AGEING AND SPIRITUALITY:AGEING AND SPIRITUALITY:Death, dying and Death, dying and

bereavementbereavement

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Definition of DyingDefinition of Dying

Clinical DeathClinical Death Brain DeathBrain Death Social DeathSocial Death Psychic DeathPsychic Death

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Clinical DeathClinical Death

Having one’s heart and breathing Having one’s heart and breathing cease spontaneously and there are cease spontaneously and there are no reflexesno reflexes

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Brain DeathBrain Death One’s brain cell is dyingOne’s brain cell is dying All electrical activity in the brain, as All electrical activity in the brain, as

determined by an electroencephalogram determined by an electroencephalogram (EEG), has ceased for a specified period (EEG), has ceased for a specified period of timeof time

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Social DeathSocial Death Occurs when a person is abandoned by or Occurs when a person is abandoned by or

isolated from othersisolated from others Often is expected to dies is talked about Often is expected to dies is talked about

as if he or she were not presentas if he or she were not present Critically ill adults and older people who Critically ill adults and older people who

are severely impaired, social death reflects are severely impaired, social death reflects the fact that their lives are seen finished the fact that their lives are seen finished even though they quite alive by other even though they quite alive by other criteriacriteria

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Psychic DeathPsychic Death

Individuals accept their fate and Individuals accept their fate and regress, a very severe and regress, a very severe and personal form of withdrawalpersonal form of withdrawal

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PERSONAL MEANINGS OF PERSONAL MEANINGS OF DEATHDEATH

Death as lossDeath as loss Death as punishment and releaseDeath as punishment and release Death as transitionDeath as transition Death and the use of time Death and the use of time

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DEATH AS LOSSDEATH AS LOSS

As Kalish (1976, 1985) has observed, As Kalish (1976, 1985) has observed, death may men losses of several kinds to death may men losses of several kinds to different peopledifferent people Loss of ability to have experiencesLoss of ability to have experiences Loss of ability to predict subsequent Loss of ability to predict subsequent

eventsevents Loss of our bodiesLoss of our bodies

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Loss of ability to care for people Loss of ability to care for people who are dependent on uswho are dependent on us

Loss of a loving relationship with Loss of a loving relationship with our familyour family

Loss of opportunity to complete Loss of opportunity to complete treasured plans and projectstreasured plans and projects

Loss of being in a relatively Loss of being in a relatively painless statepainless state

DEATHDEATH AS LOSSAS LOSS

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DEATH AS PUNISHMENT AND DEATH AS PUNISHMENT AND RELEASERELEASE

Punishment for one’s sinPunishment for one’s sin This is presumably linked to one’s belief This is presumably linked to one’s belief

about an afterlifeabout an afterlife Reynolds and Kalish (1976) found that Reynolds and Kalish (1976) found that

while older people generally equated while older people generally equated moral goodness with a longer life span, a moral goodness with a longer life span, a majority those surveyed saw, particularly majority those surveyed saw, particularly accidental death as retribution rather than accidental death as retribution rather than seeing a long life as a reward seeing a long life as a reward

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DEATH AS TRANSITIONDEATH AS TRANSITION

The person sees death as a stopping-off The person sees death as a stopping-off pointpoint

What may or may not happen afterwards What may or may not happen afterwards is really more importantis really more important

Feeling of death is also influenced by Feeling of death is also influenced by religious viewreligious view

What is meaningful about life is highly What is meaningful about life is highly subjective and varies by agesubjective and varies by age

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DEATH AND THE USE OF TIME DEATH AND THE USE OF TIME

Death is an event that makes the Death is an event that makes the dimension of time meaningful, as well as dimension of time meaningful, as well as helping us to order our liveshelping us to order our lives

Our goals and accomplishments, our Our goals and accomplishments, our sense of the past, present and future as sense of the past, present and future as well as our relationships with others well as our relationships with others become meaningful to the extent that we become meaningful to the extent that we know we will not live foreverknow we will not live forever

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Cultural meanings of deathCultural meanings of death

In studies of adults (e.g., In studies of adults (e.g., KalishKalish, 1981; , 1981; KastenbaumKastenbaum & & Herman, 1997; Ross & Pollio, Herman, 1997; Ross & Pollio, 1991; Tamm, 1996), death has 1991; Tamm, 1996), death has often been viewed as a often been viewed as a personification (such as a grim personification (such as a grim reaper, gay seducer, or gentle reaper, gay seducer, or gentle comforter) or as a metaphor comforter) or as a metaphor (e.g., a failing curtain). (e.g., a failing curtain).

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Stages of grief for a dying person Stages of grief for a dying person (Kubler Ross, 1969)(Kubler Ross, 1969)

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Denial and IsolationDenial and Isolation

““This is not happening to me”This is not happening to me”

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AngerAnger

““How dare ____ do this to me?”How dare ____ do this to me?” God/the person who died/anger directed at selfGod/the person who died/anger directed at self

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BargainingBargaining

““Just let me live to see my son graduate”Just let me live to see my son graduate”

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DepressionDepression

““I can’t bear to face going through this, putting I can’t bear to face going through this, putting my family through this.”my family through this.”

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Acceptance and HopeAcceptance and Hope ““I’m ready, I don’t want to I’m ready, I don’t want to

struggle anymore.”struggle anymore.”

“Without miracles, there are many, many ways of helping somebody, without a cure. So you have to be very careful how you word it. And you never, ever, ever take hope away from a dying patient. Without hope nobody can live. You are not God. You don't know what else is in store for them, what else can help them, or how meaningful, maybe, the last six months of a person's life are. Totally changed around.” (“On Death and Dying: An Interview with Elizabeth Kubler-Ross”, Redwood, 1995)

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GRIEF AND BEREAVEMENTGRIEF AND BEREAVEMENT

Most bereaved individuals successfully Most bereaved individuals successfully overcome their grief without professional overcome their grief without professional assistance.assistance.

Grief refers to the sorrow hurt, anger, guilt, Grief refers to the sorrow hurt, anger, guilt, confusion and other feelings that arise confusion and other feelings that arise after suffering a loss. after suffering a loss.

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STAGES OF GRIEFSTAGES OF GRIEF

Initial phaseInitial phase when death when death

occurs and for a occurs and for a weeks weeks afterwardsafterwards

Survivor’s Survivor’s reaction is reaction is shock, disbelief shock, disbelief and numbnessand numbness

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Intermediate phaseIntermediate phase Several weeks after deathSeveral weeks after death Bereaved person thinks about the Bereaved person thinks about the

death a great dealdeath a great deal Survivors try to understand why the Survivors try to understand why the

person diedperson died People search for the decease People search for the decease

STAGES OF GRIEFSTAGES OF GRIEF

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Recovery phaseRecovery phase Often results from a conscious that Often results from a conscious that

continued dwelling on the past is continued dwelling on the past is pointless and that one’s life needs pointless and that one’s life needs to move forwardto move forward

STAGES OF GRIEFSTAGES OF GRIEF

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HOSPICE CAREHOSPICE CARE Hospice care for the terminally ill has Hospice care for the terminally ill has

emerged as viable alternative to hospital emerged as viable alternative to hospital carecare

Characteristics of hospice care include:Characteristics of hospice care include:

1.1. Pain and symptom controlPain and symptom control

2.2. Alleviating isolationAlleviating isolation

3.3. Physician-directed servicesPhysician-directed services

4.4. Treatment on 24-hour-per-day basis, for Treatment on 24-hour-per-day basis, for both patient and familyboth patient and family

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5.5. Involvement of an interdisciplinary teamInvolvement of an interdisciplinary team

6.6. Bereavement follow-up for the family Bereavement follow-up for the family after deathafter death

7.7. Use of volunteersUse of volunteers

8.8. Opportunities for staff support of one Opportunities for staff support of one another, to lessen burnout and facilitate another, to lessen burnout and facilitate their own grief when a patient dies their own grief when a patient dies

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EUTHANASIAEUTHANASIA

Euthanasia means “good death”Euthanasia means “good death” Comparatively recent advances in Comparatively recent advances in

medical technology that allow for the medical technology that allow for the extension of human life indefinitelyextension of human life indefinitely

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Active euthanasiaActive euthanasia – defined as taking – defined as taking active measures to end someone’s life to active measures to end someone’s life to relieve needless suffering or to preserve relieve needless suffering or to preserve individual dignity.individual dignity.

Passive euthanasiaPassive euthanasia – defines as failing to – defines as failing to use life saving measures that might prolog use life saving measures that might prolog someone’s life, may be more acceptablesomeone’s life, may be more acceptable

EuthanasiaEuthanasia

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The End, Thank YouThe End, Thank YouThe End, Thank YouThe End, Thank You

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