Death and Grieving ©2008 McGraw-Hill Ryerson Ltd..

Death and Grieving

©2008 McGraw-Hill Ryerson Ltd.


Death and Grieving

Defining Death and Life/Death Issues

Death and Socio-historical, Cultural

Contexts

A Developmental Perspective on Death

Coping with the Death of Someone Else

Facing One’s Own Death


Defining Death and

Life/Death Issues

Issues in

Determining

Death

Decisions Regarding

Life, Death, and

Health Care

Issues in Determining Death Brain death – a neurological definition of death that states a person is brain dead when all electrical activity of the brain has ceased for a specified period of time.



Issues in Determining Death The higher portions of the brain die first.The brain’s lower portions monitor vital

functions. People whose higher brain areas have

died may continue breathing & have a heartbeat.

The current definition of brain death (for most physicians) includes the death of both the higher cortical functions & lower brain stem functions.



Decisions Regarding Life, Death, and Health Care Living Wills and

DNRsEuthanasiaNeeded: Better

Care for Dying Individuals



Living Will Recognizing that terminally ill patients

might prefer to die rather than linger in a painful or vegetative state, an organization called “Choice in Dying” created the Living Will.

The Living Will document is designed to be filled in while the individual can still think clearly & expresses their desire that extraordinary medical procedures not be used to sustain life when the medical situation becomes hopeless.



DNRsDNR, or Do Not Resuscitate is an

order preventing medical staff within a medical institution to use either specified or all means to prolong a person’s life or to resuscitate the person if their heart stops.

DNR can be arranged without a living will.



Euthanasia Euthanasia is the act of painlessly ending the

lives of individuals who are suffering from an incurable disease or severe disability.

Sometimes referred to as “mercy killing.”Passive euthanasia – occurs when a person is

allowed to die by withholding available treatment, such as withdrawing a life-sustaining device.

Active euthanasia – occurs when death is deliberately induced, as when a lethal dose of a drug is injected.



Attitudes about Euthanasia Passive euthanasia for terminally ill patients is

accepted.Precise boundaries for passive euthanasia & the

exact mechanisms by which treatment decisions should be implemented are not entirely agreed upon.

Active euthanasia is a crime in most countries & in all U.S. states except Oregon.

Walker, Gruman & Blank’s (1999) recent survey of more than 900 physicians found most opposed active euthanasia & believed that adequate pain control eliminated the need for active euthanasia.



Needed: Better Care for Dying Individuals The Canadian Senate report on end-of-life found:Only 1-in-10 Canadians received proper care as

they die. Dying individuals often get too little or too much

care.Many experience severe pain during their last days.Regulations are needed that allow physicians

flexibility in prescribing painkillers for dying patients who need them.

Many health-care professionals are not trained to provide adequate end-of-life care.



Palliative Care Palliative care is a humanized

program committed to making the end of life as free from pain, anxiety, & depression as possible.

Palliative care goals contrast with those of hospitals, which are to cure illness & prolong life.




Death and

Socio-Historical Cultural

Contexts

Changing

Historical

Circumstances

Death in

Different

Cultures

Changing Historical Circumstances One historical change already presented is the

increasing complexity of determining when someone is truly dead.

Another change is the age group death strikes most often—200 years ago it was children, now it is the elderly.

Life expectancy has increased by 50 years since 1900.In the past, most people died at home.80% of all deaths now occur in institutions,

minimizing our exposure to death.Care of the dying has shifted away from families.


Death and Socio-historical Cultural Contexts

Perceptions of Death In most societies, death is not viewed as the end

of existence—though the biological body has died, the spiritual body is believed to live on.

Some cultures: believe death is caused by magic and demons.believe death is caused by natural forces.focus on reincarnation.view death as punishment, while for others it

represents redemption.fear death, while others embrace it.



Death in Different Cultures North Americans are death avoiders &

death deniers.People in many countries face death on a

daily basis.In some countries, the presence of dying

family members & large funeral attendance are part of everyday cultural reality.

These aspects of life help prepare the young for death & provide them with guidelines on how to die.



Evidence of the Denial of Death The funeral industry glosses over death &

fashions lifelike qualities in the deadEuphemistic language for death is used (passed

away).There is a persistent search for a fountain of youthRejection & isolation of the aged, who may remind

us of death, is common.Belief in the concept of a pleasant & rewarding

afterlife, suggests that we are immortalMedical practices emphasis prolonging biological

life rather than an emphasizing diminishing human suffering




A Developmental

Perspective

On Death

Causes of

Death and

Expectations

about Death

Attitudes

toward Death

at Different Points

in the Life Span

Causes of Death and Expectations about Death Death can occur at any point in the human life span.Childhood deaths occur mostly due to accidents or

illness.Adolescent deaths are more likely to occur because of

motor vehicle accidents, suicide, & homicide.Younger adults are more likely to die from accidents.Older adults are more likely to die from chronic

diseases.Younger adults who are dying feel cheated by death

more than do older adults who are dying.



Attitudes toward Death at Different Points in the Life Span

ChildhoodAdolescenceAdulthood



Childhood Infants have no concept of death, but once they

develop an attachment, they can experience loss, separation & anxiety.

Children 3–5 years old don’t have a true idea of what death really means, often confusing death with sleep.

Young children believe death is reversible & the dead can be brought back to life spontaneously.

Cuddy-Casey & Orvaschel’s (1997) research found children don’t understand death is universal & irreversible until about age 9.



Explaining Death to Children Psychologists recommend :honesty in discussing death with children.Answering children’s questions about death

based on the child’s age & maturity level.Death can be explained to preschool children in

simple physical & biological terms.Children need reassurance that they are loved &

that they will not be abandoned.Regardless of age, adults should be sensitive &

sympathetic, encouraging children to express their own feelings & ideas.



Adolescence The prospect of death is so remote for

adolescents that it does not have much relevance.Death may be avoided, glossed over, kidded

about, neutralized, & controlled by a cool spectator-like orientation.

Adolescents have more abstract conceptions of death than children do.

Adolescents develop religious & philosophical views about the nature of death & whether there is life after death.

Adolescents are especially likely to think that they are invincible, unique & immune to death.



Adulthood There is no evidence that a special

orientation towards death develops in early adulthood.

An increase in consciousness about death accompanies individuals’ awareness that they are aging.

Kalish & Reynolds’ (1976) study found adults at midlife fear death more than do young adults or older adults.

Older adults think about death more & talk about it more than in previous adult stages.




Facing One’s

Own Death

Kubler-Ross’s

Stages of Dying

Perceived

Control

and Denial

The Contexts

in Which

People Die

Kübler-Ross’s Stages of Dying Denial and

IsolationAngerBargainingDepressionAcceptance



Denial and Isolation Kübler-Ross (1969) divided the behaviour

& thinking of dying persons into 5 stages.In the first stage, denial & isolation,

people refuse to believe that their condition is terminal.

People attempt to convince themselves that lab tests were inaccurate or that the disease will go into remission.

Dying individuals in this stage also seek isolation.



Anger In the 2nd stage of dying, anger, the dying person

recognizes that denial can no longer be maintained.Denial gives way to anger, resentment, rage, & envy.The dying person’s question is: “Why me?”The dying person becomes increasingly difficult to

care for, as anger may become displaced & projected onto physicians, nurses, family members, & God.

The realization of loss is great & those who represent life are targets of resentment



Bargaining In the 3rd stage of dying, bargaining,

Kübler-Ross states that the person develops the hope that death can somehow be postponed or delayed.

Some people enter into a bargaining or negotiation—often with God—as they try to delay their death.

In exchange for a few more days, weeks, or months of life, the person promises to lead a reformed life dedicated to God or to the service of others.



Depression In Kübler-Ross’ 4th stage of dying,

depression, the dying person accepts that death is certain.

At this point, a period of depression or preparatory grief may appear.

The dying person may become silent, refuse visitors, & spend time crying or grieving.

Attempts to cheer up the dying person at this stage should be discouraged because the person has a need to contemplate impending death.



Acceptance In the 5th stage of dying, acceptance,

the person develops a sense of peace; an acceptance of one’s fate; & in many cases, a desire to be left alone.

Feelings & physical pain may be virtually absent.

Kübler-Ross views this stage as the end of the dying struggle, the final resting stage before death.



Criticisms of Kubler-RossPsychology death expert Robert Kastenbaum

refutes the existence of Kübler-Ross’ 5 stage sequence.

Research has not demonstrated the process exists.Kastenbaum (2000) believes the stage

interpretation neglects the patients’ total life situations, including relationship support, specific effects of illness, family obligations, & the institutional climate in which they were interviewed.

Some psychologists prefer to describe the stages as reactions to dying.



Contributions of Kubler-Ross Kübler-Ross made the important

contribution of calling attention to people attempting to cope with life-threatening illnesses.

She did much to encourage needed attention to the quality of life for dying persons & their families.



Perceived Control and Denial Perceived control & denial may work

together as an adaptive strategy for some older adults facing death.

Individuals who believe they can influence & control events, become more alert & cheerful.

Denial may be a useful way for some individuals to approach death.

Denial protects us from the tortuous feeling that we are going to die.

Denial can be maladaptive if it prevents treatment.



The Contexts in Which People DieFor dying individuals, the context in which

they die is important.75% of Canadians die in hospitals or long-term

care facilities.Hospitals offer important advantages in that

professional staff members are readily available, & the medical technology may prolong life.

Kalish & Reynolds (1976) identified most individuals say they would rather die at home.




Coping with the

Death of Someone Else

Communicating

with a Dying

Person

Grieving

Making Sense

of the World

Losing a

Life Partner

Forms of

Mourning and

the Funeral

Communicating with a Dying PersonMost psychologists believe that it is best for

dying individuals to know that they are dying, & that significant others know they are dying.

Dying individuals can thus close their lives in accord with their own idea of proper dying.

They can complete plans and projects.They can make arrangements for survivors.They can participate in decisions about a

funeral.They will have the opportunity to reminisce.



GrievingDimensions of

GrievingCultural Diversity

in Healthy Grieving



Dimensions of Grieving

Emotional numbness, disbelief, separation anxiety, despair, sadness, & loneliness accompany the loss of someone we love.



Dimensions of Grieving Pining or yearning reflects a recurrent

need to recover the lost loved one.Separation anxiety includes pining but also

focuses on places & things associated with the deceased, as well as crying.

Numbness, disbelief, & outbursts of panic are typical immediate reactions.

Despair, sadness, & hopelessness are part of grief.



Cultural Diversity in Healthy Grieving In contrast to Western

beliefs, maintenance of ties with the deceased is accepted & sustained in the religious rituals of Japan.

In the Arizona Hopi, the deceased are forgotten as quickly as possible & life is carried on as usual.

In Egypt, the bereaved are encouraged to dwell at length on their grief.

In Bali, the bereaved are encouraged to laugh & be joyful, rather than be sad.

Diverse grieving patterns are culturally embedded.



Making Sense of the WorldA beneficial aspect of grieving is that it stimulates

many individuals to make sense of their world.A common occurrence is to go over again & again

all of the events that led up to the death.When death is caused by an accident or disaster,

the effort to make sense of it is pursued more vigorously.

The bereaved want to put the death in a perspective they can understand—divine intervention, a logical sequence of cause & effect, etc.



Losing a Life Partner

Those left behind after the death of an intimate partner suffer profound grief & often endure financial loss, loneliness, increased physical & psychological problems.



Losing a Life Partner Those left behind after the death of an

intimate partner suffer profound grief & often endure financial loss, loneliness, increased physical illness, & psychological disorders.

The bereaved are also at increased risk for many health problems, including death.

Optimal adjustment after a death depends on several factors.

Women do better than men in our society, due to their networks of friends & close relationships.



Forms of Mourning and the Funeral Mourning varies cross-culturally.Funeral rituals are an important aspect of

mourning in many cultures.One consideration is what to do with the

body.Approximately 80% of corpses are buried.Studies showed that bereaved individuals

who were religious derived more psychological benefits from a funeral, participated more actively in rituals, & adjusted more positively to the loss.



Death and Grieving ©2008 McGraw-Hill Ryerson Ltd..

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Transcript of Death and Grieving ©2008 McGraw-Hill Ryerson Ltd..