THE END OF LIFE

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Chapter 19

• THE END OF LIFE

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The Quest for Healthy Dying

• Thanatology The Study of Death and Dying

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Living Will

• A legal document that states an individuals
  wishes regarding medical care in case the person
  becomes incapacitated and unable to participate
  in decisions about his or her medical care.

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The Right-to-Die Movement

• Physician-Assisted Suicide
• Trend basing decisions less on legalistic
  interpretations regarding specific treatments and
  more on balancing benefits on a case-by-case
  basis
• Euthanasia Mercy killing

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Suicide

• Three concepts (NIMH)
• 1. Suicide ideas
• 2. Suicide attempts
• 3. Completed suicide
• Who Commits Suicide and Why?
• Females attempt more suicides, but males
  complete most.

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The Hospice Movement

• Provides comfort and care but with the knowledge
  that the recipients are nearing the end of their
  lifes journey--that theyre dying

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The Dying Process

• Defining Death
• Brain Death occurs when the brain receives
  insufficient oxygen to function.

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Confronting Ones Own Death

• A Life Review
• Elderly person takes stock of his life,
  reflecting and reminiscing about it

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Changes Before Death

• Death drop
• Near-Death Experiences
• Dying individuals feel themselves leave their
  bodies and watch as spectators, the resuscitation
  efforts. Then they pass through a tunnel and
  enter a spiritual realm.

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Near-Death Experiences

• Other views
• (Siegel) Arousal of nervous system and
  disorganization of brain
• (Alkon) Anoxia induces such mental states
• (Kastenbaum) Some heart-attack victims no
  recollection of experience

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Religious Beliefs

• Christian Book of Revelation
• Jewish Speculation about afterlife is
  pointless
• Buddhists Detailed account

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Stages of Dying

• (Elisabeth Kubler-Ross)
• 1. Denial
• 2. Anger
• 3. Bargaining
• 4. Depression
• 5. Acceptance

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Kastenbaums Trajectories of Death

• It is the nature of the disease that determines
  pain, mobility and length of terminal period.
• Other factors
• Gender, ethnic group, personality, developmental
  level and death environment

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Causes of Death

• National Mortality Followback Survey 1993
• Data on 23,000 records of death in 1993.
• All states except South Dakota

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Grief, Bereavement, and Mourning

• Adjusting to the Death of a Loved One
• Bereavement state in which a person has been
  deprived of a relative or friend by death

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• Grief keen mental anguish and sorrow over the
  death of a loved one
• Mourning socially established manner of
  displaying signs of sorrow over death

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Expressing Anguished Feelings

• Support groups to help people through grief work
• Culture and Grief Work
• Cultural variability in expressing grief

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Consequences of Grief

• Survivor vulnerable to physical and mental
  illness and death
• Adjusting to Violent and Premature Death
• Most severe grief reaction

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Adjusting to the Death of a Parent

• Stages of bereavement for healthy adults who
  have lost a parent
• 1. Going back to the origins
• 2. Reevaluation phase
• 3. Assuming leadership

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Phases in the Bereavement Process

• 1. Shock, numbness, denial, disbelief
• 2. Pining, yearning, and depression
• 3. Emancipation from loved one and adjustment
  to new circumstances
• 4. Identity reconstruction

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Individual Variations

• People handle grief differently
• Widows and Widowers
• Death rate for widowers higher
• Difficulty expressing emotion

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Types of Widows

• Three types (Lopata)
• 1. Better educated, middle class, strongly
  identifying with role of wife
• 2. Women who led multidimensional lives
  husband only one part of total set of relations
• 3. Lower-or working-class women in
  sex-segregated worlds immersed in kin,
  neighboring or friendship relationships with
  other women

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Death of a Child

• Loss by Miscarriage
• Sometimes receive no recognition of loss
• Support Groups
• Loss by Murder or Violence
• Bereavement process can go on indefinitely