Slide 1Defining DeathNatural Death Act and Advance DirectiveEuthanasiaCare for Dying IndividualsGenerational changesCultural VariationsDealing with DeathEvaluation of Kübler-RossCoping with Death and LossDimensions of GrievingDimensions of GrievingForms of MourningMaking Sense of the WorldDEATH, DYING, AND GRIEVINGChapter 17Defining DeathIn the past several decades, defining death has become more complexBrain death -- the neurological definition, when all electrical activity of the brain has ceased for a specified periodindividual whose higher cortical areas have died may continue breathing and have a heartbeatNatural Death Act and Advance DirectiveLiving will -- document filed while the individual can still think clearly, which expresses the person’s desires regarding extraordinary medical procedures that may or may not be used to sustain lifeadvance directiveAll 50 states now accept advance directives as reflecting an individual’s wishesEuthanasiaEuthanasia -- painlessly ending lives of individuals who are suffering from an incurable disease or severe disabilityTwo types: Active – when death is deliberately induced Assisted suicidePassive – when a person is allowed to die by withholding available treatmentCare for Dying IndividualsEnd-of-life care should include respect for the goals, preferences, and choices of the patient and his or her familyHospice -- program committed to making the end of life as free from pain, anxiety, and depression as possiblePalliative care -- reducing pain and suffering and helping individuals die with dignityGenerational changes200 years ago, many children and young adults diedaverage life expectancy was 47 yearsIn 1900, most people died at home, cared for by familyToday, death occurs most often among older adultsaverage life expectancy has increased to 7880 percent of deaths occur in institutions and hospitals with professional caregiversCultural VariationsIndividuals are more conscious of death in times of war, famine, and plagueMost societies have had philosophical or religious beliefs about death and most have a ritual that deals with deathIn most societies, death is not viewed as the end of existence; the spirit is believed to live onDealing with DeathKübler-Ross’ Stages of DyingFive stagesdenial and isolationangerbargainingdepressionacceptanceEvaluation of Kübler-Ross5-stage sequence has not been supported by research findingsStages did not account for individual circumstances of patient and support systemsHowever, she did much to call attention to the issues of quality of life and coping with dying(Kastenbaum, 2007)Coping with Death and LossIt is best for dying persons and their family members to know that death is immanent and a realityindividuals can close life with their own ideas about proper dyingthey can complete some projects and plans and can make arrangements for funeral and for survivorscan reminiscecan understand their physical sensations and medical procedures(Banja, 2005; Kalish, 1981)Dimensions of GrievingGrief -- emotional numbness, disbelief, separation anxiety, despair, sadness, and loneliness that accompany the loss of someone we loveMany dimensionspining or yearningseparation anxietydespair and sadnesshopelessness and defeat“Roller Coaster” of emotionDimensions of GrievingProlonged Grief – Grief that involves enduring despair and is still unresolved over an extended period of timeDisenfranchised grief describes an individual’s grief over a deceased person that is a socially ambiguous loss that can’t be openly mourned or supportedEx-spouseAbortionAIDSForms of MourningOne decision is to decide what to do with the bodyburialcremationFuneral services more meaningful to religious survivorsChildren?Family and community have important rolesMaking Sense of the WorldOne beneficial aspect of grieving is that it stimulates many individuals to try to make sense of the worldWhen death is caused by accident or disaster, the effort to make sense of it is pursued vigorouslyBereaved want to put death in a perspective they can