This document discusses various sociocultural, legal, medical, and ethical perspectives on death. It addresses definitions of death, views of death across cultures and within cultures, legal and medical criteria for determining death, and issues around end of life decisions including euthanasia, advance directives, theories of grief and dying, death anxiety, hospice care, and grieving.

1. The Final Passage

2. Sociocultural Definitions of Death
• Different cultures view death in diverse ways
• Customs and expectations also differ in
rituals of bereavement and mourning
• Even within a culture there is diversity in the
view of death, mourning, and bereavement

3. There Are at Least 10 Ways Death Can
Be Viewed
• Death as an image or
object
• Death as a statistic
• Death as an event
• Death as a boundary
• Death as a state of
being
• Death as a thief of
meaning
• Death as an analogy
• Death as fear and
anxiety
• Death as reward or
punishment

4. Legal and Medical Definitions
• The traditional definition of clinical death was a lack
of heartbeat and respiration
• Today, brain death is the most used definition:
– No spontaneous movement to stimulation
– No spontaneous respiration for 1 hour
– Lack of response to pain
– No eye movements, blinking, or pupil responses
– No postural activity, swallowing, or yawning
– No motor reflexes
– A flat EEG for 10 minutes
– No change in any of these in 24 hours

5. Legal and Medical Definitions (Cont)
• All eight criteria must be met and other
possible conditions ruled out
• In most hospitals, the lack of brain activity
must extend to the brainstem and cortex
• Activity only in the brainstem is called a
persistent vegetative state, from which the
person does not recover

6. Ethical Issues
• Bioethics is the study of the combination of
human values and technological advances
– Bioethics grew from the increasing concern
for respect for individual freedom and the
difficult task of defining morality in medical
care

7. Euthanasia
• Euthanasia is the practice of ending life for
reasons of mercy
– Extends from the advances that allow for
life to be extended by extraordinary means,
and the concern for quality of life and
respect for the individual

8. Active Euthanasia
• Active euthanasia is the deliberate ending of
someone’s life
• Moral and religious concerns are involved in
the issue of active euthanasia
• Physician-assisted suicide has become an
increasingly controversial issue
• Some states have passed laws specifically
making physician-assisted suicide legal,
others have banned it

9. Passive Euthanasia
• Allowing a person to die by withholding
available treatment is called passive
euthanasia
• A survey in England showed that caregivers
agreed that dementia patients should not
receive treatments when critically ill
• Most cases of passive euthanasia end up in
court which has asserted that without
advance directives, nourishment cannot be
stopped

10. Making Your Intentions Known
– There are two ways to tell others of your
choice about final decisions
• A living will in which a person states
their preferences and intentions in the
event that they may be unable to make
their intentions known
• A durable power of attorney names an
individual who will have the legal
authority to make decisions and speak
for the person

11. A durable power of attorney, like the one shown here, is a way to make you end-of-life wishes known
to others.

12. A Life Course Approach to Dying
• Young adults integrate feeling and emotions
with their thinking about death, lessening their
feelings of immortality
• Middle-age adults think about their own death
as they deal with the death of their parents
• Older adults are less anxious about death
because of achievement of ego integrity and
because of declining joy of living

13. Dealing With One’s Own Death
• Reactions to impending death can vary in its
development, especially with different causes
of terminal illness
– Diseases such as cancer may have a
terminal phase in which a patient may be
able to predict and prepare for death
– Some diseases that do not have a terminal
phase may create a condition in which a
person’s death could occur at any time

14. Kubler-Ross’ Theory
– Elisabeth Kubler-Ross began working with
terminally ill patients
– During this time, terminally ill patients were
not always told they were dying, and death
was not generally a topic of discussion.
Her research was controversial
– Kubler-Ross began to study patients’
reactions to their terminal illness and found
that most people experienced certain
emotional states

15. Kubler-Ross’ Stages of Dying
• Denial: Shock and disbelief
• Anger: Hostility and resentment
• Bargaining: Looking for a way out
• Depression: No longer able to deny, patients
experience sadness and loss
• Acceptance: Acceptance of the inevitability of
death with peace and detachment
• Though not all people experience all stages
in the same order, discussion of death helps
to move toward acceptance

16. A Contextual Theory of Dying
• Stage theories imply order to the transition
toward acceptance that may not exist
• Stage theories do not state what moves a
person through the stages
• Observations suggest that people vary
greatly in the duration of a particular stage
• There is no single correct way to die
• Each person’s own view of their death and
need for health care may impact their
movement through the stages

17. Death Anxiety
• Terror management theory asserts that the
continuation of one’s life is the primary motive
behind all behavior. Fear of dying is
consistent with this motive
• Research suggests that death anxiety
includes pain, body malfunction, humiliation,
rejection, etc. Each of these factors can be
assessed in any of three levels: public,
private, and unconscious

18. Death Anxiety (Cont)
• Death anxiety may be lower in older adults
due to ego integrity and a positive life review.
Emotional problems are predictive of higher
death anxiety

19. Learning to Deal with Death Anxiety
• Adolescents engage in more risk-taking
behavior which suggests less death anxiety
• Reduction can be achieved by contemplating
one’s own death by writing one’s own
obituary, planning one’s own funeral, etc.
• Death education strives to address death
anxiety by presenting factual information
about death and reducing sensitivity to the
issues involved

20. Creating a Final Scenario
• Discussions of the issues of management of
the final phase of life and the after-death
disposition of their body are called end-of-life
issues
• Hospitals and nursing homes teach about
advance directives like durable power of
attorney and living wills
• Making one’s choices known and providing
information about how one wants their life to
end is called a final scenario

21. The Hospice Option
• An alternative to going to a hospital or
nursing home during a terminal illness is
hospice care. This involves assisting dying
people with pain management and a death
with dignity
• The emphasis of hospice is on quality of life
• The primary goal of hospice is to make the
person comfortable and peaceful, not to delay
an inevitable death

22. The Hospice Option (Cont)
• St. Christopher’s Hospice in England was
founded by Dr. Cicely Saunders and is the
model for modern hospices
• When no treatment or cure is possible,
hospice care is requested. The family and the
patient is viewed as a unit
• May be inpatient or outpatient
• An emphasis is placed on patient dignity
• Patients show less anxiety and depression

23. The Hospice Option (Cont)
• Key questions about the possible use of hospice
services:
– Does the person know the truth about their
condition?
– What options are available for patient care?
– What are the patients expectations?
– How well do the people in the person’s social
network communicate?
– Are family members available to provide care?
– Is a high-quality hospice care program available?

24. The Grieving Process
• Bereavement is the state or condition caused
by loss through death
• Grief is the sorrow, hurt, anger, guilt,
confusion, and other feelings that arise after
suffering a loss
• Mourning is the way in which we express our
grief
• Mourning rituals can be fairly standard across
a culture. Grief varies greatly