THE END OF LIFE

The Quest for “Healthy Dying”The Quest for “Healthy Dying”

Thanatology: The Study of Death and Dying

Living WillLiving 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 MovementThe Right-to-Die Movement

Physician-Assisted Suicide Trend: basing decisions less on legalistic

interpretations regarding specific treatments and more on balancing benefits on a case-by-case basis

Euthanasia: Mercy killing

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.

SuicideSuicide

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 Hospice MovementThe Hospice Movement

The Dying ProcessThe Dying Process

Defining Death

Brain Death occurs when the brain receives insufficient oxygen to function.

A Life Review

Elderly person takes stock of his life, reflecting and reminiscing about it

Confronting One’s Own Confronting One’s Own DeathDeath

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.

Changes Before DeathChanges Before Death

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

Near-Death ExperiencesNear-Death Experiences

Christian: Book of Revelation

Jewish: Speculation about afterlife is pointless

Buddhists: Detailed account

Religious BeliefsReligious Beliefs

(Elisabeth Kubler-Ross)

1. Denial

2. Anger

3. Bargaining

4. Depression

5. Acceptance

Stages of DyingStages of Dying

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

Kastenbaum’s Trajectories Kastenbaum’s Trajectories of Deathof Death

National Mortality Followback Survey: 1993

Data on 23,000 records of death in 1993. All states except South Dakota

Causes of DeathCauses of Death

Grief, Bereavement, and Grief, Bereavement, and MourningMourning

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

Support groups to help people through grief work

Culture and Grief Work– Cultural variability in expressing grief

Expressing Anguished FeelingsExpressing Anguished Feelings

Survivor vulnerable to physical and mental illness and death

Adjusting to Violent and Premature Death– Most severe grief reaction

Consequences of GriefConsequences of Grief

Stages of bereavement for healthy adults who have lost a parent

1. Going back to the origins

2. Reevaluation phase

3. Assuming leadership

Adjusting to the Death of a Adjusting to the Death of a ParentParent

1. Shock, numbness, denial, disbelief

2. Pining, yearning, and depression

3. Emancipation from loved one and adjustment to new circumstances

4. Identity reconstruction

Phases in the Bereavement Phases in the Bereavement ProcessProcess

People handle grief differently Widows and Widowers

– Death rate for widowers higher– Difficulty expressing emotion

Individual VariationsIndividual Variations

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 sex-segregated worlds immersed in kin, neighboring or friendship relationships with other women

Types of WidowsTypes of Widows

Loss by Miscarriage– Sometimes receive no recognition of loss– Support Groups

Loss by Murder or Violence Bereavement process can go on indefinitely

Death of a ChildDeath of a Child