Life-Span DevelopmentTwelfth EditionChapter 20: Death, Dying and Grieving

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©2009 The McGraw-Hill Companies, Inc. All rights reserved.

THE DEATH SYSTEM

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

People in the U.S. tend to be death avoiders and death deniers

Changing Historical Circumstances: The age group in which death most often strikes Life expectancy has increased from 47 to 78 years Location of death

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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 Includes both the higher

cortical functions and the lower brain-stem functions

Terri Schiavo

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LIFE, DEATH, AND HEALTH CARE Advance directive & living wills are designed to be filled

in while the individual can still think clearly Designed for situations in which the individual is in a coma and

cannot express his or her desires Many states have natural death legislation People engaged in end-of-life planning are more likely to:

Have been hospitalized in the year prior Believe that patients rather than physicians should make health-

care decisions Have less death anxiety Have survived the painful death of a loved one

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ADVANCE DIRECTIVE & LIVING WILLSLIVING WILL

I, __________, of __________, being of sound mind, do hereby willfully and voluntarily make known my desire that my life not be prolonged under any of the following conditions, and do hereby further declare:

1. If I should, at any time, have an incurable condition caused by any disease or illness, or by any accident or injury, and be determined by any two or more physicians to be in a terminal condition whereby the use of "heroic measures” or the application of life-sustaining procedures would only serve to delay the moment of my death, and where my attending physician has determined that my death is imminent whether or not such "heroic measures" or life-sustaining measures are employed, I direct that such measures and procedures be withheld or withdrawn and that I be permitted to die naturally.

2. In the event of my inability to give directions regarding the application of life-sustaining procedures or the use of "heroic measures", it is my intention that this directive shall be honored by my family and physicians as my final expression of my right to refuse medical and surgical treatment, and my acceptance of the consequences of such refusal.

3. I am mentally, emotionally and legally competent to make this directive and I fully understand its import.

4. I reserve the right to revoke this directive at any time.

5. This directive shall remain in force until revoked.

IN WITNESS WHEREOF, I have hereto set my hand and seal this _____ day of __________, 20___.

Signed: __________

Declaration of Witnesses

The declarant is personally known to me and I believe him to be of sound mind and emotionally and legally competent to make the herein contined Directive to Physicians. I am not related to the declarant by blood or marriage, nor would I be entitled to any portion of the declarant's estate upon his decease, nor am I an attending physician of the declarant, nor an employee of the attending physician, nor an employee of a health care facility in which the declarant is a patient, nor a patient in a health care facility in which the declarant is a patient, nor am I a person who has any claim against any portion of the estate of the declarant upon his death.

Signed: _____________

https://www.texaslivingwill.org/

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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 Trend is toward acceptance of

passive euthanasia in the case of terminally ill patients

Experts do not agree on the boundaries or mechanisms by which treatment decisions should be implemented

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. (except Oregon)

Patients who have a desire for euthanasia are often: Less religious Have been diagnosed with depression Have a lower functional living status

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LIFE, DEATH, AND HEALTH CARE

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

and suffering, 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

Family members report better psychological adjustment to the death of a loved one when hospice care is used

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

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ATTITUDES TOWARD DEATH

Death of a parent is especially difficult for children

Most psychologists believe that honesty is the best strategy in discussing death with children Depends on the child’s maturity level

Terminally ill children may distance themselves from their parents as death approaches

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 Often think that they are somehow immune to

death

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ATTITUDES TOWARD DEATH

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

Middle-aged adults often fear death more than young adults or older adults

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

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KÜBLER-ROSS’S 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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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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CONTEXTS IN WHICH PEOPLE DIE

More than 50% of Americans die in hospitals

Nearly 20% die in nursing homes

Hospitals offer many important advantages: Professional staff members Technology may prolong life

Most individuals say they would rather die at home

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GRIEVING

Grief: emotional numbness, disbelief, separation anxiety, despair, sadness, and loneliness that accompany the loss of someone we love Grief is a complex, evolving process with multiple dimensions More like a roller-coaster ride than an orderly progression of stages

Cognitive factors are involved in the severity of grief Good family communications and grief counselors can help grievers cope

with feelings of separation and loss Prolonged Grief: approximately 10%–20% of survivors have difficulty

moving on with their life after 6 months have passed 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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GRIEVING

Dual-Process Model: Loss-oriented stressors: focus on the deceased

individual Can include grief work and both positive and negative

reappraisal of the loss Restoration-oriented stressors: secondary stressors

that emerge as indirect outcomes of bereavement Changing identity and mastering new skills

Effective coping involves cycling between coping with loss and coping with restoration

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GRIEVING

Impact of death on surviving individuals is strongly influenced by the circumstances under which the death occurs Traumatic, violent, or sudden

deaths are likely to have more intense and prolonged effects Can be accompanied by

PTSD-like symptoms

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GRIEVING

Cultural Diversity: Some cultures emphasize

the importance of breaking bonds with the deceased and returning quickly to autonomous lifestyles

Beliefs about continuing bonds with the deceased vary extensively

There is no one right, ideal way to grieve

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LOSING A LIFE PARTNER

Widows outnumber widowers 5 to 1 Women live longer than men A widowed man is more likely to remarry Widows usually marry older men

Widowed women are probably the poorest group in America

Women tend to do better than men because women typically have better networks of friends and relatives Older women do better than younger women

Religiosity and coping skills are related to well-being following the loss of a spouse in late adulthood

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FORMS OF MOURNING

Approximately 80% are buried; 20% are cremated

Funerals are an important aspect of mourning in many cultures

Cultures vary in how they practice mourning