Epilogue:
Death and Dying
Thanatology
• The study of death and dying
– Especially the social and emotional aspects.
– Neither morbid or gloomy, it reveals:
• The reality of hope in death
• Acceptance of dying
• Reaffirmation of life
Death and Hope
Death and Hope
Death in Childhood
• Children have a different perspective of death. They:
– are more impulsive and may seem happy one day and sad
the next.
– do not “get over” the death of a parent, nor dwell on it.
– may take certain explanations literally.
• Fatally ill children typically fear abandonment  frequent
and caring contact is more important than logic.
• Older children seek specific facts and become less
anxious about death and dying.
Death in Childhood
Death in Adolescence and
Emerging Adulthood
• Teenagers seem to have little fear of death
– Take risks, place a high value on appearance, and
seek thrills
– May be their way of controlling anxiety.
• Terror management theory (TMT)
– The idea that people adopt cultural values and moral
principles in order to cope with their fear of death.
– Adolescents often predict that they will die at an early
age
• Tendency toward risk taking can be deadly (e.g.,
suicides, homicides, car accidents).
Death in Adolescence and
Emerging Adulthood
Death in Adulthood
• When adults become responsible for work and
family, death is to be avoided or at least
postponed.
• Many adults quit taking addictive drugs, start
wearing seat belts, and adopt other precautions.
• Death anxiety usually increases from one’s
teens to one’s 20s and then gradually
decreases.
• Ages 25 to 60: Terminally ill adults worry about
leaving something undone or leaving family
members—especially children—alone.
Death in Late Adulthood
• Death anxiety decreases and hope rises.
• One sign of mental health among older adults is
acceptance of their own mortality and altruistic
concern about those who will live on after them.
• Many older adults accept death (e.g., they write
their wills, designate health care proxies,
reconcile with estranged family members, plan
their funeral).
• The acceptance of death does not mean that the
elderly give up on living!
Religions and Hope
• People who think they might die
soon are more likely than others to
believe in life after death.
• Virtually every world religion
provides rites and customs to
honor the dead and comfort the
living.
• Although not everyone observes
religious customs, those who care
for the dying and their families
need extraordinary sensitivity to
cultural traditions.
Near-Death Experience
• An episode in which a person comes close to dying
but survives and reports having left his or her body
and having moved toward a bright white light while
feeling peacefulness and joy.
• Near-death experiences often include religious
elements.
• Survivors often adopt a more spiritual, less
materialistic view of life.
• To some, near-death experiences prove that there is
a heaven but scientists are more skeptical.
Dying and Acceptance
• Good death
– A death that is peaceful, quick, and painless
and that occurs after a long life, in the
company of family and friends, and in familiar
surroundings.
– People in all religious and cultural contexts
hope for a good death.
• Bad death
– Lacks these six characteristics and is
dreaded, particularly by the elderly
Attending to the Needs of the
Dying
Kübler-Ross identified emotions experienced by
dying people, which she divided into five stages:
1.Denial (“I am not really dying.”)
2.Anger (“I blame my doctors, or my family, or God for my
death.”)
3.Bargaining (“I will be good from now on if I can live.”)
4.Depression (“I don’t care about anything; nothing matters
anymore.”)
5.Acceptance (“I accept my death as part of life.”)
Honest Conversation
Stage Model based on Maslow’s hierarchy of needs:
1.Physiological needs (freedom from pain)
2.Safety (no abandonment)
3.Love and acceptance (from close family and friends)
4.Respect (from caregivers)
5.Self-actualization (appreciating one’s past and present)
6.Self-transcendence (acceptance of death)
•
This stage was later suggested by Maslow.
*Other researchers have not found sequential stages in this
area.
Honest Conversation
• Most dying people want to spend time with loved
ones and talk honestly with medical and
religious professionals.
• Many thanologists find that the “stages” of death
may not go in order and some may never occur.
• Hospital personnel need to respond to each
dying person as an individual.
• Each person responds to death in their own way,
some may not want the whole truth.
The Hospice
Hospice
• An institution or program in which terminally ill
patients receive palliative care
• Hospice caregivers provide skilled treatment to
relieve pain and discomfort; they avoid measures to
delay death and their focus is to make dying easier
Two principles for hospice care:
1. Each patient’s autonomy and decisions are
respected.
2. Family members and friends are counseled before
the death, shown how to provide care, and helped
after the death.
The Hospice
Palliative Medicine
• Palliative care
– Care designed not to treat an illness but to provide
physical and emotional comfort to the patient and
support and guidance to his or her family.
• Double effect
– An ethical situation in which an action (such as
administering opiates) has both a positive effect
(relieving a terminally ill person’s pain) and a negative
effect (hastening death by suppressing respiration).
Choices and Controversies
Hastening or Postponing Death
Longer Life
• The average person lives twice as long in
2010 as in 1910.
• Later death due to drugs, surgery, and other
interventions (e.g., respirators, defibrillators,
stomach tubes, and antibiotics) .
• Many adults under age 50 once died of
causes that now kill relatively few adults in
developed nations, such as complications of
childbirth and epidemic diseases.
Hastening or Postponing Death
• Passive euthanasia
– A situation in which a seriously ill person is allowed to
die naturally, through the cessation of medical
intervention.
• DNR (do not resuscitate)
– A written order from a physician (sometimes initiated
by a patient’s advance directive or by a health care
proxy’s request) that no attempt should be made to
revive a patient during cardiac or respiratory arrest.
Hastening or Postponing Death
• Active euthanasia
– A situation in which someone takes action to bring
about another person’s death, with the intention of
ending that person’s suffering.
– Legal under some circumstances in the Netherlands,
Belgium, Luxembourg, and Switzerland, but it is
illegal (yet rarely prosecuted) in most other nations.
• Physician-assisted suicide
– A form of active euthanasia in which a doctor
provides the means for someone to end his or her
own life.
When Physician-Assisted Suicide
Is Legal
When Physician-Assisted
Suicide Is Legal
Slippery slope
• The argument that a given action will start a
chain of events that will culminate in an
undesirable outcome.
• Concern: Hastening death when terminally ill
people request may cause a society to slide
into killing sick people who are not ready to
die—especially the old and the poor.
Advance Directives
• An individual’s instructions for end-of-life
medical care, written before such care is
needed.
• Living will
– A document that indicates what kinds of medical
intervention an individual wants or does not want if he
or she becomes incapable of expressing those
wishes.
• Health care proxy
– A person chosen by another person to make medical
decisions if the second person becomes unable to do
so.
Advance Directives
Bereavement
Normal Grief
• Bereavement
– The sense of loss following a death.
• Grief
– The powerful sorrow that an individual feels at the
death of another.
• Mourning
– The ceremonies and behaviors that a religion or
culture prescribes for people to employ in expressing
their bereavement after a death.
Placing Blame And Seeking
Meaning
Placing blame
• Common impulse after death for the survivors
(e.g., for medical measures not taken, laws
not enforced, unhealthy habits not changed)
• The bereaved sometimes blame the dead
person, sometimes themselves, and
sometimes distant others.
• Nations may blame one another for public
tragedies.
• Blame is not necessarily rational.
Placing Blame And Seeking
Meaning
Seeking Meaning
• Often starts with preserving memories (e.g.,
displaying photographs, telling anecdotes)
• Support groups offer help when friends are unlikely to
understand (e.g., groups for parents of murdered
children).
• Organizations devoted to causes such as fighting
cancer and banning handguns often find supporters
among people who have lost a loved one to that
particular circumstance.
• Close family members may start a charity.
Complicated Grief
• Grief that impedes a person’s future life
• Absent grief
– A situation in which overly private people cut
themselves off from the community and customs that
allow and expect grief; can lead to social isolation.
• Disenfranchised grief
– A situation in which certain people, although they are
bereaved, are prevented from mourning publicly by
cultural customs or social restrictions.
Mourning That Does Not Heal
Incomplete grief
• A situation in which circumstances, such as a
police investigation or an autopsy, interfere
with the process of grieving.
• The grief process may be incomplete if
mourning is cut short or if other people are
distracted from their role in recovery.
Diversity of Reactions
• Reactions to death are varied
– Other people need to be especially
responsive to whatever needs a grieving
person may have.
• Most bereaved people recover within a
year
– A feeling of having an ongoing bond with the
deceased is no longer thought to be
pathological.
Diversity of Reactions