Lifespan overheads Chapter 19: Death, Dying, and Bereavement
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Death, Dying, and Bereavement
How We Die
 physical changes
o 25% of people in industrialized nations die
suddenly (80 to 90% are heart attack victims)
3 phases:
1) the agonal phase
2) clinical death
3) mortality
defining death
o loss of heartbeat and respiration?
o brain death (irreversible cessation of all activity in
the brain and brain stem) is the accepted definition
 persistent vegetative state: activity in the
brain stem but not the cortex
death with dignity
1) assure dying people that we will support them
through their physical and psychological distress
2) be candid about death’s certainty
3) help the dying person make reasoned choices about
whether to fight on or say no to treatment
Understanding of and attitudes towards death
 we are very insulated from death in our society
Lifespan overheads Chapter 19: Death, Dying, and Bereavement
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 childhood
1) permanence
2) universality
3) nonfunctionality
o religious teachings, personal experiences affect
what and how much a child knows about death
o kids who have a good grasp of death have an
easier time accepting it
 adolescence: understand the permanence and
nonfunctionality of death, but are attracted to alternative
possibilities, and may romanticize death.
o formulate personal theories about life after death
o do not “take death personally”
 adulthood
o in early adulthood, people brush aside thoughts of
death
o middle-aged people know that it will soon be their
turn to grow old and die
o in late adulthood death is thought about and talked
about more, as it is closer
Death anxiety
 Spirituality limits and curtails death anxiety even more
than religious commitment.
 Having a well-developed personal philosophy of
death also reduces fear
 As we get older, death anxiety typically drops
 Women report being more anxious about death
 Children tend not to have death anxiety
Lifespan overheads Chapter 19: Death, Dying, and Bereavement
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Are there emotional stages of dying?
 Elizabeth Kubler-Ross’s theory
1) Denial - initially does not believe the diagnosis
2) Anger - angry at having to die without being given
the chance to o everything they wanted to in life
3) Bargaining - may attempt to forestall death by
bargaining for extra time
4) Depression - depressed about the ending of their
life.
5) Acceptance – this often comes only in the last
weeks or days
Contextual influences on adaptations to dying
An appropriate death: makes sense in terms of the
person’s pattern of living and their values, takes into
account important relationships, and is as free of suffering
as possible
 nature of the disease
 personality and coping style
 family members’ and health professionals’ behaviour
Lifespan overheads Chapter 19: Death, Dying, and Bereavement
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A Place to Die
 Home: 90% of Americans would prefer to die at home
o however, there are disadvantages: ordinary
activities can be major ordeals, may not be
manageable by family members
 Hospital: 80% of deaths nowadays take place in
hospitals. They are focused on saving lives, not on
fostering a “good death”.
 The hospice approach: a program of support services
for terminally ill people and their families, where quality
of life is central.
o meeting physical, emotional, social, and spiritual
needs, controlling pain, retaining dignity, feeling
cared for and loved
o interdisciplinary team
o kept at home or in a homelike setting
o Palliative care - relieving pain and other symptoms
The Right to Die
 passive euthanasia: life-sustaining treatment is
withheld of withdrawn, permitting a patient to die
naturally.
o Most Americans (85%) support the patient’s right
to end treatment; 80% support family members’
right to do so
o widely-practiced part of ordinary medical
procedures
 living will
 durable power of attorney for health care
Lifespan overheads Chapter 19: Death, Dying, and Bereavement
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 voluntary active euthanasia: doctors or others act
directly, at the patient’s request, to end suffering before
a natural end to life
o 70% of Americans approve of this
o technically illegal (judges are usually lenient)
o some say it’s the most compassionate option for
terminally ill people in severe pain
o Others argue that there is a big difference
between “letting die” and “causing death”
 assisted suicide: providing the terminally ill person
with the means to end their own life
o illegal in all US states except Oregon
o 60% of Americans approve of assisted suicide
o Dr. Jack Kevorkian’s “suicide machines”
Bereavement
Phases of grieving
1) Avoidance –shock and disbelief, “emotional anesthesia”
that can last from hours to weeks
2) Confrontation –feels grief very intensely, along with
anxiety, anger, frustration, helplessness, and yearning.
This phase can last from several months to over a year.
3) Accommodation –person starts attending again to the
outside world. Recurrent instances of grief resurface
periodically. This phase may persist for a lifetime.
Lifespan overheads Chapter 19: Death, Dying, and Bereavement
Variations
 sudden versus prolonged deaths
 no explanation for the death
 suicide
 the loss of a child
 children grieving the loss of a parent
 adults losing an intimate partner
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