CHAPTER THIRTEEN Dying and Bereavement

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CHAPTER THIRTEENDying and Bereavement
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Sociocultural Definitions of Death

• All cultures have their own ideas about death,
  mourning rituals and states of bereavement

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Legal and Medical Definitions

• Clinical death (accepted for
• hundreds of years)
• Lack of heart beat and respiration
• Whole-Brain death (most
• widely accepted today)
• Includes eight specific criteria, all of which
  must be met
• No spontaneous responses to any stimuli
• No spontaneous respiration for at least 1 hour
• Total lack of responsiveness to even the most
  painful stimuli
• No eye movements, blinking, or pupil
  responsiveness
• No postural activity, swallowing, yawning, or
  vocalizing
• No motor reflexes
• A flat EEG for at least 10 minutes
• No change in any of these when tested again 24
  hours later

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Legal and Medical Definitions

• Persistent vegetative state a person does not
  recover following
• Disruption of the blood flow to the brain
• Severe head injury
• Drug overdose
• Abby Dorn case

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Ethical Issues

• Bioethics
• Examines the interaction between human values and
  technological advances
• Euthanasia
• The practice of ending life for reasons of mercy

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Euthanasia

• Two types of euthanasia
• Active euthanasia
• Deliberately ending someones life through some
  sort of intervention or action
• Passive euthanasia
• Ending someones life by withholding treatment
• Oregon Death with Dignity Law 1994
• Provides for people to obtain prescriptions for
  self-administered lethal doses of medication
• Terri Schiavo case

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The Price of Life-Sustaining Care

• A growing debate concerns the costs for keeping
  someone alive through technology and includes
  financial, personal, and moral costs.

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A Life Course Approach to Dying

• Young adults report a sense of being cheated by
  death.
• Middle-aged adults begin to confront their own
  mortality and undergo a change in their sense of
  time lived and time until death.
• When their parents die, people realize they are
  the oldest generation.
• Older adults are more accepting of death.

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Coping with DeathKübler-Rosss 5-Stage Theory

• DENIAL Often first reaction likely to be shock
  and disbelief
• ANGER At some point
• people express anger
• (hostility, resentment,
• frustration, envy)
• BARGAINING Looking for a
• way out setting a timetable
• DEPRESSION Occurs
• when one can no longer
• deny the illness
• ACCEPTANCE Realizing
• that death is inevitable
• often results in detachment
• from the world and sense of peace.

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Coping with DeathKübler-Rosss 5-Stage Theory

• Movement through the stages
• Some people do not progress through all of these
  stages, and people move through them at different
  rates.
• People may be in more than one stage at a time
  and do not necessarily go through them in order.

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Coping with Death A Contextual Theory of Dying

• Stage theories of dying
• assume some sort of underlying process for moving
  from one stage to another
• do not clearly state what a person must do to
  move from one stage to another
• Contextual theories of dying emphasize
• Tasks and issues that a dying person must face
• No right way to die (but there are better or
  worse ways of coping with death)
• Corr identified four dimensions of tasks that
  must be faced.
• Bodily needs, psychological security,
  interpersonal attachments, and spiritual energy
  and hope

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Death Anxiety

• Death anxiety is widespread in Western culture.
• Several components have been identified
• Anxiety about pain
• Body malfunction
• Humiliation
• Rejection
• Nonbeing
• Punishment
• Interruption of goals
• Negative impact on survivors
• These components can be expressed at public,
  private, and unconscious levels.

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Death Anxiety

• Death anxiety is demonstrated in many different
  ways, including
• Avoidance of things connected with death
• Such as refusing to go to funerals
• Directly challenging death
• Such as engaging in
• dangerous sports
• Less common ways to
• express death anxiety
• Daydreaming
• Changing ones lifestyle
• Using humor
• Displacing anxiety onto work
• Becoming a professional
• who deals with death

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Creating a Final Scenario

• End-of-life issues
• Managing the final aspects of life
• After-death disposition of the body and how one
  is memorializedcremation or burial?
• Distribution of assets

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Creating a Final Scenario

• Making choices about what people do and do not
  want done
• A crucial aspect of the final scenario is the
  process of separation from family and friends.
• Bringing closure to relationships
• Ones final scenario helps family and friends
  interpret ones death, especially when the
  scenario is constructed jointly.

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The Hospice Option

• An approach to assisting dying people that
  emphasizes pain management (palliative care) and
  death with dignity
• Emphasizes quality of life rather than quantity
  of life
• The goal is a de-emphasis on the prolongation of
  death for terminally ill patients
• Both inpatient and outpatient hospices exist.
• The role of the staff is to be with patients, not
  to do things for patients.

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Making Your End-of-Life Intentions Known

• Decisions regarding end-of-life issues are
  complex
• Legal, Political, and Ethical
• Living will and durable power of attorney for
  health care
• Personal preferences for medical intervention
• The purpose of both is to make ones wishes about
  the use of life support known in the event one is
  unconscious or otherwise incapable of expressing
  them.
• Do Not Resuscitate (DNR) medical order which is
  used when cardiopulmonary resuscitation is not
  desired.

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Survivors The Grieving Process

• Bereavement
• The state or condition caused by loss through
  death
• Grief
• The sorrow, hurt, anger, guilt, confusion, or
  other feelings that arise after a loss
• Mourning
• The way we express our grief
• Mourning is heavily influenced by cultural norms.

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The Grief Process

• Unlike bereavement, over which we have no
  control, grief is a process that involves
  choices.
• A person must
• Acknowledge the reality of the loss
• Work through the emotional turmoil
• Adjust to the environment where the deceased is
  absent
• Loosen ties to the deceased
• Grief is an active coping process.
• Grief is complicated and personal
• Anniversary reaction
• Grief that often returns around the
• anniversary of the death
• Grief Over Time
• Grief tends to peak within the first
• six months.
• People can grieve many years after the loss.

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Normal Grief Reactions

• Confusion
• Helplessness
• Emptiness
• Loneliness
• Acceptance
• Relief
• Happiness
• Lack of enthusiasm
• Absence of emotion

• Disbelief
• Denial
• Shock
• Sadness
• Anger
• Hatred
• Guilt
• Fear
• Anxiety

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News Report Green Burials