Prepared by Madeleine Lacefield Tattoon, M.A.

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Kathleen Stassen Berger

EpilogueDeath and Dying

Death and Hope

Dying and Acceptance

Bereavement

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Death and Dying• “Death mirrors the complexity of life as death highlights cultural differences and ethical dilemmas.”–thanatology is the study of death and dying, especially social and emotional aspect.

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Death and Hope• What is death?–a end or a beginning–a private and personal event–a part of the larger culture–something to deny or avoid–something to welcome

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Death and Hope

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Death Through the Life Span

“In order to understand what death means to people, we begin with developmental differences. The meaning assigned to death—either the person’s own death or the death of another person—depends partly on cognitive maturation and personal experience.”

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Death in Childhood• children as young as 2 have some understanding of death, but their perspective differs from that of older family members

• children have some comprehension of death—adults cannot assume that children share their perceptions

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Death in Adulthood

• a major shift in attitude about death occurs when adults become responsible for work and family

• death is not romanticized, but dreaded as something to be avoided or at least postponed

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Death in Late Adulthood

• in late adulthood, anxiety about death decreases

• a sign of mental health in older adults is acceptance of their mortality

• older people write their wills, designate health proxies---performing these actions does not mean that they have given up on life

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Many Religions, Many Cultures

• Views of Death in Major Religions–Buddhism–Hinduism–Native American Traditions–Judaism–Christianity–Islam

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Many Religions, Many Cultures

• Respect for Ancestors• Spiritual and Cultural Affirmation–near-death experience•an episode in which a person comes close to dying but survives and reports having left his or her body and having moved towards a bright, white light while feeling peacefulness and joy

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Dying and Acceptance• A good death is one that is peaceful and quick and occurs at the end of along life, in familiar surrounding with family and friend present and without pain, confusion, or discomfort

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Dying and Acceptance• Attending to the Needs of the Dying– Honest Conversation– The Hospice

•an institution in which terminally ill patients receive palliative care

– Comfort Care•palliative care

– care designed not to treat an illness but to relieve the pain and suffering of the patient and his or her family

•double effect– an ethical situation in which a person performs an action that is good or morally neutral but has ill effects that are foreseen, though not desired

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Dying and Acceptance•Choices and Controversies– When is a Person Dead?

• passive euthanasia– a situation in which a seriously ill person is allowed to die naturally, through the cessation of medical intervention

• do not resuscitate (DNR)– a written order from a physician (sometimes initiated by a patient’s advance directive or by a health care proxy’s request) that no attempt should be made to revive a patient if he or she suffers cardiac or respiratory arrest

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Dying and Acceptance•Choices and Controversies

– When is a Person Dead?• active euthanasia

– a situation in which someone takes action to bring about another person’s death, with the intention of ending that person's suffering» slippery slope – the argument that a given action will start a chain of events that will culminate in an undesirable outcome

• physician-assisted suicide– a form of active euthanasia in which a doctor provides the means for someone to end his or her own life

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Dying and Acceptance–The Netherlands–Oregon

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Dying and Acceptance• Advance Directives

–living will•a document that indicates what medical intervention an individual wants if he or she becomes incapable of expressing those wishes

–health care proxy•a person chosen by another person to make medical decisions if the second person becomes unable to do so

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Bereavement• Normal Grief

– Grief and Mourning•bereavement

– the sense of loss following a death

•grief– an individual's emotional response to the death of another

•mourning– the ceremonies and behavior that a religion or culture prescribes for bereaved people

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Bereavement–Seeking Blame and Meaning•a common impulse after death is for the survivor to asses blame

•the normal grief reaction is intense and irrational at first but gradually eases

•time, social support, and traditions help

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Bereavement– Complicated Grief

•absent grief– a situation in which overly private people cut themselves off from the community and customs of expected grief—can lead to social isolation

•disenfranchised grief– a situation in which certain people, although they are bereaved, are not allowed to mourn publicly

•incomplete grief– a situation in which circumstances, such as a police investigation or an autopsy, interfere with the process of grieving

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Diversity of Reactions• bereaved people depend on the customs and attitudes of their culture to guide them though their irrational thoughts and personal grief