(c) 2011 Worth Publisher Invitation to the Lifespan by Kathleen Stassen Berger

1. Invitation to the Life Span
by Kathleen Stassen Berger
Epilogue:
Death and Dying
PowerPoint Slides developed by
Martin Wolfger and Michael James
Ivy Tech Community College-Bloomington

2. Thanatology
Thanatology
– The study of death and dying, especially of
the social and emotional aspects
– Thanatology is not morbid or gloomy; it
reveals the reality of hope in death,
acceptance of dying, and reaffirmation of life

4. Death and Hope – Understanding
Death Throughout the Life Span
Death in Childhood
• Children have a different perspective of death.
– They are more impulsive and may seem happy one day and
morbidly sad the next.
– They do not “get over” the death of a parent, nor do they dwell
on it.
– They may take certain explanations (e.g. Grandma is sleeping,
Grandpa went on a trip) literally.
– Fatally ill children typically fear abandonment  frequent and
caring contact is more important than logic.
• Older children turn into more concrete operational
thinkers; they seek specific facts and become less
anxious about death and dying.

6. Death in Adolescence and
Emerging Adulthood
• Teenagers have little fear of death (they take risks, place
a high value on appearance, and seek thrills).
• Adolescents often predict that they will die at an early
age and their developmental tendency toward risk taking
can be deadly (e.g., suicides, homicides, car accidents).
• Romanticizing death makes young people vulnerable to
cluster suicides, foolish dares, fatal gang fights, and
drunk driving.

8. Death in Adulthood
• When adults become responsible for work and family
death is to be avoided or at least postponed.
• Many adults quit taking addictive drugs, start wearing
seat belts, and adopt other precautions.
• Death anxiety usually increases from one’s teens to
one’s 20s and then gradually decreases.
• Ages 25 to 60: Terminally ill adults worry about leaving
something undone or leaving family members—
especially children—alone.

9. Death in Late Adulthood
• Death anxiety decreases and hope rises.
• One sign of mental health among older adults is
acceptance of their own mortality and altruistic concern
about those who will live on after them.
• Many older adults accept death (e.g. they write their
wills, designate health care proxies, reconcile with
estranged family members, plan their funeral).
• The acceptance of death does not mean that the elderly
give up on living!

10. Religions and Hope
• People who think they might die
soon are more likely than others to
believe in life after death.
• Virtually every world religion
provides rites and customs to
honor the dead and comfort the
living.
• Although not everyone observes
religious customs, those who care
for the dying and their families
need extraordinary sensitivity to
cultural traditions.

11. Near-Death Experience
– An episode in which a person comes close to dying
but survives and reports having left his or her body
and having moved toward a bright white light while
feeling peacefulness and joy.
– Near-death experiences often include religious
elements.
– Survivors often adopt a more spiritual, less
materialistic view of life.
– To some, near-death experiences prove that there is
a heaven but scientists are more skeptical.

12. Dying and Acceptance
Good death
– A death that is peaceful, quick, and painless
and that occurs after a long life, in the
company of family and friends, and in familiar
surroundings.
– People in all religious and cultural contexts
hope for a good death.
Bad death
– Lacks these six characteristics and is
dreaded, particularly by the elderly

13. Honest Conversation
Stages of Dying
I. Kübler-Ross: Identified emotions experienced by dying
people, which she divided into a sequence of five stages:
1. Denial (“I am not really dying.”)
2. Anger (“I blame my doctors, or my family, or God for my
death.”)
3. Bargaining (“I will be good from now on if I can live.”)
4. Depression (“I don’t care about anything; nothing matters
anymore.”)
5. Acceptance (“I accept my death as part of life.”)

14. Honest Conversation
II. Stage Model based on Maslow’s hierarchy of
needs:
1. Physiological needs (freedom from pain)
2. Safety (no abandonment)
3. Love and acceptance (from close family and friends)
4. Respect (from caregivers)
5. Self-actualization (spiritual transcendence)

15. Honest Conversation
Telling the Truth
• Most dying people want to spend time with loved ones
and to talk honestly with medical and religious
professionals.
• It is unethical to withhold information if the patient asks
for it although some people do not want the whole truth.
• Hospital personnel need to respond to each dying
person as an individual, not merely as someone who
must understand that death is near.

16. The Hospice
Hospice
– An institution or program in which terminally ill
patients receive palliative care
– Hospice caregivers provide skilled treatment to relieve
pain and discomfort; they avoid measures to delay
death and their focus is to make dying easier
Two principles for hospice care:
1. Each patient’s autonomy and decisions are
respected.
2. Family members and friends are counseled before
the death, shown how to provide care, and helped
after the death.

18. Palliative Medicine
Palliative care
– Care designed not to treat an illness but to provide
physical and emotional comfort to the patient and
support and guidance to his or her family.
Double effect
– An ethical situation in which an action (such as
administering opiates) has both a positive effect,
which is intended (relieving a terminally ill person’s
pain), and a negative effect, which is foreseen but not
intended (hastening death by suppressing
respiration).

19. Choices and Controversies
WHEN IS A PERSON DEAD?
Brain death: Prolonged cessation of all brain activity with
complete absence of voluntary movements; no
spontaneous breathing; no response to pain, noise, and
other stimuli. Brain waves have ceased; the EEG is flat;
the person is dead.
Locked-in syndrome: The person cannot move, except
for the eyes, but brain waves are still apparent; the
person is not dead.

20. Choices and Controversies
Coma: A state of deep unconsciousness from which the
person cannot be aroused. Some people awaken
spontaneously from a coma; others enter a vegetative
state; the person is not dead.
Vegetative state: A state of deep unconsciousness in
which all cognitive functions are absent, although eyes
may open, sounds may be emitted, and breathing may
continue; the person is not yet dead. This state can be
transient, persistent, or permanent. No one has ever
recovered after two years; most who recover (about 15
percent) improve within three weeks. After time has
elapsed, the person may, effectively, be dead.

21. HASTENING OR POSTPONING
DEATH
Longer Life
– The average person lived twice as long in 2010 as in
1910.
– Later death due to drugs, surgery, and other
interventions (e.g., respirators, defibrillators, stomach
tubes, and antibiotics) .
– Many adults under age 50 once died of causes that
now kill relatively few adults in developed nations,
such as complications of childbirth and epidemic
diseases.

22. ALLOWING DEATH
Passive Euthanasia
– A situation in which a seriously ill person is allowed to
die naturally, through the cessation of medical
intervention.
DNR (do not resuscitate)
– A written order from a physician (sometimes initiated
by a patient’s advance directive or by a health care
proxy’s request) that no attempt should be made to
revive a patient if he or she suffers cardiac or
respiratory arrest.

23. ALLOWING DEATH
Active Euthanasia
– A situation in which someone takes action to bring
about another person’s death, with the intention of
ending that person’s suffering.
– Legal under some circumstances in the Netherlands,
Belgium, Luxembourg, and Switzerland, but it is illegal
(yet rarely prosecuted) in most other nations.
Physician-Assisted Suicide
– A form of active euthanasia in which a doctor provides
the means for someone to end his or her own life.

25. Slippery Slope
– The argument that a given action will start a
chain of events that will culminate in an
undesirable outcome.
– Concern: Hastening death when terminally ill
people request may cause a society to slide
into killing sick people who are not ready to
die—especially the old and the poor.

26. Advance Directives
Advance Directive
– A document that contains an individual’s instructions
for end-of-life medical care, written before such care
is needed.
Living Will
– A document that indicates what kinds of medical
intervention an individual wants or does not want if he
or she becomes incapable of expressing those
wishes.
Health Care Proxy
– A person chosen by another person to make medical
decisions if the second person becomes unable to do
so.

28. Bereavement
Normal Grief
Bereavement
– The sense of loss following a death
Grief
– The powerful sorrow that an individual feels at the
death of another
Mourning
– The ceremonies and behaviors that a religion or
culture prescribes for people to employ in expressing
their bereavement after a death

29. Placing Blame And Seeking
Meaning
Placing blame
– Common impulse after death for the survivors (e.g.,
for medical measures not taken, laws not enforced,
unhealthy habits not changed)
– The bereaved sometimes blame the dead person,
sometimes themselves, and sometimes distant others
– Nations may blame one another for public tragedies
– Blame is not necessarily rational

30. Placing Blame And Seeking
Meaning
Seeking Meaning
– Often starts with preserving memories (e.g.,
displaying photographs, telling anecdotes)
– Support groups offer help when friends are unlikely to
understand (e.g., groups for parents of murdered
children)
– Organizations devoted to causes such as fighting
cancer and banning handguns often find supporters
among people who have lost a loved one to that
particular circumstance
– Close family members may start a charity

31. Complicated Grief
Absent Grief
– A situation in which overly private people cut
themselves off from the community and customs that
allow and expect grief; can lead to social isolation.
Disenfranchised Grief
– A situation in which certain people, although they are
bereaved, are prevented from mourning publicly by
cultural customs or social restrictions.

32. Incomplete Grief
– A situation in which circumstances, such as a
police investigation or an autopsy, interfere
with the process of grieving.
– The grief process may be incomplete if
mourning is cut short or if other people are
distracted from their role in recovery.

33. Diversity of Reactions
• Reactions to death are varied
– Other people need to be especially
responsive to whatever needs a grieving
person may have.
• Most bereaved people recover within a
year
– A feeling of having an ongoing bond with the
deceased is no longer thought to be
pathological.