Lecturer: Dr. Joana Salifu Yendork , Department of Psychology Contact Information: jyendork@ug.edu.gh College of Education School of Continuing and Distance Education 2014/2015 – 2016/2017
Session Overview • Ageing comes with the experience of witnessing death of others and preparations towards one’s death. In this session, death will be discussed from different perspectives. Issues surrounding how death is defined legally and medically will be explored. Lastly, coping strategies for grief will be explored. Slide 2
Session Outline The key topics to be covered in the session are as follows: • Definition of death • Stages of death and death anxiety • Bereavement and grieving Slide 3
Reading List • Read Chapter 13 of Recommended Text – Adult development and aging, Cavanaugh & Blanchard-Fields (2006). Slide 4
Topic One DEFINITION OF DEATH Slide 5
Sociocultural definitions of death • Different cultures have different meanings for death – Images or object (e.g., tombstone, sympathy card, etc) – Statistics (e.g., mortality rates, life expectancy tables, murder rates, etc.) – Events (e.g., funeral, memorial service, family gathering) – A state of being (e.g., as time of waiting, being with God) – An analogy (e.g., dead- end street, you’re dead meat, etc.) – A mystery (e.g., what is like to die?) – A boundary (e.g., you can’t come back, what do I do now) – A thief of meaning (e.g., I feel cheated, I have much left to do) – A basis for fear and anxiety (e.g., will dying be painful, who will care for my children, etc.) – Reward and punishment (e.g., heaven awaits the just, the wicked will go to hell, etc.) Slide 6
Legal and medical definitions of death • Modern medical definitions focus on concept of “brain death” – No spontaneous movement in response to any stimuli – No spontaneous respiration for at least 1 hour – Lack of responsiveness to even the most painful stimuli – No eye movements, blinking, or pupil responses – No postural activity, swallowing, yawning or vocalizing – No motor reflexes – A flat electroencephalogram (EEG) for at least 10 minutes – No change in any of these criteria when the are tested again 24 hours later. • All 8 criteria should be met before a person is declared brain dead Slide 7
Legal and medical definitions of death • Brain death – Strong definition = absence of both cortical and brain stem functions and reflexes, total unconsciousness • Persistent vegetative state occurs when cortical functioning ceases while brain stem activity continues. • Due to persistent vegetative state, family members can face difficult ethical issues – Other conditions which might produce this state must be ruled out, e.g., coma, hypothermia, drug overdose – Inability to live on one’s own , without use of supportive technology for cardiovascular function Slide 8
Ethical issues • Bioethics : the study of the interface between human values and technological advances in health and life sciences. – Grew from two bases: respect for individual freedom and the impossibility of establishing any single version of morality by rational argument or common sense – Emphasise minimising harm over maximizing good and importance of individual choice • An important issue in bioethics in death and dying is euthanasia: the practice of ending life for reasons of mercy. Slide 9
Euthanasia issues: ending life • Euthanasia can be carried out in two ways : • Active vs. Passive Euthanasia – Active euthanasia involves the deliberate ending of a person’s life through an intervention or action, which may be based on a clear statement of the person’s wishes or a decision made by someone else who has the legal authority to do so. – Passive euthanasia involves allowing a person to die by withholding available treatment. More of an issue as life sustaining technology has developed to more sophisticated levels • Voluntary vs non-voluntary Euthanasia – Voluntary: A person wants to die and says so. May include cases of asking for help with dying (assisted suicide), asking for medical treatment to be stopped, refusing to eat. – Non-voluntary: The person cannot make a decision or cannot make their wishes known. Includes cases where the person is in coma, too young (e.g., a baby), the person is mentally retarded, etc. Slide 10
Euthanasia issues: ending life • Terri Schiavo case (March, 2005) – withholding of nourishment from a woman in persistent vegetative state for 15 years – US Supreme Court upheld husband’s right to have feeding tube removed • Legal issues – some countries and jurisdictions allow active euthanasia under medical supervision (e.g., the Netherlands) • Canadians can leave a DNR (“do not resuscitate”) document to prevent use of extraordinary measures, but active euthanasia is illegal – Sue Rodriguez case, amyotrophic lateral sclerosis (ALS) • Hitler’s “euthanasia” programs for undesirable persons! Slide 11
A life course approach to dying • Young adults tend to have intense feelings toward death; a sense of being cheated. Because they are just beginning to pursue family, career and personal goals. • Middle-aged adults begin to confront their own mortality and undergo a change in their sense of time lived and time until death – Arise from witnessing death of parents • Older adults are less anxious and more accepting of death – May result from achievement of ego integrity Slide 12
Topic Two DEALING WITH DEATH AND DEATH ANXIETY Slide 13
Dealing with one’s own death: Kubler- Ross • The work of Kubler-Ross revealed that when people are faced with imminent death (as in terminal illnesses), they exhibit five different emotions that represent how they deal with death • Although initially presented as sequence, research later showed that these emotions can overlap and can be experienced in different order. – People grief at different rate of time • Delayed grief can occur when people suppress the emotions of the death and years later, get depressed. – People may switch back and forth between the stages with necessarily following the order – It is possible to get stuck in a specific stage • Cultural differences, age, gender, race, and personality change the way people grieve. • Everyone copes with loss in a different way • Also, these emotions may also be expressed by those dealing with the loss of a love one Slide 14
Dealing with one’s own death: Kubler-Ross • Stage 1: Denial & Isolation (shock) – Denial and/or shock are often a person’s initial reaction followed by numbness. – There may also be a feeling of isolation or helplessness. – These feelings are an attempt to avoid reality by saying or thinking, “It is all a bad dream and will go away.” – Protect individual from being overwhelmed and buys us time to be able to cope with the loss. Slide 15
Dealing with one’s own death: Kubler- Ross • Stage 2: Anger (suffering) – May occur once grieving person faces reality – Anger is a natural reaction, an outlet for resentment at being a victim. • Anger could be directed towards God, doctors, family etc – There may be envy of others who have not experienced such a loss. – The person often takes out the anger on those close by – friends and family or towards the deceased, health care workers or self. – “ Why me? How? Now?...” Slide 16
Dealing with one’s own death: Kubler- Ross • Stage 3: Bargaining (suffering) – The person seeks to postpone the loss by making promises, often to God, to be a better person. – “I’ll do this if you only do…” – Provides temporary escape and hope as well as allows time to adjust to reality • Stage 4: Depression (suffering) – Occurs when reality really sinks in – The numbness, anger, and rage felt previously are now replaced with a sense of great loss. – Feelings of great loneliness, isolation, helplessness, sadness as well as decreased sleep and appetite are characteristics of this stage. Slide 17
Dealing with one’s own death: Kubler- Ross • Stage 5: Acceptance (recovery) – Facing reality in a constructive way • Accepting the fact that nothing can change the reality – It allows for action. – Learning from our mistakes and remembering the good times. Slide 18
Fear of death • Death anxiety is multidimensional and has several components – pain, body malfunction, humiliation, rejection, nonbeing, punishment, interruption of goals, and negative impact on survivors (Fortner & Neimeyer, 1999). – These components can be assessed on three levels: public, private and con-conscious Slide 19
Fear of death and some of its correlates • Generally, people fear most the process of dying and the unknown • Self-efficacy beliefs are important predictors of death anxiety • Personality & demographic variables: – Lower ego integrity, more physical problems, and more psychological problems are predictive of higher levels of death anxiety in older adults (Fortner & Neimeyer, 1999). • Religiosity can be an important factor in moderating fear of unknown • Previous experience with death of a loved one • Feelings of purpose and accomplishment can help lower fear • Less social support and greater external locus of control Slide 20
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