Death, Dying, and Bereavement

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Death, Dying, and Bereavement. PS277 – Lecture 19 – Chapter 13. Literary Commentary on the Great Mystery: Shakespeare vs. Dylan Thomas. Julius Caesar : “Of all the wonders that I have yet heard, It seems to me most strange that men should fear; Seeing that death, a necessary end, - PowerPoint PPT Presentation

Transcript of Death, Dying, and Bereavement

  • Death, Dying, and BereavementPS277 Lecture 19 Chapter 13

  • Literary Commentary on the Great Mystery: Shakespeare vs. Dylan ThomasJulius Caesar: Of all the wonders that I have yet heard, It seems to me most strange that men should fear;Seeing that death, a necessary end, Will come when it comes.

    Dylan Thomas: Do not go gentle into that good night. Old age should burn and rave at close of day; rage, rage against the dying of the light.

  • OutlineEuthanasia and Death

    Cultural and Historical Context of Death

    Experiencing Death Personally

    Dying as a Process

    Death Anxiety

    Grieving: Process and Causes

  • Medical - Legal Definitions of DeathModern medical definitions focus on concept of brain death

    Strong definition = absence of both cortical and brain stem functions and reflexes, total unconsciousness

    Other conditions which might produce this state must be ruled out

    Inability to live on own, without use of supportive technology for cardiovascular function

  • Various States of Awareness after Injury and Their Relations

  • Euthanasia Issues: Ending LifeActive vs. Passive Euthanasia actively inducing death vs. withholding treatment. More of an issue as life sustaining technology has developed to more sophisticated levels

    Terri Schiavo case (March, 2005) withholding of nourishment from a woman in persistent vegetative state for 15 years US Supreme Court upheld husbands right to have feeding tube removed

    Legal issues some countries and jurisdictions allow active euthanasia under medical supervision (e.g., the Netherlands)

    Canadians can leave a DNR document to prevent use of extraordinary measures, but active euthanasia is illegal Sue Rodriguez case, ALS

    Hitlers euthanasia programs for undesirable persons!

  • Historical Context of Death and DyingDeath occurs primarily away from home and from our everyday life

    60 years ago, fewer than 50% of all deaths occurred at hospital, now over 80% do

    Philippe Aries, a French historian, notes how much this has led to the hiding of death: Our senses can no longer tolerate the sights and smells that in the early 19th century were part of daily life, along with suffering and illness. The physiological effects have passed from daily life to the aseptic world of hygiene, medicine and moralityThe hospital has become the place of solitary death.

  • My Grandparents

    Both died at home in 1958

    Very quickly and within two weeks of one another

  • Some Issues for Person and Society of Our Modern Technological ContextPersonal: Dying alone more common today

    Personal: Dying with little dignity or control

    Society: Avoidance of contemplation of death and dying

    Society: Difficulty in accepting death as a natural process

  • Sherwin Nuland: How We Die

  • Immediate Causes and Experience of DeathNulands 23 cases of autopsy of people in 80s & 90s: 7 heart attacks, 4 strokes, 3 pneumonias, 5 severe infections, 4 advanced cancers these are the most common ends

    All of these 23 cases had serious atherosclerosis diseases of heart or brain associated with aging, plus many other incidental diseases wear and tear for every one of them

    Lack of oxygen is most direct cause of death, however

    Sequence of death: shock due to oxygen loss to organs, agonal moments (gasping, etc.), clinical death, irretrievable mortality

    Common for the brain to secrete endorphins during these final moments, makes people more tranquil than we might expect

  • Famous African Explorer, David Livingstones Lion Attack 1844, Age 30Later description of the attack, which almost killed him:Growling horribly close to my ear, he shook me as a dog does a rat. The shock produced a stupor similar to that which seems to be felt by a mouse after the first shake of the cat. It caused a sort of dreaminess, in which there was no sense of pain nor feeling of terror, though quite conscious of all that was happening. The shake annihilated fear, and allowed no sense of horror in looking round at the beast. This peculiar state is probably produced in all animals killed by carnivores; and if so, is a merciful provision by our benevolent Creator for lessening the pain of death.

  • Kubler-Ross: Stages of Death and Dying

  • Stages of Dying and the Process Itself Kubler-Rosss 5 stages:

    Shock and DenialAnger (Why me?)BargainingDepression, sadnessAcceptance/accommodation

    Not likely that these represent stages or that everyone experiences all of them

    Cultural variations may shape these, etc.

  • Fear of Death and Some of Its CorrelatesWhat do you fear most about death?

    Generally, people fear most the process of dying and the unknown

    Religiosity can be an important factor in moderating fear of unknown

    Previous experience with death of a loved one can affect

    Feelings of purpose and accomplishment can help lower fear

  • Age Differences in Fear of Death

  • Coping with the Fear and Avoidance of DeathExercises: Doing a personal obituary

    Decide on final scenarios end state care, hospice care, funeral choices, burial or cremation, etc.

    Thich Nhat Han: Contemplating being dead: Buddhist meditation exercises imaging yourself as a corpse and meditating on what will happen to itnot fun, but important to integrating ones death and life with equanimity?

  • My Parents

  • My Fathers Death Non-Hodgkins lymphoma cancer of the bloodRecurrence led to very low red blood counts and heavy stress on heart, many other health problems w/ treatmentLast 2 years in and out of hospital many timesHospice care at home, but limited time permitted in USSeveral times convinced he was dying, angina symptomsEnd: had a fall, high fever, etc. had to go to hospital Last phase was short, massive pneumonia - led to death in a few daysVery clear that wanted to dieAble to say good-bye to family + strong religious beliefsLast evening- not completely lucid, but very gentle endingFuneral was a positive process, community celebration of his life

  • Bereavement and GriefGrief work: Freuds theory of the need to work through attachment to lost person and resolve negative emotions over time, important to talk through the loss

    Recent research questions those who do more early grief work actually seem to have more problems later on

    Wortman & Silver found much variability in grieving, not the case that failure to grieve necessarily means problems several patterns are normal

    typical (high initial, fairly quick recovery) = 35% chronic (high over several years) = 30%-35% delayed (low then increases) = 5% absent (person shows and feels little distress at all) = 25%

  • Loss of ParentsLoss of parents is the most expectable bereavement, but still very difficult

    Has much symbolic meaning about ones generational place

    Context is everything my fathers parents and his grief

  • Darwins Father RobertDarwins father, Robert, died in 1848, age 82, of heart failure

    Darwins illness during these months was much worse, he visited often but could not attend funeral

    Darwin had a very difficult relationship as child, but was closer to father as adult

  • Loss of a SpouseDisrupts immune function, strong rise in depression for some time, 1-2 years as typical for older adult spouses

    Quality of bond, social support available, other factors can moderate these effects Emma Darwin

    Seems to be worse in some ways for men, who may have less social support, harder time talking about this

  • Losing a ChildSeems most unnatural, probably hardest to fully resolve

    Historical Context: Many parents in past generations lost children to illness, etc. Some people have suggested that attachments to infants were less these claims are strongly disputed, certainly grief occurred nonetheless

    My cousins daughters - sudden, shocking, more difficult to handle immediately, some research suggests stronger health effects for sudden deaths

    Overall, grieving is highly individual, variable, personal takes time

  • Darwins First Daughter, AnnieParents favourite, died at age 10 in 1851 of TB

    Darwin did not attend this funeral either, overcome with grief

    Lost what little faith he had left at this point, though his wife continued to believe

    Annies box