety for those who did not depend on their spouse very not depend on their spouse very muchmuch
Forms of MourningForms of Mourning
Approximately 80 percent of corpses are disposed Approximately 80 percent of corpses are disposed of by burial, the remaining 20 percent by of by burial, the remaining 20 percent by cremation cremation
Funeral industry is source of controversyFuneral industry is source of controversy
Funeral is important aspect of mourning in many Funeral is important aspect of mourning in many culturescultures
Cultures vary in how they practice mourningCultures vary in how they practice mourning
Amish MourningAmish Mourning
Conservative group; family-oriented Conservative group; family-oriented
societysociety Live same unhurried pace as ancestorsLive same unhurried pace as ancestors
Time of death met with calm acceptanceTime of death met with calm acceptance
Neighbors notify community; funeral atNeighbors notify community; funeral at homehome
High level of support to family for one yearHigh level of support to family for one year
Traditional Judaism and MourningTraditional Judaism and Mourning
Mourning in graduated time periods; Mourning in graduated time periods; each with appropriate practiceseach with appropriate practices
1st period: 1st period: AninutAninut —— between death between death and burialand burial
2nd period: 2nd period: AvelutAvelut period period —— mourning mourning properproperShivahShivah period period —— 7-day begins at burial 7-day begins at burialSheloshimSheloshim period period —— 30-day period after 30-day period after
burialburial
Mourning over for all but parents who Mourning over for all but parents who mourn another 11 monthsmourn another 11 months