Chapter 21:   Death and Grieving

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Defining DeathandLife/Death Issues. Brain death occurs when all electrical activity in the brain ceasesHigher portions of the brain die sooner than the lower portionsThere is controversy over what medical experts should use as criteria for deathWhen does intelligence and personality end

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Chapter 21: Death and Grieving

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1. Chapter 21: Death and Grieving

2. Defining Death and Life/Death Issues

3. Brain death occurs when all electrical activity in the brain ceases Higher portions of the brain die sooner than the lower portions There is controversy over what medical experts should use as criteria for death When does intelligence and personality end?

4. Termination of medical treatments is controversial Dying patients in coma need living wills Physicians have concerns over malpractice suits in the absence of a living will or defining laws Euthanasia is often called mercy killing Passive euthanasia – treatment is withheld Active euthanasia – death deliberately induced Euthanasia evokes a variety of emotions among health-care professionals and family members

5. 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 for the state of Oregon Most physicians surveyed oppose active euthanasia Better care is needed for dying persons, as death is often lonely, prolonged, and painful

6. The hospice movement Is a new kind of medical institution Began in London at the end of the 1960s Is dedicated to reducing pain and helping patients 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

7. Death and Cultural Contexts

8. Death has changed historically 200 years ago, 1 out of every 2 children died before age 10, and one parent usually died before a child grew up Today, death occurs mostly among the elderly Life expectancy has increased from 47 years for a person born in 1900 to 77 years for a person born today Over 80% of all U.S. deaths occur in hospitals

9. Culture affects how death is experienced Americans live as if they were immortal India and Africa have many young children and infants dying of malnutrition and disease Most societies throughout history have had religious or philosophical beliefs about death and rituals surrounding it Some societies welcome death while others fear it In most societies, death is not an end to existence

10. A Developmental Perspective on Death

11. Causes of death vary across the life span: Prenatal death through miscarriage Death during birth or shortly afterwards Accidents or illness cause most childhood deaths Most adolescent deaths result from suicide, homicide, or motor vehicle accident Deaths among young adults are increasing due to AIDS Middle-age and older adult deaths usually result from chronic diseases

12. Attitudes toward death vary at different points in the life span Young children use illogical reasoning to explain death, believing magic or treatment can return life Others claim separation anxiety is an indicator of a child’s awareness of separation and loss Those in middle and late childhood have more realistic perceptions of death – that it is a finality

13. Children and youth can reexperience grief as they age, and it may affect future relationships Many strategies, including honesty, should be adopted when discussing death with children Extent of explanations will vary according to a child’s age 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

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

15. Facing One’s Own Death

16. Knowledge of death’s approach forces the dying person to change their attitudes and behaviors Kübler-Ross identified 5 stages in 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 In facing their own deaths, some people struggle desperately until the end

17. The quality of one’s life is linked to how death will be approached Meaning and purpose bring peaceful acceptance An unfulfilled life brings distress and despair Perceived control and denial may be adaptive strategies for remaining alert and cheerful Denial insulates and allows one to avoid coping with intense feelings of anger and hurt In the U.S., most people die in hospitals, and fewer die in nursing homes or a hospice

18. Coping with the Death of Someone Else

19. No loss is greater than that of a loved one Open communication with a dying person is very important because it gives them A chance to plan activities for the time left An opportunity to reminisce A chance to examine what is happening to them Effective strategies for open communication vary and should be directed toward internal growth

20. Grief is not a simple emotional process and may not end anytime soon after the loss A variety of cognitive factors influence the severity of the grief process Good family communications and grief counselors can help grievers cope with feelings of separation and loss Cross-culturally, people in some societies forget the deceased as quickly as possible, while in others they try to hold on

21. Grieving forces one to try and make sense of the world – reliving one or more events over and over Finding meaning may enhance or ease the ability to cope Researchers have identified 3 types of meaning-making coping Personal – cognitive acceptance is sought Family – members search for common factors Community – a broader level of loss

22. Women feel the loss of a life partner more than men because They live longer than men A widowed man is more likely to remarry They usually marry older men Cross-culturally, many widows fall into poverty after the loss of a life partner Impact on one’s physical and psychological health is linked to how long one grieves and remains widowed

23. Funerals are an important aspect of mourning and a source of closure in many cultures Forms of mourning include Making some type of funeral arrangement Deciding on burial or cremation for the body Holding ceremonies after the funeral – in some cultures Being supported as a family by the community Dividing the mourning into time periods Designating one time frame for mourning

24. The End

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