THE END OF LIFE
The Quest for “Healthy Dying”

Thanatology: The Study of Death and
Dying
Living Will
A legal document that states an individual’s
wishes regarding medical care in case the
person becomes incapacitated and unable to
participate in decisions about his or her
medical care.
The Right-to-Die Movement
Physician-Assisted Suicide
 Trend: basing decisions less on legalistic
interpretations regarding specific treatments
and more on balancing benefits on a caseby-case basis
 Euthanasia: Mercy killing

Suicide

Three concepts: (NIMH)
1. Suicide ideas
2. Suicide attempts
3. Completed suicide

Who Commits Suicide and Why?
Females attempt more suicides, but males
complete most.
The Hospice Movement

Provides comfort and care but with the
knowledge that the recipients are nearing
the end of their life’s journey--that they’re
dying
The Dying Process

Defining Death
Brain Death occurs when the brain receives
insufficient oxygen to function.
Confronting One’s Own
Death

A Life Review

Elderly person takes stock of his life,
reflecting and reminiscing about it
Changes Before Death
Death drop
 Near-Death Experiences

– Dying individuals feel themselves leave their
bodies and watch as spectators, the resuscitation
efforts. Then they pass through a tunnel and
enter a spiritual realm.
Near-Death Experiences
Other views:
–
–
–
(Siegel) Arousal of nervous system and
disorganization of brain
(Alkon) Anoxia induces such mental states
(Kastenbaum) Some heart-attack victims: no
recollection of experience
Religious Beliefs

Christian: Book of Revelation
Jewish: Speculation about afterlife is
pointless
Buddhists: Detailed account
Stages of Dying
(Elisabeth Kubler-Ross)
1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance
Kastenbaum’s Trajectories
of Death
It is the nature of the disease that determines
pain, mobility and length of terminal period.
 Other factors:
– Gender, ethnic group, personality,
developmental level and death environment
Causes of Death
National Mortality Followback Survey:
1993
 Data on 23,000 records of death in 1993.
 All states except South Dakota

Grief, Bereavement, and
Mourning
Adjusting to the Death of a Loved One
 Bereavement: state in which a person has
been deprived of a relative or friend by
death

Grief: keen mental anguish and sorrow over
the death of a loved one
Mourning: socially established manner of
displaying signs of sorrow over death
Expressing Anguished Feelings
Support groups to help people through grief
work
 Culture and Grief Work

– Cultural variability in expressing grief
Consequences of Grief
Survivor vulnerable to physical and mental
illness and death
 Adjusting to Violent and Premature Death

– Most severe grief reaction
Adjusting to the Death of a
Parent
Stages of bereavement for healthy adults
who have lost a parent
1. Going back to the origins
2. Reevaluation phase
3. Assuming leadership
Phases in the Bereavement
Process
1. Shock, numbness, denial, disbelief
2. Pining, yearning, and depression
3. Emancipation from loved one and
adjustment to new circumstances
4. Identity reconstruction
Individual Variations
People handle grief differently
 Widows and Widowers

– Death rate for widowers higher
– Difficulty expressing emotion
Types of Widows

Three types (Lopata)
1. Better educated, middle class, strongly
identifying with role of wife
2. Women who led multidimensional lives;
husband only one part of total set of relations
3. Lower-or working-class women in sexsegregated worlds immersed in kin,
neighboring or friendship relationships with
other women
Death of a Child

Loss by Miscarriage
– Sometimes receive no recognition of loss
– Support Groups
Loss by Murder or Violence
 Bereavement process can go on indefinitely
