Death and Grieving
Chapter 17
Issues in Determining Death

Brain death — neurological definition of
death



All electrical activity of brain has ceased for a
specified period of time
Flat EEG recording
Some medical experts argue criteria for death
should include only higher cortical functioning
Death becoming increasingly complex
1. When to determine death has
occurred?
2. Life expectancy has increased
3. Care for dying shifted away from family
4. Minimized exposure to death and its
pain
Death in Different Cultures

Most societies have

Philosophical or religious beliefs about
death

Rituals that deal with death

View that death does not end existence
U.S. Denial and Avoidance of Death ?
Funeral industry emphasizes lifelike
qualities
 Euphemisms — softening language for
death
 Persistent search for “fountain of youth”
 Rejection and isolation of aged
 Hope that everyone goes to heaven
 Medical emphasis — prolonging life, not
easing suffering

Attitudes Toward Death at Different
Points in the Life Span
Childhood
Infant has no concept of death; perceptions
of death develop in middle/late childhood;
even very young children concerned about
separation and loss
Adolescence
Develop more abstract concepts of death;
common to think they are immune to death
Adulthood
Middle-aged adults fear death more than
young adults or older adults; older adults
think about death more
A Developmental Perspective of Death
Suicide
Risk factors
Serious physical illness
 Feelings of disparity,
isolation, failure, loss
 Serious financial
problems
 Drug use or prior
suicide attempts
 Antidepressant 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
Facing One’s Own Death

Most dying individuals want to make
decisions regarding their life and
death

Complete unfinished business

Resolve problems and conflicts

Put their affairs in order
Kubler-Ross’ Stages of Dying
Denial and isolation
Denies s/he is going to die
Anger
Denial gives way to anger,
resentment, rage, and envy
Bargaining
Develops hope that death can
somehow be postponed
Depression
Comes to accept the certainty
of her or his death
Acceptance
Develops sense of peace and
may desire to be left alone
Perceived Control and Denial

When individuals believe they can influence and
control events, they may become more alert and
cheerful

Denial can be adaptive or maladaptive
Care for Dying Individuals
?

Death in U.S.: often lonely, prolonged, painful

Plan for your death

Make a living will

Give someone power of attorney

Give your doctor specific instructions

Discuss desires with family and doctor

Check insurance plan coverage
The Contexts in Which People Die

Most would rather die at home but worry
over

Burden at home

Limited space

May alter relationships

Competency and availability of emergency
medical treatment
Communicating with the Dying Person

Establish your presence

Eliminate distraction

Ask if there is anyone s/he
would like to see

Encourage the dying individual
to reminisce

Limit visit time

Don’t insist on acceptance

Talk with the individual when
s/he wishes to talk

Allow expressions of guilt or
anger

Express your regard

Discuss alternatives,
unfinished business
Decisions Regarding Life, Death,
and Health Care

Natural Death Act and Advance Directive
 Expresses
person’s desires regarding
extraordinary medical procedures that might
be used to sustain life when medical situation
becomes hopeless
Euthanasia

Painlessly ending lives of persons suffering from incurable
diseases or severe disabilities
Passive euthanasia — withholding of
available treatments, allowing the person to
die
 Active euthanasia — death induced
deliberately, as by injecting a lethal dose of
drug


Publicized controversy: assisted suicide
Care for Dying Individuals

Hospice — humanized program
committed to making the end of life as
free from pain, anxiety, and depression
as possible

Palliative care — reducing pain and
suffering and helping individuals die
with dignity
When Others Decide

Remember Terry Schaivo

What is a persistent vegetative state?

Who decides?

What are their motives?
Should the government decide?

Social security bankruptcy – workerpensioner imbalance

Medicare/Medicaid bankruptcy

Generational inequity – rationing of care
Grieving

Grief: emotional numbness; a complex
emotional state of…
Disbelief
 Separation anxiety
 Despair
 Sadness
 Loneliness

…that accompanies loss of someone we
love
Cultural Diversity in Healthy Grieving


Contemporary western orientation

Breaking bonds with the dead

Returning survivors to autonomous lifestyle
Non-Western cultures


Maintaining ties with deceased
Influenced by religious beliefs and lifestyle
Making Sense of Grief

Grieving stimulates many to try to make
sense of their world — positive themes
linked to hopeful future and better
adjustment

Effort to make sense of it pursued more
vigorously when caused by an accident or
disaster
Losing a Life Partner

Those left behind after the death of an
intimate partner suffer profound grief and
often endure

Financial loss

Loneliness linked to poverty and education

Increased physical illness

Psychological disorders, including depression
Marital Quality and
Adjustment to Widowhood

Widowhood associated with increased
anxiety among those highly dependent
on their spouses

Lower anxiety for those who did not
depend on their spouse very much
Forms of Mourning

Approximately 80 percent of corpses are disposed of by
burial, the remaining 20 percent by cremation

Funeral industry is source of controversy

Funeral is important aspect of mourning in many cultures

Cultures vary in how they practice mourning
Amish Mourning
Conservative group; family-oriented society

Live same unhurried pace as ancestors

Time of death met with calm acceptance

Neighbors notify community; funeral at home

High level of support to family for one year
Traditional Judaism and Mourning

Mourning in graduated time periods; each
with appropriate practices
1st period: Aninut — between death and
burial
2nd period: Avelut period — mourning proper
 Shivah
period — 7-day begins at burial
 Sheloshim period — 30-day period after burial
Mourning over for all but parents who mourn
another 11 months