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Chapter 19:
Death, Dying, and Bereavement
Death anxiety?
“According to most studies, people's number one fear is public speaking. Number two is death. Death is number two. Does that sound right? This means to the average person, if you go to a funeral, you're better off in the casket than doing the eulogy.” Jerry Seinfeld
The Experience of Death
Characteristics What
How is death defined?
Where How
The Experience of Death
Characteristics What Where
Where do most people die?
How
The Experience of DeathHospice Care
Philosophy Death viewed as normal Families and the patient encouraged to
prepare for death Family are involved in patient’s care Medical care is palliative rather than curative
HospiceHospital-based and Home-based Care
Comparison
Hospital-Based Care Home-Based Care
Patient Pain Same Same
Length of Survival Same Same
Patient Satisfaction with Care
Same Same
Family Satisfaction with Care
Higher Lower
Family Sense of Burden Higher Lower
Hospice
The Experience of Death
Characteristics What Where How
Developmental understanding of death Process of dying
Preschoolers: reversible
School-agers: permanent and universal
Adolescents: inevitable; sometimes unrealistic
Early adulthood: unique invulnerability; challenged by early death
Middle and late adulthood: finality, inevitability, universality Who has greatest death anxiety?
Developmental Understanding of Death
What would you do about your impending death? (see Table 19.2)
1. Make a marked change in lifestyle (travel, new experiences)
2. Center on inner life (read, pray)
3. Be with others.
4. Attempt to complete projects.
5. No change in lifestyle.
Figure 19.1 Age, Ethnicity and Fear of Death
If you were told that you had a terminal disease and only 6 months to live, how would you want to spend your time until you died?
Questions To PonderQuestions To PonderQuestions To PonderQuestions To Ponder
The Process of DyingPreparation for Death
Kinds of preparations Practical preparations Deeper preparations Older adults more likely to have made
these arrangements
Theoretical Perspectives on Dying Elisabeth Kubler-Ross’s Stages of Dying
Responses to Impending Death
Greer: Female cancer patients
Five groups Denial (positive avoidance) Fighting spirit Stoic acceptance Helplessness/hopelessness Anxious preoccupation
“Those who struggle the most, fight the hardest, express their anger and hostility openly, and who find some sources of joy in their lives live longer.”
Theoretical Perspectives on Grieving Attachment Theory
Bowlby: Four stages of grief
Figure 19.2 Jacobs’s Model of Grieving
Theoretical Perspectives on Grieving Wortman and Silver
Normal Chronic Delayed- 1-5% Absent- 26%
So distress is neither inevitable nor necessary for normal grieving
Theoretical Perspectives on Grieving The Experience of Grieving: Death Rituals
Psychosocial functions of death rituals such as funerals
Help family and friends manage grief by giving a specific set of roles
Bring family members together in unique ways
Establish shared milestones for families
Factors Associated with Grief
Age of the Bereaved Teens often show prolonged grief responses
Modes of Death Death with intrinsic meaning reduces
grief. Sudden and violent or suicide
Gender Incidence of depression among widows
and widowers rises substantially Death of a spouse more negative for men
Theoretical Perspectives on Grieving Pathological Grief
Depression-like symptoms lasting longer than 2 months can lead to long-term depression and
physical ailments may continue for up to 2 years after death
of loved one BUT cultural practices may mimic
pathological grief
Funeral Rites
“Have the courage to live. Anyone can die.” Robert Cody
“I want to die in my sleep like my grandfather... Not screaming and yelling like the passengers in his car.” Will Shriner
“Some die too young, some die too old; the precept sounds strange, but die at the right age” Friedrich Nietzsche
“Death is caused by swallowing small amounts of saliva over a long period of time.” George Carlin
No one can confidently say that he will still be living tomorrow. ~Euripides
From my rotting body, flowers shall grow and I am in them and that is eternity. ~Edvard Munch