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Cultures: Epochs, and Death: Consistent theme in known ancient societies

1. Life actions affect destiny after death 2. Afterlife was assumed 3. Particular prayers and offerings engaged to prevent haunting from spirit of death

Deciding when death occurs: brain death

1. Prolonged cessation of all brain activity with complete absence of voluntary movements; no spontaneous breathing; no response to pain, noise, and other stimuli 2. Cessation of brain waves; EEG is flat

Stages of Dying: Kubler-Ross's emotions and stages experienced by dying people

1. Denial: "I am not really dying" 2. Anger: "I blame my doctors, or my family, or God for my death" 3. Bargaining: "I will be good from now on if I can live" 4. Depression: "I don't care about anything; nothing matters anymore" 5. Acceptance: "I accept my death as part of life"

Cultures: Epochs, and Death: Contemporary religions

1. Each faith displays diversity in death practices 2. Examples: Hinduism, Islam, Buddhism, Native Americans, North American Christians, Latin Americans (Dia de los Muertos)

Better way to die: two principles for hospice care

1. Each patient's autonomy and decisions are respected 2. Family members and friends are counseled before the death, shown how to provide care, and helped after the death

Barriers to entering hospice care

1. Hospice patients must be terminally ill 2. Patients and caregivers must accept death 3. Hospice care is costly 4. Availability varies 5. Ethnic differences influence usage

Deciding when death occurs: locked-in syndrome

1. Inability to move, except for the eyes, but brain waves still apparent 2. Person is not dead

Bad death

1. Lack these six characteristics and is dreaded, particularly by the elderly

Choices in dying: longer life

1. Later death due to drugs, surgery, and other interventions (respirator, defibrillators, stomach tubes, antibiotics) 2. 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

Good death: honest conversations

1. Most dying people want to spend time with loved ones and talk honestly with medical and religious professionals 2. Is unethical to withhold information if the patient asks for it, although some people do not want the whole truth 3. Hospital personnel need to respond to each dying person as an individual, not merely as someone who must understand that death is near

Cultures, Epochs, and Death: Ancient times

1. Neanderthals 2. Egyptians 3. Greeks

Seeking Meaning

1. Often starts with preserving memories (displaying photographs, telling anecdotes) 2. Support groups offer help when friends are unlikely to understand (groups for parents of murdered children) 3. 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 4. Close family members may start a charity

Reactions to death are varied

1. Other people need to be especially responsive to whatever needs a grieving person may have 2. Grief is less likely to destroy survivors when markers or rituals are observed

Bad death: when modern medicine makes a bad death

1. People may submit to surgery and drugs that prolong pain and confusion, especially when cure is not possible 2. Hospital restrictions may make dying in peace more difficult

Maslow's Hierarchy of Needs

1. Physiological needs (freedom from pain) 2. Safety (no abandonment) 3. Love and acceptance (from close family and friends) 4. Respect (from caregivers) 5. Self-actualization (spiritual transcendence)

Normal grief

1. Powerful sorrow that an individual feels at a profound loss, especially when a loved one dies 2. Criteria changed with DSM-5 3. Empty boots: military custom to hold an informal memorial service, placing the dead soldier's boots, helmet, and rifle in the middle of a circle of mourners, who weep, pray, and reminisce

Better ways to die: hospice caregivers

1. Provide skilled treatment to relieve pain and discomfort 2. Measures to delay death are avoided 3. Focus is to make dying easier

Resilience after a death: four types of responses

1. Resilient (66%) 2. Depressed (15%) 3. Less depressed after death than before (10%) 4. Slow to recover/complicated grief (9%)

Incomplete grief

1. Situation in which circumstances, such as a police investigation or an autopsy, interfere with the process of grieving 2. Grief process may be incomplete if mourning is cut short or if other people are distracted from their role in recovery

Allowing death: active euthanasia/physician-assisted suicide

1. Situation in which someone takes action to bring about another person's death, with the intention of ending that person's suffering 2. Doctor provides the means for someone to end his or her own life 3. Legal under some circumstances in the Netherlands, Belgium, Luxembourg, and Switzerland, but it is illegal in most other nations

Deciding when death occurs: coma

1. State of deep unconsciousness from which the person cannot be aroused 2. Some people awaken spontaneously from a coma; others enter a vegetative state after six months of coma state; the person is not dead

Deciding when death occurs: vegetative state

1. State of deep unconsciousness in which all cognitive functions are absent, although eyes may open, sounds may be emitted, and breathing may continue; the person is not yet dead 2. Can be transient, persistent, or permanent 3. No one has ever recovered after two years; most who recover improve within three weeks 4. After time has elapsed, the person may, effectively, be dead

Mourning

1. Ceremonies and behaviors that a religion or culture prescribes for people to employ in expressing their bereavement after a death 2. Mourning customs designed to move grief from loss toward reaffirmation

Reactions to death are filtered

1. Cultural prisms 2. Historical changes 3. Regional variations 4. Age of dying and bereaved

Resilience after a death: General trends

1. Past marriages idealized 2. Thoughts of dead spouse gradually decrease

What is the leading cause of death of 15- to 24-year-olds in the United States in the twenty-first century?

Accidents

Double effect

An ethical situation in which an action (administering opiates) has both a positive effect, which is intended (relieving a terminally ill person's pain), and a negative effect, which is foreseen but not intended (hastening death by suppressing respiration)

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/her family

_____ is the medical order that would precede _____.

DNR; passive euthanasia

Better ways to die: hospice

Involves institution or program in which terminally ill patients receive palliative care

Absent grief

Situation in which overly private people cut themselves off from the community and customs that allow and expect grief; can lead to social isolation

Allowing death: DNR (Do Not Resuscitate)

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 if he/she suffers cardiac or respiratory arrest

First state to legalize physician-assisted death with dignity is Oregon (1994, modified in 1997)

- Requirements: Record keeping and annual reporting - Dying person must: 1. Be Oregon resident over age 17 2. Request lethal drugs twice orally and once in writing 3. Allow fifteen days elapse between first request and prescription 4. Obtain confirmation from two physicians of terminal illness, less than six months to live, and competence

Good Death

1. 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 2. People in all religious and cultural contexts hope for a good death 3. Having control over circumstances and acceptance of the outcome (cultures and individuals differ)

Near-Death Experience

1. 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 2. Often includes religious elements 3. Survivors may adopt a more spiritual, less materialistic view of life 4. To some, near-death experiences prove that there is a heaven, but scientists are more skeptical 5. In every culture, all varieties of the dying experience move people toward the same realizations: limitations of social status, insignificance of material possessions, and narrowness of self-centeredness

Understanding Death Throughout the Life Span: Childhood

1. Children have a different perspective death. 2. Older children use more concrete operational cognition; they seek specific facts and become less anxious about death and dying. 3. More impulsive and may seem happy one day and morbidly sad the next 4. Do not "get over" the death of a parent not do they dwell on it 5. May take certain explanations literally (Grandma went on a trip) 6. Fatally ill children typically fear abandonment - frequent and caring contact is more important than logic

Placing Blame

1. Common impulse after death for the survivors (for medical measures not taken, laws not enforced, unhealthy habits not changed) 2. Bereaved sometimes blame the dead person, sometimes themselves, and sometimes distant others 3. Nations may blame each other for public tragedies 4. Blame is not necessarily rational

Changes in death in the past century

1. Death occurs later 2. Dying takes longer 3. Death often occurs in hospitals 4. The causes of death have changed (diseases) 5. And after death...

Good death: when modern medicine makes a good death

1. Death usually occurs at the end of a long life 2. Illness often treated effectively 3. Death at young age is often quick

Choices in dying: ethical issues

1. Deciding when death occurs 2. Death does not necessarily occur when vital organs stop 3. Death is no longer the natural outcome of age and disease; when and how death occurs involves human choices

Death in Adolescence and Emerging Adulthood

1. Teens have little fear of death 2. Adolescents often predict that they will die at an early age and their developmental tendency toward risk-taking can be deadly 3. Romanticizing death makes young people vulnerable to cluster suicides, foolish dares, fatal gang fights, and drunk driving

Death in Adulthood

1. With age and responsibility for work and family, death is avoided or at least postponed (quit taking addictive drugs, start wearing seat belts, and adopt other precautions) 2. Terminally ill adults worry about leaving something undone or leaving family members, especially children, alone 3. Older adults accept death (write wills, plan funeral) 4. 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

Most bereaved people recover within a year

A feeling of having an ongoing bond with the deceased is no longer thought to be pathological

The "Right to Die": Slippery slope

A given action will start a chain of events that will culminate in an undesirable outcome

Affirmation of Life (Grief and mourning are part of living): Mourning

Ceremonies and behaviors that a religion or culture prescribes for people to employ in expressing their bereavement after a death

Which statement does NOT describe one of the changes that has occurred surrounding death in the past 100 years?

Death is more spiritually accepted.

Advance directives

Document that contains an individual's instructions for end-of life medical care, written before such care is needed

Living will

Document that indicates what kinds of medical intervention an individual wants or does not want if he/she becomes incapable of expressing those wishes

Pain (Physical and Psychological): What is unbearable suffering?

Fatigue, pain, decline, negative feelings, loss of self, fear of future suffering, dependency, loss of autonomy, being worn out, being a burden, loneliness, loss of all that makes life worth living, hopelessness, pointlessness, and being tired of living a life of unbearable suffering

The "Right to Die": Slippery slope relating to death

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

Many who experienced the tragedy of the 9/11 terrorist attacks were not able to fully grieve the loss of loved ones because of the immediate security threat related to the attack. What kind of grief would those individuals have experienced?

Incomplete grief

Which of the following does research show is the MOST common reaction to the death of a spouse?

Most people are resilient and happy/productive after six months

Resilience after a death: personality has a major effect on grief and mourning

Only about 10-15% exhibit extreme or complicated grief

Health care proxy

Person chosen by another person to make medical decisions if the first person becomes unable to do so

Affirmation of Life (Grief and mourning are part of living): Bereavement

Sense of loss following a death

Allowing death: passive euthanasia

Situation in which a seriously ill person is allowed to die naturally through the cessation of medical intervention

Disenfranchised grief

Situation in which certain people, although they are bereaved, are prevented from mourning publicly by cultural customs or social restrictions

According to Kübler-Ross, the fifth and final stage of dying is:

acceptance

Compared to their ancestors and those in developing nations, people in developed nations are less likely to:

have watched someone die.

In all religions and cultures, death is regarded as a(n):

passage, not an endpoint

Typically, young children who have a fatal illness fear death mainly because it means that:

they may be abandoned