The Developing Person Through the Life Span 8eby Kathleen Stassen Berger Epilogue: Death and Dying PowerPoint Slidesdeveloped by Martin Wolfger and Michael James Ivy Tech Community College-Bloomington Reviewed by Raquel Henry Lone Star College, Kingwood
Death and Dying Thanatology • The study of death and dying • Especially the social and emotional aspects. • Neither morbid or gloomy, it reveals: • The reality of hope in death • Acceptance of dying • Reaffirmation of life
Death and Hope Death in Childhood • Children have a different perspective of death. They: • are more impulsive and may seem happy one day and sad the next. • do not “get over” the death of a parent, nor dwell on it. • may take certain explanations literally. • Fatally ill children typically fear abandonment frequent and caring contact is more important than logic. • Older children seek specific facts and become less anxious about death and dying.
Death in Adolescence and Emerging Adulthood • Teenagers seem to have little fear of death • Take risks, place a high value on appearance, and seek thrills • May be their way of controlling anxiety. • Terror management theory (TMT) • The idea that people adopt cultural values and moral principles in order to cope with their fear of death. • Adolescents often predict that they will die at an early age • Tendency toward risk taking can be deadly (e.g., suicides, homicides, car accidents).
Death in Adulthood • When adults become responsible for work and family, death is to be avoided or at least postponed. • Many adults quit taking addictive drugs, start wearing seat belts, and adopt other precautions. • 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. • One sign of mental health among older adults is acceptance of their own mortality and altruistic concern about those who will live on after them. • Many older adults accept death (e.g., they write their wills, designate health care proxies, reconcile with estranged family members, plan their funeral). • The acceptance of death does not mean that the elderly give up on living!
Religions and Hope • People who think they might die soon are more likely than others to believe in life after death. • Virtually every world religion provides rites and customs to honor the dead and comfort the living. • Although not everyone observes religious customs, those who care for the dying and their families need extraordinary sensitivity to cultural traditions.
Near-Death Experience • An episode in which a person comes close to dying but survives and reports having left his or her body and having moved toward a bright white light while feeling peacefulness and joy. • Near-death experiences often include religious elements. • Survivors often adopt a more spiritual, less materialistic view of life. • To some, near-death experiences prove that there is a heaven but scientists are more skeptical.
Dying and Acceptance • Good death • A death that is peaceful, quick, and painless and that occurs after a long life, in the company of family and friends, and in familiar surroundings. • People in all religious and cultural contexts hope for a good death. • Bad death • Lacks these six characteristics and is dreaded, particularly by the elderly
Attending to the Needs of the Dying Kübler-Ross identified emotions experienced by dying people, which she divided into five stages: • Denial (“I am not really dying.”) • Anger (“I blame my doctors, or my family, or God for my death.”) • Bargaining (“I will be good from now on if I can live.”) • Depression (“I don’t care about anything; nothing matters anymore.”) • Acceptance (“I accept my death as part of life.”)
Honest Conversation Stage Model based on Maslow’s hierarchy of needs: • Physiological needs (freedom from pain) • Safety (no abandonment) • Love and acceptance (from close family and friends) • Respect (from caregivers) • Self-actualization (appreciating one’s past and present) • Self-transcendence (acceptance of death) • This stage was later suggested by Maslow. *Other researchers have not found sequential stages in this area.
Honest Conversation • Most dying people want to spend time with loved ones and talk honestly with medical and religious professionals. • Many thanologists find that the “stages” of death may not go in order and some may never occur. • Hospital personnel need to respond to each dying person as an individual. • Each person responds to death in their own way, some may not want the whole truth.
The Hospice Hospice • An institution or program in which terminally ill patients receive palliative care • Hospice caregivers provide skilled treatment to relieve pain and discomfort; they avoid measures to delay death and their focus is to make dying easier Two principles for hospice care: • Each patient’s autonomy and decisions are respected. • Family members and friends are counseled before the death, shown how to provide care, and helped after the death.
Palliative Medicine • Palliative care • Care 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. • Double effect • An ethical situation in which an action (such as administering opiates) has both a positive effect (relieving a terminally ill person’s pain) and a negative effect (hastening death by suppressing respiration).
Hastening or Postponing Death Longer Life • The average person lives 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) . • Many adults under age 50 once died of causes that now kill relatively few adults in developed nations, such as complications of childbirth and epidemic diseases.
Hastening or Postponing Death • Passive euthanasia • A situation in which a seriously ill person is allowed to die naturally, through the cessation of medical intervention. • DNR (do not resuscitate) • A written order from a physician (sometimes initiated by a patient’s advance directive or by a health care proxy’s request) that no attempt should be made to revive a patient during cardiac or respiratory arrest.
Hastening or Postponing Death • Active euthanasia • A situation in which someone takes action to bring about another person’s death, with the intention of ending that person’s suffering. • Legal under some circumstances in the Netherlands, Belgium, Luxembourg, and Switzerland, but it is illegal (yet rarely prosecuted) in most other nations. • Physician-assisted suicide • A form of active euthanasia in which a doctor provides the means for someone to end his or her own life.
When Physician-Assisted Suicide Is Legal Slippery slope • The argument that a given action will start a chain of events that will culminate in an undesirable outcome. • Concern: Hastening death when terminally ill people request may cause a society to slide into killing sick people who are not ready to die—especially the old and the poor.
Advance Directives • An individual’s instructions for end-of-life medical care, written before such care is needed. • Living will • A document that indicates what kinds of medical intervention an individual wants or does not want if he or she becomes incapable of expressing those wishes. • Health care proxy • A person chosen by another person to make medical decisions if the second person becomes unable to do so.
Bereavement Normal Grief • Bereavement • The sense of loss following a death. • Grief • The powerful sorrow that an individual feels at the death of another. • Mourning • The ceremonies and behaviors that a religion or culture prescribes for people to employ in expressing their bereavement after a death.
Placing Blame And Seeking Meaning Placing blame • Common impulse after death for the survivors (e.g., for medical measures not taken, laws not enforced, unhealthy habits not changed) • The bereaved sometimes blame the dead person, sometimes themselves, and sometimes distant others. • Nations may blame one another for public tragedies. • Blame is not necessarily rational.
Placing Blame And Seeking Meaning Seeking Meaning • Often starts with preserving memories (e.g., displaying photographs, telling anecdotes) • Support groups offer help when friends are unlikely to understand (e.g., groups for parents of murdered children). • Organizations devoted to causes such as fighting cancer and banning handguns often find supporters among people who have lost a loved one to that particular circumstance. • Close family members may start a charity.
Complicated Grief • Grief that impedes a person’s future life • Absent grief • A situation in which overly private people cut themselves off from the community and customs that allow and expect grief; can lead to social isolation. • Disenfranchised grief • A situation in which certain people, although they are bereaved, are prevented from mourning publicly by cultural customs or social restrictions.
Mourning That Does Not Heal Incomplete grief • A situation in which circumstances, such as a police investigation or an autopsy, interfere with the process of grieving. • The grief process may be incomplete if mourning is cut short or if other people are distracted from their role in recovery.
Diversity of Reactions • Reactions to death are varied • Other people need to be especially responsive to whatever needs a grieving person may have. • Most bereaved people recover within a year • A feeling of having an ongoing bond with the deceased is no longer thought to be pathological.