copyright © allyn & bacon 2007 development through the lifespan chapter 18 death, dying, and...
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Copyright © Allyn & Bacon 2007
Development Through the LifespanDevelopment Through the Lifespan
Chapter 18
Death, Dying, and Bereavement
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Chapter 18
Death, Dying, and Bereavement
This multimedia product and its contents are protected under copyright law. The following are prohibited by law:
Any public performance or display, including transmission of any image over a network;
Preparation of any derivative work, including the extraction, in whole or in part, of any images;
Any rental, lease, or lending of the program.
Copyright © Allyn & Bacon 2007
Phases of DyingPhases of Dying
Agonal phase Suffering in first moments body can no
longer support life
Clinical death Heart, breathing, brain stopped,
but still can resuscitate
Mortality Permanent death
Agonal phase Suffering in first moments body can no
longer support life
Clinical death Heart, breathing, brain stopped,
but still can resuscitate
Mortality Permanent death
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Defining DeathDefining Death
Brain death All activity in brain and brain stem stopped Irreversible
Persistent vegetative state Activity in cerebral cortex stopped Brain stem still active
Brain death All activity in brain and brain stem stopped Irreversible
Persistent vegetative state Activity in cerebral cortex stopped Brain stem still active
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Death with DignityDeath with Dignity
Communication with and care of dying person: Assurance of support Humane, compassionate care Esteem and respect Candid about certainty of death Information to make end-of-life choices
Communication with and care of dying person: Assurance of support Humane, compassionate care Esteem and respect Candid about certainty of death Information to make end-of-life choices
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Concept of DeathConcept of Death
Permanence Inevitability Cessation Applicability Causation
Permanence Inevitability Cessation Applicability Causation
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Children’s Understanding of DeathChildren’s Understanding of Death
Most develop adultlike concept of death by middle childhood
Factors that affect understanding Experience with death Religious teachings Candid, sensitive
discussion with adults
Most develop adultlike concept of death by middle childhood
Factors that affect understanding Experience with death Religious teachings Candid, sensitive
discussion with adults
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Adolescents’ Understanding of DeathAdolescents’ Understanding of Death
Logically understand death, but problems applying idea to their real lives High-risk activities
Conversations with parents promote understanding
Logically understand death, but problems applying idea to their real lives High-risk activities
Conversations with parents promote understanding
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Discussing Death with Children and AdolescentsDiscussing Death with Children and Adolescents
Take the lead Listen perceptively Acknowledge feelings Provide facts
Be culturally sensitive
Joint problem solving
Take the lead Listen perceptively Acknowledge feelings Provide facts
Be culturally sensitive
Joint problem solving
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Adulthood andUnderstanding of DeathAdulthood andUnderstanding of Death
Early Adulthood
Avoidance• Death anxiety• Death considered distant
Middle Adulthood
• Begin to think of death• Aware of limited time left to live
• Focus on tasks to be completed
Late Adulthood
• Think and talk more of death• Practical concern about how and when
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Death AnxietyDeath Anxiety
Cultural Variations
Religious teachings Westerners -
spirituality, meaning of life
Cultural Variations
Religious teachings Westerners -
spirituality, meaning of life
Individual Variations
Personal philosophy of death
Consistency of religious beliefs and practice
Symbolic immortality Age Gender
Individual Variations
Personal philosophy of death
Consistency of religious beliefs and practice
Symbolic immortality Age Gender
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Kübler-Ross’s TheoryKübler-Ross’s Theory
Denial Anger Bargaining Depression Acceptance
Denial Anger Bargaining Depression Acceptance
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Appropriate DeathAppropriate Death
Makes sense with person’s pattern of living, values
Preserves or restores significant relationships
Free of suffering As much as possible
Makes sense with person’s pattern of living, values
Preserves or restores significant relationships
Free of suffering As much as possible
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Communicating withDying PeopleCommunicating withDying People
Be truthful Diagnosis Course of disease
Listen perceptively Acknowledge feelings Maintain realistic hope Assist final transition
Be truthful Diagnosis Course of disease
Listen perceptively Acknowledge feelings Maintain realistic hope Assist final transition
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Factors That Influence Thoughts About DyingFactors That Influence Thoughts About Dying Cause of death
Nature of disease
Personality Coping style Family members’ behavior Health professionals’ behavior Spirituality and religion Culture
Cause of death Nature of disease
Personality Coping style Family members’ behavior Health professionals’ behavior Spirituality and religion Culture
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Places of DeathPlaces of Death
Home Most preferred Only 20–25% die at home
Hospital Emergency room Intensive care unit Cancer care unit
Hospice
Home Most preferred Only 20–25% die at home
Hospital Emergency room Intensive care unit Cancer care unit
Hospice
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Hospice ApproachHospice Approach
Comprehensive support for dying and their families Family and patient as a unit Team care Palliative (comfort) care Home or homelike Bereavement help
Comprehensive support for dying and their families Family and patient as a unit Team care Palliative (comfort) care Home or homelike Bereavement help
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Forms of EuthanasiaForms of Euthanasia
Voluntary Passive
• Withdraw treatment• Advance medical directives
Voluntary Active
Medical staff or others act to end life at patient’s request
Assisted Suicide
• Medical staff provide means for patient to end own life• Controversial
Involuntary Active
Medical staff end life without patient’s consent
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Advance Medical DirectivesAdvance Medical Directives
Living Will Specify unwanted treatments
Durable Power of Attorney for health care Appoint someone to make health
care decisions
Living Will Specify unwanted treatments
Durable Power of Attorney for health care Appoint someone to make health
care decisions
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International Public Opinion onVoluntary Active EuthanasiaInternational Public Opinion onVoluntary Active Euthanasia
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Assisted SuicideAssisted Suicide
Doctor provides drugs for patient to use Legal in few nations, only in Oregon in U.S. Few use
.1% in Oregon Highly controversial
About half disapprove Some find option comforting
Doctor provides drugs for patient to use Legal in few nations, only in Oregon in U.S. Few use
.1% in Oregon Highly controversial
About half disapprove Some find option comforting
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Grief ProcessGrief Process
Avoidance “Emotional anesthesia”
Confrontation Most intense grief
Restoration Dual-process model of coping with loss
Alternate between dealing with emotions and with life changes
Avoidance “Emotional anesthesia”
Confrontation Most intense grief
Restoration Dual-process model of coping with loss
Alternate between dealing with emotions and with life changes
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Grieving Sudden or Prolonged DeathsGrieving Sudden or Prolonged Deaths
Sudden, Unexpected
Avoidance from shock and disbelief
May not understand reasons
Suicide especially hard
Sudden, Unexpected
Avoidance from shock and disbelief
May not understand reasons
Suicide especially hard
Prolonged, Expected
Anticipatory grieving Allows emotional
preparation Reasons usually
known
Prolonged, Expected
Anticipatory grieving Allows emotional
preparation Reasons usually
known
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Difficult Grief SituationsDifficult Grief Situations
Parents losing a child Children or adolescents
losing a parent Adults losing an
intimate partner Bereavement overload
Parents losing a child Children or adolescents
losing a parent Adults losing an
intimate partner Bereavement overload
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Bereavement InterventionsBereavement Interventions
General Support
Sympathy, understanding Patient listening, “being there”
Interventions Self-help groups Daily living help
Children & Adolescents
After violent death, prevent unnecessary reexposure Help adults master own distress
Difficult situations
Sudden, violent, unexplained, ambiguous deaths Grief therapy, individual counseling
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Resolving GriefResolving Grief
Give yourself permission to feel the loss
Accept social support
Be realistic about course of grieving
Remember the deceased
When ready: Engage in new activities, relationships Master tasks of daily living
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Death EducationDeath Education
Courses in death and dying Offered at many educational levels
Lecture format Increases discomfort
Experiential format Role playing, discussions,
guests, field trips May reduce death anxiety
Courses in death and dying Offered at many educational levels
Lecture format Increases discomfort
Experiential format Role playing, discussions,
guests, field trips May reduce death anxiety
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Goals of Death EducationGoals of Death Education
Understand physical, psychological changes in dying
Learn to cope with death of loved ones Inform consumers of medical, funeral
services Understand social, ethical issues
Understand physical, psychological changes in dying
Learn to cope with death of loved ones Inform consumers of medical, funeral
services Understand social, ethical issues