Important Announcement There will be no class on Thursday, April 3, 2014 Instead, I will hold a review session: Date: Tuesday, April 8, 2014 Time: 12:30 2 PM Location: H104 Repeated: Thursday, April 10, 2014 The End of Life Death and Bereavement Death and Bereavement Thinking about death: Personal Aspects Surviving the loss: The grieving process Death and Bereavement Thinking about death: Personal Aspects Surviving the loss: The grieving g process Perspectives of death vary across cultures In Eastern Cultures Death natural part of life In Western Cultures Death is final assault on personhood Postponed as long as possible In our culture, death can be viewed in at least 10 different ways Death as an image or object Death as an event Death as a state of being Death as an analogy Death as a mystery Death as a statistic Death as a boundary Death as a thief of meaning Death as fear and anxiety Death as reward or punishment 1
For most of human history Death when heart and breathing stops Today Brain death most widely accepted definition Necessary Criteria of Brain Death 1. No spontaneous response to any stimuli 2. No spontaneous respiration for at least one hour 3. Total lack of responsiveness to even the most painful stimuli 4. No eye movements, blinking, or pupil response 5. No postural activity, swallowing, yawning or vocalizing 6. No motor responses 7. A flat electroencephalogram (EEG) for at least 10 minutes 8. No change in any of these criteria when they are tested again 24 hours later If given choice Most would die suddenly When death become inevitable Most still prefer to have control Ways of gaining control Active euthanasia Deliberately ending someone s life Examples Administering drug overdose Disconnecting life support Mercy killings Ways of gaining control Active euthanasia Passive euthanasia Allowing a person to die by withholding treatment Examples include Withholding chemotherapy food In most jurisdictions Euthanasia only legal when person makes clear wishes concerning medical intervention ti Common device to do this Living Will Durable power of attorney 2
The Living Will When person states wishes Regarding life support and other forms of treatment What individual wants done in case of vegetative state or brain death Durable Power of Attorney Similar to Living Will Makes clear wishes if incapacitated However, also names someone who has legal authority to speak if individual cannot speak for him/herself Death and Bereavement Thinking about death: Personal Aspects When thinking about death, anxiety is a common experience Surviving the loss: The grieving process When thinking about death, anxiety is a common experience A complete understanding of death requires at least 3 components Irreversibility Nonfunctionality Universality 3 components of a complete understanding of death Irreversibility Realization that there is no reversing death Nonfunctionality Universality 3
3 components of a complete understanding of death 3 components of a complete understanding of death Irreversibility Nonfunctionality Understanding that all functions cease at death Universality Irreversibility Nonfunctionality Universality Death occurs to all living organisms Beliefs about death: Developmental trends Preschoolers Don t understand death s finality Beliefs about death: developmental trends Preschoolers Between ages 6-11 Gain understanding of 3 aspects of death However, death is personified Beliefs about death: developmental trends Preschoolers Between ages 6-11 By age 12 Accurate understanding of death While older adults think about death more, they fear it less 4
Empirical Studies of death Find 4 components Concern about physical change Awareness of the passage of time Concern about the pain and stress accompanying death Concern about intellectual and emotional reactions to death Factors influencing death anxiety Religious beliefs Reduce anxiety Inconsistent religious beliefs Related to highest death anxiety The Process of Dying People expected to accept death Expectations of a well behaved dying person: Pretend that improvement is at hand Turn over treatment decisions to others Talk only about Neutral topics The immediate future The Process of Dying Elisabeth Kübler-Ross proposed a 5 stage process of coming to terms with one s own death Elizabeth Kübler-Ross 1926-20042004 Kübler-Ross s Stages of Dying Denial No, not me, this cannot be true During this stage Obvious symptoms Ignored or discounted Kübler-Ross s Stages of Dying Denial Anger Why me? 5
Kübler-Ross s Stages of Dying Denial Anger Bargaining Try to bargain with higher power For longer life Bargaining is acceptance That time is limited That life is finite Kübler-Ross s Stages of Dying Denial Anger Bargaining Depression Kübler-Ross s Stages of Dying Denial Anger Bargaining Depression Acceptance Individual has come to terms with the end of life Documentary on Kübler-Ross To Live Until You Die Dr. Elisabeth Kubler-Ross http://www.youtube.com/watch? v=jtxoiq3v7bw Alternative views According to Schneidman (1982) Death imposes two kinds of burdens Dying individual must prepare him/herself for death Dying individual must deal with interpersonal aspects of death affecting loved ones Edwin Schneidman talks about his own impending death Edwin Schneidman 1918-2009 http://www.latimes.com/news/lo cal/ed_shneidmanff_ss,0,341499 3.htmlstory 6
Alternative views Corr (1991-1992) take a more lifespan approach Propose 4 challenges faced by dying One must Satisfy Bodily needs Psychological security Interpersonal attachment Spiritual energy and hope Hospices can be good alternative for the dying Hospices emphasize Pain management Death with dignity In hospice Concern is with making individual as peaceful and comfortable as possible Not concerned with delaying inevitable death Hospice = Death with dignity Death and Bereavement Thinking about death: Personal Aspects Surviving the loss: The grieving g process According to Pincus (1974) When hear of death important person 1 st reaction = Shock Particularly when death unexpected Initially, shock is extreme Last only a few days 7
According to Pincus (1974) When hear of death important person 1 st reaction = Shock Then enter a controlled phase The individual must get things done Relatives and friends may help out According to Pincus (1974) When hear of death important person 1 st reaction = Shock Controlled phase is next Next phase, Searching for the lost loved one According to Pincus (1974) When hear of death important person 1 st reaction = Shock Controlled phase is next Search for the lost loved one is next phase Finally, adaptation is reached When (hopefully) real grieving occurs Important that grief be experienced in his/her own way According to Pincus (1974) Those who have the most difficulty dealing with the death of a loved one are those who fear their own death the most Bowlby (1974) proposes stages of grieving 1st stage Bereaved yearns for deceasedd Bowlby (1974) proposes stages of grieving 1st stage 2 nd stage Characterized by apathy and disorganized behaviour 8
Bowlby (1974) proposes stages of grieving 1st stage 2 nd stage Final stage Bereaved reorganizes life Readjustment and recovery According to Worden (1991) Grief is an active process Grieving individual must Acknowledge the reality of the loss Work through the emotional turmoil Adjust to the environment without the deceased Loosen ties to the deceased Important considerations of the grief process Grieving is a highly individual process Grieving takes time 1 year quite common May take 2+ years Full recovery may never be reached Death and Bereavement Thinking about death: Personal Aspects Surviving the loss: The grieving process Childhood experiences of grief Preschoolers Tend to see death as temporary and magical Believe death is something dramatic Coming in middle of night Between ages 5 and 7, the child will learn to appreciate 3 aspects of death When child experiences death of loved one Unwise to use euphemisms of death E.g., mommy is only sleeping 9
When explaining death to children Deal with them on their terms Keep explanations simple Reassure them That their grief is natural Grieving Adolescents Grieving Adolescents Hogan & DeSantis (1996) report Younger adolescents who have lost a sibling Reluctant to share grief with peers Leaves them vulnerable to psychosomatic symptoms E.g., headaches and stomach pains Grieving Adolescents Hogan & DeSantis (1996) report Younger adolescents who have lost a sibling As adolescent matures More willing to talk But peers not very willing to listen Grieving Adolescents Hogan & DeSantis (1996) report Younger adolescents who have lost a sibling As adolescent matures Thus, no clear end-point to grief Grieving in Adulthood 10
Grieving in adulthood Young adults Tend to believe that people dying at this time of life are cheated out of their future. According to attachment theory Grief natural part of attachment Feel grief when lose attachment figure Grieving in adulthood Shift from Formal to Postformal thinking very important No longer consider themselves immortal If lose spouse Must deal with own grief And grief of children When widowed in young adulthood Derman (2000) found Grief may last as long as 5 to 10 years Widows maintain strong attachment to deceased husbands Grieving in Late adulthood Grieving in Late adulthood Older adults Less anxious about death More accepting of death Why? Have most experience with death Have more chronic diseases May feel that their most important life tasks are behind them Grieving in late adulthood When lose partner Can be a very serious loss Society tends to specify mourning period Must wait specified period before trying to find new partner If don t wait long enough, the widow/widower will get negative comments 11
Grieving in late adulthood When lose partner Grief can last a long time Thompson et al. (1991) found it to last as long as 30 months Grieving in late adulthood When lose partner Grief can last a long time Thompson et al. (1991) found it to last as long as 30 months Social support very important in the outcome of grief process over first 2 years Quality of support more important than number of friends Grieving in late adulthood When lose partner Futterman et al. (1990) Studied how bereaved rated their marriage when compared to those who were not bereaved Futterman et al. (1990) Bereaved rated marriage higher Rated themselves happier in their marriage Particularly when depressed Futterman et al. (1990) Why did people rate their marriage as happier when depressed? Depression following bereavement signifies positive aspects of relationship Depression for other reasons indicates troubled relationships Next Review for Final Exam Tuesday April 8, 12:30 2 PM Room H104 Repeated again on Thursday April 10, 12:30 2 PM 12
Next (Cont.) Final Exam Weds., April 23, 6 PM. Canadore Gym Structure Multiple Choice Questions from Chapters 10-17 Short answer questions from All material covered in class 13