Epilogue:

Death and Dying

THANATOLOGY

Thanatology The study of death and dying

DEATH AND HOPE – UNDERSTANDING DEATH THROUGHOUT THE LIFE SPAN

Death in Childhood Children have a different perspective of

death.

DEATH IN ADOLESCENCE AND EMERGING ADULTHOOD Teenagers have little fear of death

Adolescents often predict that they will die at an early age

DEATH IN ADULTHOOD When adults become responsible for work

and family death is to be avoided or at least postponed.

Death anxiety usually increases from one’s teens to one’s 20s and then gradually decreases.

Ages 25 to 60: Terminally ill adults worry about leaving something undone or leaving family members—especially children—alone.

DEATH IN LATE ADULTHOOD Death anxiety decreases and hope rises. Mental health Many older adults accept death

DYING AND ACCEPTANCE

Good death

Bad death

HONEST CONVERSATION

Stages of Dying I. Kübler-Ross: Identified emotions experienced

by dying people, which she divided into a sequence of five stages:

1. Denial (“I am not really dying.”)

2. Anger (“I blame my doctors, or my family, or God for my death.”)

3. Bargaining (“I will be good from now on if I can live.”)

4. Depression (“I don’t care about anything; nothing matters anymore.”)

5. Acceptance (“I accept my death as part of life.”)

HONEST CONVERSATION

II. Stage Model based on Maslow’s hierarchy of needs:

1. Physiological needs (freedom from pain)2. Safety (no abandonment)3. Love and acceptance (from close family

and friends)4. Respect (from caregivers)5. Self-actualization (spiritual transcendence)

THE HOSPICE

HospiceAn institution or program in which

terminally ill patients receive palliative care

Two principles for hospice care:1.Each patient’s autonomy and decisions are

respected.2.Family members and friends are counseled

before the death, shown how to provide care, and helped after the death.

PALLIATIVE MEDICINE

Palliative careCare designed not to treat an illness but to

provide physical and emotional comfort to the patient and support and guidance to his or her family.

CHOICES AND CONTROVERSIES

WHEN IS A PERSON DEAD? Brain death: Prolonged cessation of all brain

activity with complete absence of voluntary movements

Locked-in syndrome: The person cannot move, except for the eyes, but brain waves are still apparent; the person is not dead.

CHOICES AND CONTROVERSIES

Coma: A state of deep unconsciousness from which the person cannot be aroused.

Vegetative state: A state of deep unconsciousness in which all cognitive functions are absent, although eyes may open, sounds may be emitted, and breathing may continue; the person is not yet dead.

HASTENING OR POSTPONING DEATH

Longer LifeThe average person lived twice as long in

2010 as in 1910.

Later death due to drugs, surgery, and other interventions (e.g., respirators, defibrillators, stomach tubes, and antibiotics) .

ALLOWING DEATHPassive Euthanasia

DNR (do not resuscitate)

ALLOWING DEATHActive Euthanasia

Physician-Assisted Suicide

ADVANCE DIRECTIVESAdvance Directive

Living Will

Health Care Proxy

BEREAVEMENT

Normal Grief

BereavementThe sense of loss following a death

GriefThe powerful sorrow that an individual

feels at the death of another

MourningThe ceremonies and behaviors that a

religion or culture prescribes for people to employ in expressing their bereavement after a death