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CHAPTER THIRTEEN Dying and Bereavement


CHAPTER THIRTEEN Dying and Bereavement * * * * * * * * * * * Sociocultural Definitions of Death All cultures have their own ideas about death, mourning rituals and ... – PowerPoint PPT presentation

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Title: CHAPTER THIRTEEN Dying and Bereavement

CHAPTER THIRTEENDying and Bereavement
Sociocultural Definitions of Death
  • All cultures have their own ideas about death,
    mourning rituals and states of bereavement

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
  • No postural activity, swallowing, yawning, or
  • No motor reflexes
  • A flat EEG for at least 10 minutes
  • No change in any of these when tested again 24
    hours later

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

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

  • 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

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.

A Life Course Approach to Dying
  • Young adults report a sense of being cheated by
  • 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.

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
  • 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.

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
  • People may be in more than one stage at a time
    and do not necessarily go through them in order.

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

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.

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

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

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.

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.

Making Your End-of-Life Intentions Known
  • Decisions regarding end-of-life issues are
  • 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
  • Do Not Resuscitate (DNR) medical order which is
    used when cardiopulmonary resuscitation is not

Survivors The Grieving Process
  • Bereavement
  • The state or condition caused by loss through
  • 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.

The Grief Process
  • Unlike bereavement, over which we have no
    control, grief is a process that involves
  • A person must
  • Acknowledge the reality of the loss
  • Work through the emotional turmoil
  • Adjust to the environment where the deceased is
  • 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.

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

News Report Green Burials