Chapter 20: Death, Dying, and Grieving ©2011 The McGraw-Hill Companies, Inc. All rights reserved.

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Chapter 20: Death, Dying, and Grieving ©2011 The McGraw-Hill Companies, Inc. All rights reserved

Transcript of Chapter 20: Death, Dying, and Grieving ©2011 The McGraw-Hill Companies, Inc. All rights reserved.

Chapter 20: Death, Dying, and Grieving

©2011 The McGraw-Hill Companies, Inc. All rights reserved

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The Death System and Its Cultural Variations

Components comprising the death system: People: involved with death at some point, either their own death

or the death of others. Places or contexts: hospitals, funeral homes, cemeteries,

hospices, battlefields, and memorials Times: hours or days when death takes place, or when it is

remembered. Objects: associated with death or remembrance Symbols: from religions or other belief systems associated with

death

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The Death System and Its Cultural Variations

Cultural variations in the death system Ancient Greeks – to live a full life and die with glory

In the United States, we are more insulated from death and from dying people, and tend to live as though immortal.

Most societies have a ritual that deals with death

In most societies, death is not viewed as the end of existence as the spiritual body is believed to live on

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Changing Historical Circumstances:

The age group in which death most often occurs, most often among older adults

Life expectancy has increased from 47 years for a person born in 1900 to 78 years for someone born today

Location of death; 80% of deaths in the U.S. today occur in institutions or hospitals

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Issues in Determining Death

Brain Death: a person is brain dead when all electrical activity of the brain has ceased for a specified period of time

A flat EEG – recorded for a specific period of time is one criterion of death.

Includes both the higher cortical functions and the lower brain-stem functions. Higher portions of the brain die sooner than the lower portions

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Decisions Regarding Life, Death, and Health Care

Natural Death Act and Advance Directive

Living Will is designed to be filled in while the individual can still think clearly

Advance directive: states that life-sustaining procedures shall not be used to prolong their lives when death is imminent

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Decisions Regarding Life, Death, and Health Care

Euthanasia: the act of painlessly ending the lives of individuals who are suffering from an incurable disease or severe disability Passive euthanasia: treatment is withheld Active euthanasia: death deliberately induced Case of Terry Schiavo who had suffered brain damage related to

cardiac arrest and a lack of oxygen to the brain. She spent 15 years in a vegetative state until a court ordered that her

feeding tube be removed. Appeals led to 2 reinsertions of the tube, but she died on 3/18/05 13

days after it had been removed for the 3rd time. Jack Kevorkian was convicted of 2nd degree murder for his

assistance in active euthanasia for a number of patients.

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Active euthanasia is a crime in most countries and in every state in the U.S. except for Oregon Oregon passed the Death with Dignity Act in

1994. By 2001, 91 individuals were known to have

died by active euthanasia in Oregon.

Most physicians surveyed oppose active euthanasia

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Decisions Regarding Life, Death, and Health Care

Needed: Better Care for Dying Individuals

Death in America is often lonely, prolonged, and painful

A “good death” involves physical comfort, support from loved ones, acceptance, and appropriate medical care

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Decisions Regarding Life, Death, and Health Care

Fail-safe measures for avoiding pain at the end of life Make a living will

Give someone power of attorney

Give doctors specific instructions such as “Do not resuscitate” or “Do everything possible”

Discuss with the family whether or not you want to die at home

Check insurance to see if it covers home care or hospice care

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Hospice: a program committed to making the end of life as free from pain, anxiety, and depression as possible

Began in London at the end of the 1960s hospice care emphasizes palliative care, which involves

reducing pain and suffering and helping individuals die with dignity

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

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

Hospices are more likely to serve patients with cancer than with other terminal illnesses.

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Causes of Death

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

SIDS is the leading cause of infant death in the U.S.

Accidents or illness cause most childhood deaths

Most adolescent and young adult deaths result from suicide, homicide, or motor vehicle accidents

Middle-age and older adult deaths usually result from chronic diseases

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Attitudes Toward Death at Different Points in the Life Span

Childhood Young children believe the dead can be brought back to life

Around 9 years of age, children view death as universal and irreversible

Honesty is the best strategy in discussing death with children

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Attitudes Toward Death at Different Points in the Life Span

Adolescence Death regarded as remote and may be avoided, glossed over, or

kidded about.

Death of friends, siblings, parents, or grandparents bring death to the forefront of adolescents’ lives

Develop more abstract conceptions about death than children

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Attitudes Toward Death at Different Points in the Life Span

Adulthood There is no evidence that a special orientation toward death

develops in early adulthood. Middle-aged adults actually fear death more than young adults

Older adults are forced to examine the meanings of life and death more frequently than younger adults

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Knowledge of death’s inevitability permits us to establish priorities and structure our time

A recent study examined the concerns of 36 dying individuals from 38 to 92 years of age with a mean age of 68 Privacy and autonomy in regard to their families

Inadequate information about physical changes and medication as death approached

Motivation to shorten their lives (Terry & others, 2006).

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Kübler-Ross’ Stages of 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

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Research does not support the idea that dying people go through these stages or go through any stages in any predictable order.

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

A recent study of more than 100 patients with advanced congestive heart failure who were studied at two times six months apart found that as the patients perceived they were closer to death, they became more spiritual (Park, 2009).

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Kübler-Ross’ Stages of Dying

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Perceived Control and Denial

Perceived control may be an adaptive strategy for remaining alert and cheerful

Denial insulates and allows one to avoid coping with intense feelings of anger and hurt Can be maladaptive depending on extent

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The Contexts in Which People Die

More than 50% of Americans die in hospitals and nearly 20% die in nursing homes

Hospitals offer many important advantages: Professional staff members

Technology may prolong life

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Communicating with a Dying Person

Open communication with a dying person is very important because: They can close their lives in accord with their own ideas about

proper dying

They may be able to complete plans and projects, and make arrangements and decisions

They have the opportunity to reminisce and converse with others

They have more understanding of what is happening to them

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Dimensions of Grieving Grief: emotional numbness, disbelief, separation anxiety,

despair, sadness, and loneliness that accompany the loss of someone we love

Pining or yearning reflects an intermittent, recurrent wish or need to recover the lost person

Grief is not a simple emotional process and may not end anytime soon after the loss Process is more of a roller coaster rather than orderly progression of

clear-cut stages with clear-cut time frames. Complicated grief: involves enduring despair and is still unresolved over

an extended period of time.

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Grieving

Good family communications can help reduce the incidence of depression and suicidal thoughts

Prolonged Grief: difficulty moving on with their life; experienced by 10-20% of survivors.

Disenfranchised Grief: an individual’s grief involving a deceased person that is a socially ambiguous loss that can’t be openly mourned or supported

Examples: ex-spouse, abortion, stigmatized death (such as AIDS)

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Cognitive factors are involved in the severity of grief after a loved one has died. One study focused on 329 adults who had suffered the loss of a

first-degree relative (Boelen, van den Bout, & van den Hout, 2003). The more negative beliefs and self-blame the adults had, the more

severe were their symptoms of traumatic grief, depression, and anxiety.

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Grieving

Dual-Process Model of Coping and Bereavement Two Main Dimensions

1) Loss-oriented stressors focus on the deceased person and can include grief work and finding the

positive aspects of the loss (relief from suffering) and experiencing the negative (yearning and rumination)

2) Restoration-oriented stressors Involve secondary stressors that emerge as indirect outcomes of

bereavement. Examples include developing a new identity and learning new skills (such

as managing finances). Effective coping involves oscillation between coping with loss and

coping with restoration

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Grieving

Coping and Type of Death Impact of death on surviving individuals is strongly influenced by

the circumstances under which the death occurs

Sudden deaths are likely to have more intense and prolonged effects on surviving individuals

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Grieving

Cultural Diversity in Healthy Grieving Some cultures emphasize the importance of breaking bonds with

the deceased and returning quickly to autonomous lifestyles

Non-Western cultures suggest that beliefs about continuing bonds with the deceased vary extensively

There is no one right, ideal way to grieve

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Making Sense of the World

Grieving often stimulates individuals to try to make sense of their world

A reliving of the events leading to the death is common

When a death is caused by an accident or a disaster, the effort to make sense of it is often pursued more vigorously

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Losing a Life Partner

The death of an intimate partner often brings profound grief

Widows outnumber widowers because women live longer than men

Widowed women are probably the poorest group in America The poorer and less educated they are, the lonelier they tend to be.

Many widows are lonely

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Forms of Mourning

Approximately two-thirds are buried and one-third are cremated Cremation is less popular in the South region of the US and more

popular in the Pacific region.

Funerals are an important aspect of mourning in many cultures

Cultures vary in how they practice mourning