DEATH, DYING, AND BEREAVEMENT
DEFINING DEATH
--bodily functioning begins to cease as time goes by; it’s more gradual instead of sudden
--before, death meant loss of a heartbeat or respiration
however, vital signs can be restored using resuscitation techniques
now, the avg. person today lives twice as long as the avg. person did a century ago
brain death: all activity in the brain and the brain stem (which controls reflexes)
irreversibly cease
vegetative state: cerebral cortex no longer shows electrical activity but the brain
stem remains active
--is possible for a person to regain activity in the
but
it’s usually with very limited functioning, possibly because of loss of activity for so long
UNDERSTANDING OF AND ATTITUDES TOWARD DEATH
Childhood
--children have a harder time understanding death but if exposed early, gain a better
understanding earlier than those who weren’t exposed
--mainly don’t understand that it’s permanent; may think that the person will “come back”
after a while
--children may internalize the death of another person and thinks it’s something they
have done to cause the person’s death
--adults should listen to the child with full attention when the child talks about death to
help with their understanding of death
--children who are terminally ill fear that death means they will be abandoned
Adolescence
--do understand that death is permanent
--but understanding isn’t fully mature due to
(so mainly when it
applies to them, their understanding falls short)
--will still engage in risky behaviors to cope with death (terror management theory)
Adulthood
--in
, tend to think that death won’t happen until much later
--in
, think about death more; think about how much time they
have left and what needs to be done before they die
--in
, think about it because they know it’s not too far away
Death Anxiety
death anxiety: fear and apprehension of death
--in early adulthood, brush aside thoughts of death, possibly because of death anxiety
--in Western culture,
seems to be more important than
in reducing death anxiety
--women more than men suffer from death anxiety; may be because women voice it more
than men
--death anxiety
in late adulthood
THINKING AND EMOTIONS OF DYING PEOPLE
Stages of Dying – Kubler-Ross
1. denial: may deny diagnosis or how serious it is; more to escape from the thought
of dying; allows them to deal with it at their own pace; can go in and out of denial
2. anger: time is limited so get angry about not being able to do everything they
had planned to do with their life
3. bargaining: bargain for extra time; bargain with doctors or God; wishes are
usually unrealistic and impossible to fill
4. depression: become depressed because realize that denial, anger, and
bargaining are not working to prolong their life
5. acceptance: usually happens in the last weeks or days before actual death takes
place; tend to be closer to family and close friends during this time
CARE FOR THE DYING
Hospice Care
hospice: Designed for the terminally ill to spend their last days; usually, doctors
have done all they can for these patients
expect these patients to live no more than
will have doctors, nurses, psychologists, social workers, clergy, etc.
give pain management
of those admitted die before the end of the first week
Palliative Care (or Comfort Care)
palliative care: the person receives care to relieve any pain associated with their
illness—physical, psychological, social, and spiritual.
also helps relieve psychological pain
double effect: medicine to relieve pain brings about death more quickly by slowing
respiration
EX:
THE RIGHT TO DIE
Euthanasia
passive euthanasia: person dies naturally because of no medical interventions
DNR (do not resuscitate) order: patient does not want to be resuscitated and
allows a natural death
active euthanasia: another person brings about the person’s death, intending to
end the person’s suffering
medication, lethal injection, turning off a respirator
physician assisted suicide: a doctor provides the means for a person to end
his/her own life; may be in the form of lethal drugs
legal in Oregon but law has strict guidelines:
1) person must be terminally ill and not expected to live more than 6 months
2) must be diagnosed as terminally ill by 2 doctors
3) both doctors agree that the condition doesn’t impair the patient’s
judgment
4) patient has to ask for prescription at least twice orally and once in writing
5) has to be 15 days between the first request and the written prescription
6) the person must be an Oregon resident over 17
Legal Preparations
living will: states the medical interventions a person wants in the event they are
not able to express it themselves
health care proxy: someone other than the patient has the right to arrange for
medical intervention or not; usually a spouse or child
COPING WITH BEREAVEMENT
bereavement: the sense of loss after a death
grief: emotional response to bereavement
sometimes is overpowering to where the individual is not able to function
normally as they did before
complicated grief: impedes a person’s future life
absent grief: an individual may not appear to grieve
disenfranchised grief: people are not allowed to publicly mourn because of cultural
customs or social restrictions
mourning: the public display of bereavement
differ from
important function is to allow expression of grief publicly
of mourners experience extreme or complicated grief
Grief Process
1. avoidance: the death is too much to comprehend so the person experiences
shock and then disbelief
2. confrontation: grief is more intense now; different emotional reactions
including
3. restoration: as grief lessens, begin to do “normal” things such as everyday
responsibilities, socializing with friends and family and possibly new friends
Parents Grieving the Loss of a Child
most difficult loss an adult can face b/c children are extensions of the parent’s feelings
about themselves; much distress even many years later; unnatural
Children & Adolescents Grieving the Loss of a Parent or Sibling
when a parent dies, children lose their
if a sibling, lose that close
crying, trouble concentrating at school, sleep difficulties, headaches for several months
to years after the death
teenagers are more likely to experience
to
cope with grief
Adults Grieving the Loss of an Intimate Partner
more negative outcomes if the spouse is young instead of elderly; b/c it’s not normal and
disrupts plans they had for life
have to possibly face single parenthood and
gets
smaller b/c this happens to few people
the majority of widows and widowers within 6 months were about as happy and productive
as they had been before their spouse’s death
Bereavement Overload
several deaths at once or in close succession making it more difficult to cope
are more likely to experience bereavement overload
because of loss of spouse, siblings, and friends in close succession
Responses to Bereavement
different responses may depend on the