©2008 The McGraw-Hill Companies, Inc. All rights reserved. Chapter 21: Death and Grieving.

©2008 The McGraw-Hill Companies, Inc. All rights reserved.

Chapter 21:

Death and Grieving


Defining Deathand

Life/Death Issues


• Brain death occurs when all electrical activity in the brain ceases.

• Higher portions of the brain die sooner than the lower portions.

• There is controversy over what medical experts should use as criteria for death.

• When does intelligence and personality end?


• Termination of medical treatments is controversial:– Dying patients in comas need living wills.

– Physicians have concerns over malpractice suits in the absence of a living will or defining laws.

– Euthanasia is often called mercy killing:

• Passive euthanasia—treatment is withheld.

• Active euthanasia—death deliberately induced.

– Euthanasia evokes a variety of emotions among health-care professionals and family members.


• Active euthanasia was made famous by Dr. Jack Kevorkian in the U.S. as “assisted suicide.”

• Active euthanasia is a crime in most countries and in the U.S.

• Oregon has a law allowing doctors to prescribe enough medication for a person to end his/her own life, but the doctor cannot aid in any way, and it must be certified that the patient is terminally ill.

• Most physicians surveyed oppose active euthanasia.

• Better care is needed for dying persons, as death is often lonely, prolonged, and painful.


• The hospice movement: – Is a new kind of medical institution.

– Began in London at the end of the 1960s.

– Is dedicated to reducing pain and helping patients die with dignity, known as palliative care.

– Makes every effort to include the dying patient’s family members.

– Includes home-based programs today, supplemented with care for medical needs and staff.


Death and Cultural Contexts


• Death has changed historically:– 200 years ago, 1 out of every 2 children died

before age 10, and one parent usually died before a child grew up.

– Today, death occurs mostly among the elderly.

– Life expectancy has increased from 47 years for a person born in 1900 to 77 years for a person born today

– Over 80% of all U.S. deaths occur in hospitals.


• Culture affects how death is experienced:– Americans live as if they were immortal.

– India and Africa have many young children and infants dying of malnutrition and disease.

– Most societies throughout history have had religious or philosophical beliefs about death, and rituals surrounding it.

– Some societies welcome death while others fear it.

– In most societies, death is not an end to existence.


A Developmental Perspective on

Death


• Causes of death vary across the life span:– Prenatal death through miscarriage.

– Death during birth or shortly afterwards.

– Accidents or illness cause most childhood deaths.

– Most adolescent deaths result from suicide, homicide, or motor vehicle accident.

– Deaths among young adults are increasing due to AIDS.

– Middle-age and older adult deaths usually

– result from chronic diseases.


• Attitudes toward death vary at different points in the life span:– Young children use illogical reasoning

to explain death, believing magic or treatment can return life.

– Others claim separation anxiety is an indicator of a child’s awareness of separation and loss.

– Those in middle and late childhood have more realistic perceptions of death—that it is a finality.


• Children and youth can reexperience grief as they age, and it may affect future relationships.

• Many strategies, including honesty, should be adopted when discussing death with children: – Extent of explanations will vary

according to a child’s age.

• Most adolescents: – Avoid the subject of death until a loved

one or close friend dies.

– Describe death in abstract terms and have religious or philosophical views about it.


• Concerns about death increase as one ages:– Awareness usually intensifies in middle age.

– Older adults are more often preoccupied by it and want to talk about it more.

– One’s own death usually seems more appropriate in old age, possibly a welcomed event, and there is an increased sense of urgency to attend to unfinished business.


Facing One’s Own Death


• Knowledge of death’s approach forces the dying person to change their attitudes and behaviors.

• Kübler-Ross identified 5 stages in dying:– Denial and isolation – “It can’t be!”

– Anger – “Why me?”

– Bargaining – “Just let me do this first!”

– Depression – withdrawal, crying, and grieving.

– Acceptance – a sense of peace comes.

• In facing their own deaths, some people struggle desperately until the end.


• The quality of one’s life is linked to how death will be approached:– Meaning and purpose bring peaceful acceptance.

– An unfulfilled life brings distress and despair.

• Perceived control and denial may be adaptive strategies for remaining alert and cheerful.

• Denial insulates and allows one to avoid coping with intense feelings of anger and hurt.

• In the U.S., most people die in hospitals, and fewer die in nursing homes or a hospice.


Coping with

the Death of

Someone Else


• No loss is greater than that of a loved one.• Open communication with a dying

person is very important because it gives them:– A chance to plan activities for the time left.

– An opportunity to reminisce.

– A chance to examine what is happening to them.

• Effective strategies for open communication vary and should be directed toward internal growth.


• Grief is not a simple emotional process and may not end anytime soon after the loss.

• A variety of cognitive factors influence the severity of the grief process.

• Good family communications and grief counselors can help grievers cope with feelings of separation and loss.

• Cross-culturally, people in some societies forget the deceased as quickly as possible, while in other societies they try to hold on.


• Grieving forces one to try and make sense of the world—reliving one or more events over and over.

• Finding meaning may enhance or ease the ability to cope.

• Researchers have identified 3 types of meaning-making coping:– Personal – cognitive acceptance is sought.

– Family – members search for common factors.

– Community – a broader level of loss.


• Women feel the loss of a life partner more than men because:– Widows outnumber widowers 5 to 1, because

they live longer than men.

– A widowed man is more likely to remarry.

– Widows usually marry older men.

• Cross-culturally, many widows fall into poverty after the loss of a life partner.

• Impact on one’s physical and psychological health is linked to how long one grieves and remains widowed.


• Funerals are an important aspect of mourning and a source of closure in many cultures.

• Forms of mourning include:– Making some type of funeral arrangement.

– Deciding on burial or cremation for the body.

– Holding ceremonies after the funeral—in some cultures.

– Being supported as a family by the community.

– Dividing the mourning into time periods.

– Designating one time frame for mourning.

©2008 The McGraw-Hill Companies, Inc. All rights reserved. Chapter 21: Death and Grieving.

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Transcript of ©2008 The McGraw-Hill Companies, Inc. All rights reserved. Chapter 21: Death and Grieving.