Chapter 15: Dying and Bereavement

“I am not afraid of death – I just don’t want to be there when it happens!”

Woody Allen

The Many Faces of Death Death as an image

Tombstone Hearse

Death as a statistic Mortality rates Life expectancy tables

Death as an event Funeral Memorial Service

Faces of Death (cont.) Death as a state of being

Nonthingness Being with God

Death as an analogy Dead meat Dead as a doornail

Death as a mystery What is it like to die? What happens after death?

Faces of Death, contd. Death as a boundary

You’ll never get out of this world alive How many years do I have left?

Death as a thief of meaning I have much left to do I feel so cheated

Death as fear/anxiety I’m afraid to die I worry about my family

Death as a reward or punishment The wicked go to Hell Heaven awaits the just

Brain Death No spontaneous movement No spontaneous respiration/1 hour Total lack of responsiveness No eye movement (blinking/pupil) No postural activity – swallowing, yawning,

vocalizing No motor reflexes Flat EEG - 10 minutes No change in any of these if tested again in 24

hours

Issues about Death Persistent Vegetative State

Cortical functions cease Brain stem activities continue

Euthanasia Active Passive Dr. Kevorkian

Ideas about Death Childhood

Death of a pet Lack of abstractive abilities

Adolescence Sensitive – still no real restriction until personal

experience Young Adulthood

Cheated of future Middle Age

Most people confront death at this time Late Adulthood

Imminent

Death Anxiety Elisabeth Kübler-Ross Stage Theory

Denial Anger Bargaining Depression Acceptance

Alternate Theory Phase Theory (Pattison)

Acute – become aware that condition is terminal High anxiety, denial, anger, and bargaining

Chronic Living Dying Phases Adjusts to idea of terminal illness Anxiety declines

Terminal phase - withdrawal

Task Based Approach 1. Satisfy physical needs – minimize

physical stress 2. Maximize psychological security – live

life to fullest 3. Sustain/enhance interpersonal

Commitments 4. Develop/reaffirm spiritual energy;

fosters hope.

Hospice- dying with dignity -

Grief Process Acknowledge reality of loss Work through emotional turmoil Adjust to environment where deceased is

absent Loosen ties to deceased.

Death expectations Expected vs. unexpected death Grief over time Abnormal grief reactions Death of loved ones

Death of parent Death of child Death of partner