Paper Requirement

JKJKJJK

Psych41Ch20OnlineWi16.pdf

Home >Psychology homework help >Paper Requirement

CHAPTER 20: DEATH, DYING AND GRIEVING

As we get started on this chapter, please consider the following:

 Has anyone you have known died? How many people?

 Who was the person in relation to you (e.g., brother, aunt, or friend)?

 How and where did the person die?

 Were you present at the time of death? What was your reaction?

 If you were not present at the time of death, how did you react when you learned of the death?

 Did you view the body of the dead person at some time after death (e.g., at a funeral home)? If so, what was your reaction to seeing the body?

 How involved were you in taking care of practical matters concerning the deceased?

 How involved were you in mourning the deceased?

 How involved were you in caring for other people who were mourning the deceased?  For how long did the individual’s death have a daily impact on you (e.g., thinking about the

person every day)?

 Have you worked through any concerns the person’s death created for you? Learning Goals

Learning Goal 1: Describe the death system and its cultural and historical contexts.

A. Discuss the death system and its cultural variations.

B. Describe changes in death through the historical context.

Learning Goal 2: Evaluate issues in determining death and decisions regarding death.

A. Discuss issues in determining death.

B. Describe decisions regarding life, death, and health care

Learning Goal 3: Discuss death and attitudes about it at different points in development.

A. Describe and discuss the causes of death.

B. Discuss the attitudes toward death at different points in the life span.

Learning Goal 4: Explain the psychological aspects involved in facing one’s own death and

the contexts in which people die.

A. Explain Kübler-Ross’ stages of dying.

B. Describe and discuss individuals’ perceived control and denial in relation to attitudes

toward death.

C. Describe the contexts in which people die.

Learning Goal 5: Identify ways to cope with the death of another person.

A. Describe and discuss effective strategies for communicating with a dying person.

B. Explain the process of grieving.

C. Discuss how individuals try to make sense of the world while grieving.

D. Review the experience of losing a life partner.

E. Describe and discuss the different forms of mourning.

The Death System

 In most societies, death is not viewed as the end of existence because the spiritual body is believed to live on

 People in the U.S. tend to be death avoiders and death deniers  Changing Historical Circumstances:

 The age group in which death most often strikes  Life expectancy has increased  Location of death

Issues in Determining Death

 Brain Death: a person is brain dead when all electrical activity of the brain has ceased for a specified period of time

 Includes both the higher cortical functions and the lower brain-stem functions  Technology has made it harder to determine whether someone is dead now than it

was 100 years ago. Cortical Death: When a person has no higher brain functioning (associated with

intelligence and personality), even though the lower brain stem is functioning.

What viewpoint do you agree with more? Personally, I side more with the cortical death

definition. Personally, I would not want to be kept alive indefinitely if I had no chance for

recovery and no chance for semi-normal thought and functioning.

The Case of Terry Schaivo

The Terry Schiavo case ignited the debate on euthanasia.

http://www.nbcnews.com/id/8225637/ns/us_news/t/schiavo-autopsyshows-irreversiblebrain-

damage/#.U3eYs_ldUuc

Life, Death, and Health Care

 Living Will is designed to be filled in while the individual can still think clearly  Designed for situations in which the individual is in a coma and cannot express his or

her desires about whether extraordinary means should be used to keep them alive.

http://www.nbcnews.com/id/8225637/ns/us_news/t/schiavo-autopsyshows-irreversiblebrain-damage/#.U3eYs_ldUuc

When my grandma was dying, the family tried to have her sign a living will making my uncle the Healthcare Agent for her so that he could make medical decisions for her. However, she was not cognizant enough to legally sign the document.

 Many states have natural death legislation  People engaged in end-of-life planning are more likely to:

 Have been hospitalized in the year prior  Believe that patients rather than physicians should make health-care decisions  Have less death anxiety  Have survived the painful death of a loved one

When my dad died, he didn’t have a will and so everything defaulted to my stepmom. She

didn’t have a will either and was worried that should she die, her next-of-kin might

mismanage the inheritance. Instead, she wanted the inheritance to go to me and a couple

of her other relatives. So, she didn’t leave the house for a week until she could get an

appointment with her lawyer to get her will drawn up (in case she got “hit by a bus”). She

then made a binder with the will, all account numbers, etc.. so that when she dies, I will

have an easier time taking care of the business end of things than we did when my dad

died.

 Euthanasia: the act of painlessly ending the lives of individuals who are suffering from an incurable disease or severe disability

 Passive euthanasia: treatment is withheld  Active euthanasia: death deliberately induced (this is like what we do to our pets who

are ill)

 Trend is toward acceptance of passive euthanasia in the case of terminally ill patients  Experts do not agree on the boundaries or mechanisms by which treatment decisions

should be implemented

 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 Oregon, Washington, and Vermont). California also passed death-with-dignity legislation in 2015. Please see this website for more information: https://www.deathwithdignity.org/learn/death-with-dignity- acts/

https://www.deathwithdignity.org/learn/death-with-dignity-acts/

 Patients who have a desire for euthanasia are often:  Less religious  Have been diagnosed with depression  Have a lower functional living status

What are your viewpoints on euthanasia? Personally, I think I would be pro-euthanasia for

myself if I was terminally ill, imminently going to die, and in a lot of pain.

Please read about the case of Brittany Maynard, death-with-dignity advocate who died in

November 2014: http://www.cnn.com/2014/11/02/health/oregon-brittany-maynard/

 Death in America is often lonely, prolonged, and painful  End of life care should include respect for the goals, preferences, and choices of the patient

and his or her family

 A “good death” involves physical comfort, support from loved ones, acceptance, and appropriate medical care

 Hospice: a program committed to making the end of life as free from pain, anxiety, and depression as possible

 Palliative care: reducing pain and suffering, helping individuals 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

 Family members report better psychological adjustment to the death of a loved one when hospice care is used

Here are some of the services offered by hospice:

 Hospice Nurse (coordinates care, is the principal support for patients and their families)

 Hospice Aide (provides personal care and light housekeeping duties in the home)

 Counselor (provides support for families, seeks out community resources, and helps with financial, legal, and insurance issues)

 Therapists (physical, occupational, and speech therapists)

 Nutritionist (counsels family members on the special nutritional needs of the patient)  Medical Director (is the direct symptom manager for the patient, educates patient and

staff regarding the illness)

 Chaplain (attends to the spiritual needs of the patients and their families)

 Volunteer (is the friend and companion for patients, helps with home care, office help, fundraising, etc.)

I’ve known a few people who had loved ones die in hospice and they reported relatively good adjustment as opposed to those who didn’t have hospice.

http://www.cnn.com/2014/11/02/health/oregon-brittany-maynard/

Causes of Death

 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 and young adult deaths result from suicide, homicide, or motor

vehicle accidents

 Middle-age and older adult deaths usually result from chronic diseases

Attitudes Toward Death

 Attitudes toward death vary at different points in the life span:  Separation anxiety in infants may be an indicator of a child’s awareness of separation

and loss

 Young children use illogical reasoning to explain death, believing magic or treatment can return life. When I was 5, my uncle died. I remember telling another young family member to come up to pray over his body because then he would come back to life. I was confused when it didn’t work. By the time I was 12 when my grandpa died of cancer, I had a much more realistic perception of what happens when someone dies.

 Those in middle and late childhood have more realistic perceptions of death  Occurs at about age 9

 Death of a parent is especially difficult for children  Most psychologists believe that honesty is the best strategy in discussing death with

children

 Level of detail depends on the child’s maturity level  Terminally ill children may distance themselves from their parents as death approaches  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  Often think that they are somehow immune to death

 Concerns about death increase as one ages:  Awareness usually intensifies in middle age  Middle-aged adults often fear death more than young adults or older adults

 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

Facing One’s Own Death

 Knowledge of death’s approach permits us to reflect on our life, make decisions about dying, establish priorities, and structure our time

 Most dying individuals what an opportunity to make some decisions regarding their own life and death

 Three areas of concern:  Privacy and autonomy in regard to their families  Inadequate information about physical changes and medication as death approached  Motivation to shorten their life

KÜBLER-ROSS’S STAGES OF DYING

 Denial and Isolation: “It can’t be!”  Anger: “Why me?”  Bargaining: “Just let me do this first!”, “I’ll do anything to stay alive!”  Depression: withdrawal, crying,

and grieving

 Acceptance: a sense of peace comes  Problems:

 Existence of 5-stage sequence has not been demonstrated  Stage interpretation neglects patients’ unique situations

 Some psychologists prefer to describe them not as stages but as potential reactions to dying. These are not neat, orderly stages.

 Some individuals never reach acceptance and struggle until the end

What would you want to have included in your obituary?

Perceived Control and Denial

 Perceived control may be an adaptive strategy for remaining alert and cheerful  Denial insulates and allows one to avoid coping with intense feelings of anger and hurt

 Can be maladaptive depending on extent

Contexts in Which People Die

 More than 50% of Americans die in hospitals  Nearly 20% die in nursing homes  Hospitals offer many important advantages:

 Professional staff members  Technology may prolong life

 Most individuals say they would rather die at home

Where would you like to die? At this point in my life, I would say that I would prefer to die in a

hospital so that there is someone there to make me comfortable and give me treatments so

that I am not in pain.

Communicating with a Dying Person

 Open communication with a dying person is very important because:  They can close their lives in accord with their own ideas about proper dying  They may be able to complete plans and projects, and make arrangements and

decisions

 They have the opportunity to reminisce and converse with others  They have more understanding of what is happening to them

When my dad died of lung cancer, it was difficult because he was diagnosed as Stage IV, the most

advanced stage. He was very ill, and died only a month after being diagnosed. While I don’t think

he had the chance to do all he wanted to do to wrap up loose ends, I was grateful that he knew he

was very ill so that he could take care of some business and also it gave me the opportunity to

come up to Fresno when I wasn’t at work to help care for him and spend time with him.

Reflect

 Have you experienced this loss of a loved one? What were your thoughts when you found out?

 What was your emotional reaction? How did others around you act?

 Did experiencing this loss impact how you view your own death?

Grieving

 Grief: emotional numbness, disbelief, separation anxiety, despair, sadness, and loneliness that accompany the loss of someone we love

 Grief is a complex, evolving process with multiple dimensions. It’s been 8 years since my grandma died and almost 5 since my dad died and I the grief is still difficult at times. It hits me at unexpected moments, like when watching a commercial that reminds me of my dad, or eating a food that my grandma used to make.

 More like a roller-coaster ride than an orderly progression of stages  Cognitive factors are involved in the severity of grief  Good family communications and grief counselors can help grievers cope with feelings of

separation and loss

 Prolonged Grief: approximately 10%–20% of survivors have difficulty moving on with their life after 6 months have passed

 Disenfranchised Grief: an individual’s grief involving a deceased person that is a socially ambiguous loss that can’t be openly mourned or supported

 Examples: ex-spouse, abortion, stigmatized death (such as AIDS)

 Impact of death on surviving individuals is strongly influenced by the circumstances under which the death occurs

 Traumatic, violent, or sudden deaths are likely to have more intense and prolonged effects

 Can be accompanied by PTSD-like symptoms. My mom had a friend whose brother died in a car accident on the freeway. When he would pass that stretch of freeway, her friend would often have panic attacks.

 Cultural Diversity:  Some cultures emphasize the importance of breaking bonds with the deceased and

returning quickly to autonomous lifestyles

 Beliefs about continuing bonds with the deceased vary extensively  There is no one right, ideal way to grieve

Making Sense of the World

 Grieving often stimulates individuals to try to make sense of their world  A reliving of the events leading to the death is common

 When a death is caused by an accident or a disaster, the effort to make sense of it is often pursued more vigorously

Losing a Life Partner

 Widows outnumber widowers 5 to 1  Women live longer than men  A widowed man is more likely to remarry  Widows usually marry older men

 Widowed women are probably the poorest group in America  Women tend to do better than men because women typically have better networks of

friends and relatives

 Older women do better than younger women  Widow-to-Widow program provides support for newly widowed women  Religiosity and coping skills are related to well-being following the loss of a spouse in late

adulthood

Papalia, Camp, and Feldman’s Adult Development and Aging (1996) found the following

potential grief reactions:

Shock and disbelief: The time frame for this phase varies. It may last several weeks, especially if

the death was unexpected and sudden. Initially, the survivor is lost and confused. The shock

and disbelief may buffer him or her against other intense reactions. Physical symptoms often

accompany this phase (shortness of breath, tightening of the chest and throat, and a feeling of

emptiness in the abdomen). The initial numbness gradually shifts to overwhelming feelings of

sadness.

Preoccupation with the memory of the dead person: The time frame for this phase is

approximately six months or longer. Physical symptoms continue with frequent crying,

insomnia, loss of appetite, and fatigue. Much research has examined how widows cope with

the loss of a spouse. She may relive her husband’s death or their entire relationship. While a

widow used to be considered emotionally disturbed if she talked to her dead husband, it is now

considered common and potentially helpful to the widow (Lund, 1993). The widow may feel his

presence, hear his voice, or see his face. These vivid perceptions tend to diminish over time,

though they may persist for years.

Resolution: This phase involves renewed interest in everyday activities. The realization that life

must go on sparks an increase in social activity. Memories of the dead person persist, though

the reaction to these memories change. Rather than the sharp pain and longing, the memories

provoke fond, positive feelings mingled with sadness.

Forms of Mourning

 Approximately 80% are buried; 20% are cremated  Funerals are an important aspect of mourning in many cultures. My dad didn’t want a

funeral or memorial. A few family and friends just went out for ribs and beer and talked about our favorite memories of him.

 Cultures vary in how they practice mourning. Here are some interesting ones from the Filipino culture (below), one of which in particular I encountered at my grandma’s funeral. An aunt encouraged us to break the string of my grandma’s rosary that she was being buried with as we needed to “break the cycle of death”. My mother did not comply. See: http://lifestyle.inquirer.net/20003/the-black-butterfly-effect

Videos

 What is Death? (25:46) http://www.learner.org/vod/vod_window.html?pid=1270  Facing Mortality (25:36): http://www.learner.org/vod/vod_window.html?pid=1272  Grief and Bereavement (25:36):

http://www.learner.org/vod/vod_window.html?pid=1277

Here are some good links related to this chapter:

American Hospice Foundation

http://www.americanhospice.org/

Assisted Suicide Laws

http://lifestyle.inquirer.net/20003/the-black-butterfly-effect

http://www.learner.org/vod/vod_window.html?pid=1270

http://www.learner.org/vod/vod_window.html?pid=1272

http://www.learner.org/vod/vod_window.html?pid=1277

http://www.americanhospice.org/

http://www.internationaltaskforce.org/assisted_suicide_laws.htm

Association for Death Education and Counseling