CHAPTER 15

NOTES AND TEST

Dying and Bereavement

Definitions and ethical issues

1.  Socioculturaldefintions

a.      Death is very difficult concept to define precisely.  The definition differs from culture to culture as well as the meaning

b.     Some of the meanings in Western culture include images, statistics, state of being, analogy, mystery, boundary, thief of meaning, basis for anxiety and reward or punishment

2.  Legal and medical definitions

a.      For many centuries, the clinical definition of death was based on the absence of heartbeat and respiration

b.     Currently, the most widely used definition of death is brain death and is based on a number of specific criteria such as brain activity and response to specific stimuli

3.  Ethical issues

a.      Today there are two types of euthanasia

b.     Active euthanasia – deliberately ending and individual’s life based on the patient’s wishes by taking some action, such as turning off a life support system

c.     Passive euthanasia – ending an individual’s life by withholding some type of intervention or treatment such as stopping nutrition

d.     It is important that individuals make their wishes known, either by power of attorney of a living will

Ideas about death across the life span

1.  Childhood

a.      Until around the age of 5 to 7, children do not fully understand the permanence, universality and lack of functioning in death

b.     Children’s first experiences with death are likely to be with pets

c.     With this support, children are capable of attending funerals and other rituals

2.  Adolescence

a.      Usually adolescents do not talk about death.  Some of the reasons are feelings of immortality and also a tendency to believe that death affects other people and not them

b.     The grieving process for adolescence does not have a clear endpoint, however it has not shown to interfere with the normal development process

3. Young adulthood

a.      young adults believe that individuals are cheated out of their future when they die at this point in life

c.     Attachment theory suggests that reactions to death are the normal consequence of forming attachments

d.     Cognitive developmental changes involving postformal thought may help integrate feelings and thoughts about death

4.Middle age

a.      Middle age individuals come to the realization that they are next in line to die, especially when they experience the loss of their parents

b.     Middle aged adults usually change their perception of time from the amount of time they have lived to the amount of time they have left

5.  Late adulthood

a.      Older adults are least concerned with dying, and sometimes they may even look forward to it for a variety of reasons

b.  This is due in part to achievement of integrity in Erikson’s theory

The process of dying

1.  Death anxiety

a.      The level of death anxiety varies across the age spectrum, with middle-age adults being the most anxious

2.  The stage theory of dying

a.      Kubler-Ross’s theory includes five stages: denial, anger, bargaining, depression and finally acceptance

b.     Individuals that are dying could be in more than one stages of dying at a time, and they do not necessarily go through all of them or go through them in order

3.  Alternative views

a.      Phase theory suggests that individuals do not pass through a sequence of stages.  Instead they experience a complex set of emotions.  Dying happens is three phases: an acute phase, a chronic living-dying phase and a terminal phase

b.     The task-based approach emphasizes coping with dying in four areas: satisfying needs and minimizing stress, maximizing security and autonomy, sustaining relationships, identifying and developing spiritual energy

c.     The goal of hospice is to maintain the quality of life and to manage the pain of terminal individuals.  Research has found that hospice patients are usually in better psychological status when compared to hospital patients

d.     Hospice care is requested only after no treatment or cure are possible and may involve inpatient or outpatient care

4.  Life span developmental perspective on dying

a.      Older adults take longer to die and are more likely to die alone

b.     Age differences in the dying experience and in the social definitions of loss help put the meaning of dying in perspective

The grieving process

1.  The grief process

a.      The frieg process is an active process.  Individuals that are grieving must: acknowledge the loss, work through the turmoil, adjust to the absence, loosen ties to the deceased

b.     Grieving is an individual process and the amount of time individuals need to grieve should not be underestimated.  The recovery period may take several years

c.     When the death of an individual is expected, people go through anticipatory grief.  The unexpected death of an individual is usually more difficult for people to handle

2.  Normal grief reactions

a.      Grief work – dealing with grief usually takes at least one to two years

b.     The grief experienced is equally intense in both expected and unexpected death, the difference is that when the individual has a terminal illness grieving may begin before the actual death

c.     Normal grief reactions include: sorrow, sadness, denial, disbelief, guilt, and anniversary reactions

d.     Middle-aged individuals have the most difficult time in terms of dealing with normal grief, which is attributed to dealing with their own mortality

3.  Abnormal grief reactions

a.      Excessive guilt and self-blame

b.     Reactions that impair normal functioning more than two years after the loss, although the decision must be made on an individual basis

Dealing with different types of loss

1.  Death of one’s parent

a.      The death of a parent serves to remind individuals of their own mortality and deprives them of a very important person in their lives

b.     The transition of being the oldest generation in one’s family is sometimes difficult

2.  Death of one’s child

a.      The death of a child is one of the most traumatic types of losses.   Other traumatic types of losses include: miscarriage, abortion, stillbirth and neonatal death

b.     The loss of a child is seen as violating the natural order of things as one assumes he/she will die before their child

3.  Death of one’s partner

a.      The loss of a partner is a great loss of a lover and companion.  Spouses that are grieving tend to have a positive bias about their marriage

b.     The loss of a spouse does not significantly impair an individual’s physical health but it does increase the psychological stress

4.  Comparison across types of loss

a.      There is very little research comparing different types of loss

b.     What research exists reveals that bereaved mothers report more depressive symptoms than widows, who report more symptoms than bereaved adult daughters