Transcript No Slide Title - Black Hawk College

Chapter 21
Death and Grieving
Death and Grieving
Defining Death
and Life/Death
Issues
2
Death and
Sociohistorical,
Cultural
Contexts
A Developmental
Perspective
on Death
Facing One's
Own Death
Coping
with the
Death of
Someone Else
Black Hawk College Chapter 21
Defining Death and
Life/Death Issues
Issues in
Determining
Death
3
Decisions Regarding
Life, Death, and
Health Care
Black Hawk College Chapter 21
Issues in Determining Death
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Brain death - a neurological definition of
death which states that a person is
brain dead when all electrical activity of
the brain has ceased for a specified
period of time.
Black Hawk College Chapter 21
Issues in Determining Death
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The brain’s lower portions monitor vital
functions, thus people whose higher
brain areas have died may continue
breathing and have a heartbeat.
The current definition of brain death for
most physicians includes the death of
both the higher cortical functions and
lower brain stem functions.
Black Hawk College Chapter 21
Other Considerations for
Determining Death
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Some medical experts argue that the
criteria for death should include only
higher cortical functioning.
They argue that the functions we
associate with being human, such as
intelligence and personality, are located
in the higher cortical part of the brain.
Black Hawk College Chapter 21
Other Considerations for
Determining Death
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They believe that when these functions
are lost, the “human being” is no longer
alive.
To date, the cortical definition of death is
not a legal definition of death anywhere
in the U.S.
Black Hawk College Chapter 21
Decisions Regarding Life,
Death, and Health Care
The Living Will
 Natural Death Act and Advanced
Directives
 Euthanasia
 Needed: Better Care for
Dying Individuals
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Black Hawk College Chapter 21
The Living Will
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Recognizing that terminally ill patients might
prefer to die rather than lingering in a painful
or vegetative state, an organization called
“Choice in Dying” created the Living Will.
This document is designed to be filled in
while the individual can still think clearly and
expresses the person’s desire that
extraordinary medical procedures not be
used to sustain life when the medical
situation becomes hopeless.
Black Hawk College Chapter 21
Natural Death Act and
Advanced Directives
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Physicians’ concerns over malpractice
suits and the efforts of Living Will
supporters have produced natural death
legislation in many states.
California’s Natural Death act permits
individuals who have been diagnosed
by two physicians as terminally ill to
sign an advanced directive.
Black Hawk College Chapter 21
Natural Death Act and
Advanced Directives
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This advanced directive states that lifesustaining procedures not be used to
prolong their lives when death is
imminent.
All 50 states now accept advanced
directives.
Black Hawk College Chapter 21
Euthanasia
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The act of painlessly ending the lives of
individuals who are suffering from an
incurable disease or severe disability.
Sometimes referred to as “mercy
killing.”
Black Hawk College Chapter 21
Euthanasia
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Passive euthanasia - occurs when a
person is allowed to die by withholding
available treatment, such as
withdrawing a life-sustaining device.
Active euthanasia - occurs when death
is deliberately induced, as when a lethal
dose of a drug is injected.
Black Hawk College Chapter 21
Attitudes About Euthanasia
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The trend is toward acceptance of
passive euthanasia for terminally ill
patients.
The precise boundaries and the exact
mechanisms by which treatment
decisions should be implemented are
not entirely agreed upon.
Black Hawk College Chapter 21
Attitudes About Euthanasia
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Active euthanasia is a crime in most countries
and in all U.S. states except Oregon.
In a recent survey of more than 900
physicians, most opposed active euthanasia
and said that adequate pain control often
eliminates the need for it and that the primary
role of the physician is to preserve life.
Black Hawk College Chapter 21
Needed: Better Care for
Dying Individuals
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A recent report concluded that death in
America is often lonely, prolonged, and
painful.
Dying individuals often get too little or too
much care.
Black Hawk College Chapter 21
Needed: Better Care for
Dying Individuals
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Too many experience severe pain during the last
days and months of life.
It is recommended that regulations be changed
to make it easier for physicians to prescribe
painkillers for dying patients who need them.
The report also noted many health-care
professionals are not trained to provide adequate
end-of-life care.
Black Hawk College Chapter 21
Suggestions for the End of
Life
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Make a living will, and be sure there is
someone who will draw your doctor’s
attention to it.
Give someone the power of attorney
and make sure this person knows your
wishes regarding medical care.
Black Hawk College Chapter 21
Suggestions for the End of
Life
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Give your doctors specific instructions—from
“Do not resuscitate” to “Do everything
possible”—for specific circumstances.
If you want to die at home, talk it over with
your family and doctor.
Check to see whether your insurance plan
covers home care and hospice care.
Black Hawk College Chapter 21
Hospices
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A humanized program committed to
making the end of life as free from pain,
anxiety, and depression as possible.
The hospice’s goals contrast with those
of a hospital, which are to cure illness
and prolong life.
Black Hawk College Chapter 21
Hospices
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A primary goal is to bring pain under
control and to help dying patients face
death in a psychologically healthy way.
They make every effort to include the
dying individual’s family.
Today, more hospice programs are
home-based.
Black Hawk College Chapter 21
Death and
Sociohistorical,
Cultural Contexts
Changing
Historical
Circumstances
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Death in
Different
Cultures
Black Hawk College Chapter 21
Changing Historical
Circumstances
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One historical change already presented is
the increasing complexity of determining
when someone is truly dead.
Another change is the age group death
strikes most often—200 years ago it was
children, now it is the elderly.
Black Hawk College Chapter 21
Changing Historical
Circumstances
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Life expectancy has increased by 50 years
since 1900.
With a mobile society, more people die
apart from their families.
The care of the dying has shifted away from
families.
Black Hawk College Chapter 21
Death in Different Cultures
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Americans are conditioned to live life as
though they were immortal.
People in many countries face death all
around them on a daily basis.
Even in areas where life is better, the
presence of dying family members and
large funeral attendance is a regularity.
These aspects of life help prepare the young
for death and provide them with guidelines on
how to die.
Black Hawk College Chapter 21
Perceptions of Death
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In most societies, death is not viewed as the end of
existence—though the biological body has died, the
spiritual body is believed to live on.
Some cultures:
 believe death is caused by magic and demons.
 believe death is caused by natural forces.
 focus on reincarnation.
 view death as punishment, while for others it
represents redemption.
 fear death, while others embrace it.
Black Hawk College Chapter 21
Evidence of the Denial of
Death
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The tendency of the funeral industry to
gloss over death and fashion lifelike
qualities in the dead
The adoption of euphemistic language
for death
The persistent search for a fountain of
youth
Black Hawk College Chapter 21
Evidence of the Denial of
Death
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The rejection and isolation of the aged,
who may remind us of death
The adoption of the concept of a
pleasant and rewarding afterlife,
suggesting that we are immortal
The medical community’s emphasis on
the prolongation of biological life rather
than an emphasis on diminishing
human suffering
Black Hawk College Chapter 21
A Developmental
Perspective
On Death
Causes of
Death and
Expectations
About Death
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Attitudes
Toward Death
at Different Points
in the Life Span
Black Hawk College Chapter 21
Causes of Death and
Expectations About Death
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Death can occur at any point in the human
life span.
In childhood, death occurs most often
because of accidents or illness.
Death in adolescence is more likely to
occur because of motor vehicle accidents,
suicide, and homicide.
Black Hawk College Chapter 21
Causes of Death and
Expectations About Death
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Younger adults are more likely to die from
accidents.
Older adults are more likely to die from
chronic diseases.
Younger adults who are dying often feel
cheated more than do older adults who
are dying.
Black Hawk College Chapter 21
Attitudes Toward Death at
Different Points in the Life Span
 Childhood
 Adolescence
 Adulthood
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Black Hawk College Chapter 21
Childhood Attitudes
Toward Death
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Infants don’t have even a rudimentary
concept of death, but once they develop an
attachment, they can experience loss or
separation and anxiety.
Children 3-5 years old don’t have a true idea
of what death really means, often confusing
death with sleep.
Young children believe that the dead can be
brought back to life spontaneously.
It is believed children don’t believe death is
universal and irreversible until about age 9.
Black Hawk College Chapter 21
Explaining Death to
Children
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Most psychologists believe that
honesty is the best strategy in
discussing death with children.
Respond to children’s queries about
death based on their maturity level.
Black Hawk College Chapter 21
Explaining Death to
Children
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Death can be explained to preschool
children in simple physical and biological
terms.
What children need the most is reassurance
that they are loved and will not be
abandoned.
Regardless of age, adults should be
sensitive and sympathetic, encouraging
them to express their own feelings and
ideas.
Black Hawk College Chapter 21
Adolescent Attitudes
Toward Death
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In adolescence, the prospect of death is so remote
that it does not have much relevance.
The subject of death may be avoided, glossed over,
kidded about, neutralized, and controlled by a cool
spectatorlike orientation.
Adolescents develop more abstract conceptions of
death than children do.
They also develop religious and philosophical views
about the nature of death and whether there is life
after death.
Adolescents are especially likely to think that they are
invincible and unique and immune to death.
Black Hawk College Chapter 21
Adult Attitudes Toward
Death
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There is no evidence that a special
orientation toward death develops in early
adulthood.
An increase in consciousness about death
accompanies individuals’ awareness that they
are aging.
This usually intensifies in middle adulthood,
as those in midlife fear death more than do
young adults or older adults.
Older adults think about death more and talk
about it more than in previous adult stages.
Black Hawk College Chapter 21
Facing One's
Own Death
Kubler-Ross'
Stages of
Dying
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Perceived Control
and Denial
The Contexts
in Which
People Die
Black Hawk College Chapter 21
Kubler-Ross’ Stages of Dying
 Denial
and Isolation
 Anger
 Bargaining
 Depression
 Acceptance
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Black Hawk College Chapter 21
Denial and Isolation
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In the first stage of dying, Kübler-Ross states
that individuals refuse to believe that their
condition is terminal.
These individuals attempt to convince
themselves that lab tests were inaccurate or
that the disease will go into remission.
Dying individuals in this stage also seek
isolation from others.
Black Hawk College Chapter 21
Anger
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In this second stage of dying, the dying
person recognizes that denial can no
longer be maintained.
Denial often gives way to anger,
resentment, rage, and envy.
Black Hawk College Chapter 21
Anger
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The dying person’s question is: “Why me?”
At this point, the dying person becomes
increasingly difficult to care for, as anger may
become displaced and projected onto
physicians, nurses, family members, and God.
The realization of loss is great and those who
represent life are targets of resentment and
jealousy.
Black Hawk College Chapter 21
Bargaining
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In the third stage of dying, Kübler-Ross states
that the person develops the hope that death
can somehow be postponed or delayed.
Some people enter into a bargaining or
negotiation —often with God—as they try to
delay their death.
In exchange for a few more days, weeks, or
months of life, the person promises to lead a
reformed life dedicated to God or to the
service of others.
Black Hawk College Chapter 21
Depression
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In Kübler-Ross’ fourth stage of dying,
the dying person comes to accept the
certainty of death.
At this point, a period of depression or
preparatory grief may appear.
Black Hawk College Chapter 21
Depression
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The dying person may become silent,
refuse visitors, and spend much time
crying or grieving.
Attempts to cheer up the dying person
at this stage should be discouraged,
says Kübler-Ross, because the dying
person has a need to contemplate
impending death.
Black Hawk College Chapter 21
Acceptance
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In the fifth stage of dying, the person
develops a sense of peace; an acceptance of
one’s fate; and, in many cases, a desire to be
left alone.
In this stage, feelings and physical pain may
be virtually absent.
Kübler-Ross views this stage as the end of
the dying struggle, the final resting stage
before death.
Black Hawk College Chapter 21
Criticisms of Kübler-Ross
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According to psychology death expert
Robert Kastenbaum, the existence of
the five-stage sequence has not been
demonstrated by research.
Black Hawk College Chapter 21
Criticisms of Kübler-Ross
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Kastenbaum also believes that the stage
interpretation neglected the patients’ total life
situations, including relationship support,
specific effects of illness, family obligations,
and institutional climate in which they were
interviewed.
Some psychologists prefer to describe the
stages as reactions to dying rather than
stages.
Black Hawk College Chapter 21
The Contributions of
Kübler-Ross
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She made the important contribution of
calling attention to people attempting to cope
with life-threatening illnesses.
She did much to encourage needed attention
to the quality of life for dying persons and
their families.
Black Hawk College Chapter 21
Perceived Control and Denial
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Perceived control and denial may work
together as an adaptive strategy for
some older adults who face death.
When individuals are led to believe they
can influence and control events, they
may become more alert and cheerful.
Black Hawk College Chapter 21
Perceived Control and Denial
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Denial may also be a fruitful way for
some individuals to approach death.
Denial can protect us from the tortuous
feeling that we are going to die.
Denial can be maladaptive if it prevents
treatment.
Black Hawk College Chapter 21
The Contexts in Which
People Die
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For dying individuals, the context in
which they die is important.
More than 50% of Americans die in
hospitals.
Black Hawk College Chapter 21
The Contexts in Which
People Die
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Nearly 20% die in nursing homes.
Hospitals offer important advantages in
that professional staff members are
readily available, and the medical
technology may prolong life.
Most individuals say they would rather
die at home, and many choose a
hospice.
Black Hawk College Chapter 21
Coping with the
Death of Someone Else
Communicating
with a
Dying Person
54
Grieving
Making Sense
of the World
Losing a
Life Partner
Forms of
Mourning and
the Funeral
Black Hawk College Chapter 21
Communicating with a
Dying Person
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Most psychologists believe that it is best for
dying individuals to know that they are dying,
and that significant others know they are dying.
Dying individuals can thus close their lives in
accord with their own idea of proper dying.
They can complete plans and projects.
They can make arrangements for survivors.
They can participate in decisions about a
funeral.
They will have the opportunity to reminisce.
Black Hawk College Chapter 21
Suggestions for Conversing
with a Dying Individual
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Experts believe that conversation should
not focus on mental pathology or
preparation for death, but should focus
on strengths of the individual and
preparation for the remainder of life.
Black Hawk College Chapter 21
Suggestions for Conversing
with a Dying Individual
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Communication should be directed at internal
growth.
Caring for a dying individual can come from:
 an attentive physician.
 a concerned nurse.
 a sensitive spouse.
 an intimate friend.
Black Hawk College Chapter 21
Grieving
Dimensions of Grieving
 Cultural Diversity in Healthy Grieving
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Black Hawk College Chapter 21
Dimensions of Grieving
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The emotional numbness, disbelief,
separation anxiety, despair, sadness,
and loneliness that accompany the loss
of someone we love.
Pining or yearning reflects a recurrent
need to recover the lost person.
Black Hawk College Chapter 21
Dimensions of Grieving
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Separation anxiety includes pining but
also focuses on places and things
associated with the deceased, as well
as crying.
Numbness, disbelief, and outbursts of
panic are typical immediate reactions.
Despair, sadness, and hopelessness
are included.
Black Hawk College Chapter 21
The Ups and Downs
of Grieving
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Rapidly changing emotions
Meeting the challenges of learning new
skills
Detecting personal weaknesses and
limitations
Creating new patterns of behavior
Forming new friendships and
relationships
Black Hawk College Chapter 21
Issues Related to Grieving
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Researchers have found that the
grieving process is more like a rollercoaster ride than an orderly progression
of stages with clear-cut time frames.
For most individuals the roller-coaster
dimensions of grief become more
manageable over time, with fewer
abrupt highs and lows.
Black Hawk College Chapter 21
Issues Related to Grieving
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Long-term grief is sometimes masked
and can lead to depression and suicidal
behavior.
Good family communication may help
reduce the incidence of depression and
suicidal thoughts.
Black Hawk College Chapter 21
Cultural Diversity in
Healthy Grieving
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In contrast to Western beliefs, maintenance of
ties with the deceased is accepted and
sustained in the religious rituals of Japan.
In the Arizona Hopi, the deceased are
forgotten as quickly as possible and life is
carried on as usual.
In Egypt, the bereaved are encouraged to
dwell at length on their grief.
Black Hawk College Chapter 21
Cultural Diversity in
Healthy Grieving
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In Bali, the bereaved are encouraged to
laugh and be joyful, rather than be sad.
Diverse grieving patterns are culturally
embedded.
Black Hawk College Chapter 21
Making Sense of the World
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A beneficial aspect of grieving is that it
stimulates many individuals to make
sense of their world.
A common occurrence is to go over again
and again all of the events that led up to
the death.
Black Hawk College Chapter 21
Making Sense of the World
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When death is caused by an accident or
disaster, the effort to make sense of it is
pursued more vigorously.
The bereaved want to put the death in a
perspective they can understand—divine
intervention, a logical sequence of cause
and effect, etc.
Black Hawk College Chapter 21
Losing a Life Partner
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Those left behind after the death of an
intimate partner suffer profound grief
and often endure financial loss,
loneliness, increased physical illness,
and psychological disorders.
The bereaved are also at increased risk
for many health problems, including
death.
Black Hawk College Chapter 21
Losing a Life Partner
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Optimal adjustment after a death
depends on several factors.
Women do better than men in our
society, due to their networks of friends
and close relationships.
Black Hawk College Chapter 21
Forms of Mourning
and the Funeral
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Mourning varies cross-culturally.
The funeral is an important aspect of
mourning in many cultures.
Black Hawk College Chapter 21
Forms of Mourning
and the Funeral
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One consideration is what to do with the
body.
Approximately 80% of corpses are buried.
A recent study showed that bereaved
individuals who were religious derived more
psychological benefits from a funeral,
participated more actively in rituals, and
adjusted more positively to the loss.
Black Hawk College Chapter 21