The document discusses various topics related to death, dying, and grieving. It covers the historical changes in how death is viewed and addressed in the U.S., how death is determined, end-of-life planning tools like advance directives and living wills, perspectives on euthanasia and physician-assisted suicide, hospice care, cultural views of death and grieving, Kübler-Ross's stages of dying, and losing a life partner. The document provides information on these topics to help understand psychological and social aspects of approaching the end of life.

1. Life-Span Development
Twelfth Edition
Chapter 20: Death, Dying and Grieving
©2009 The McGraw-Hill Companies, Inc. All rights reserved.

2. ©2009 The McGraw-Hill Companies, Inc. All rights reserved.
THE DEATH SYSTEM
 In most societies, death is not viewed as the
end of existence because the spiritual body is
believed to live on
 People in the U.S. tend to be death avoiders
and death deniers
 Changing Historical Circumstances:
 The age group in which death most often strikes
 Life expectancy has increased from 47 to 78 years
 Location of death

3. ©2009 The McGraw-Hill Companies, Inc. All rights reserved.
ISSUES IN DETERMINING DEATH
 Brain Death: a person is
brain dead when all
electrical activity of the
brain has ceased for a
specified period of time
 Includes both the higher
cortical functions and the
lower brain-stem functions
Terri Schiavo

4. ©2009 The McGraw-Hill Companies, Inc. All rights reserved.
LIFE, DEATH, AND HEALTH CARE
 Advance directive & living wills are designed
to be filled in while the individual can still
think clearly
 Designed for situations in which the individual is
in a coma and cannot express his or her desires
 Many states have natural death legislation
 People engaged in end-of-life planning are
more likely to:
 Have been hospitalized in the year prior
 Believe that patients rather than physicians should

5. ©2009 The McGraw-Hill Companies, Inc. All rights reserved.
ADVANCE DIRECTIVE & LIVING WILLS
LIVING WILL
I, __________, of __________, being of sound mind, do hereby willfully and voluntarily make known my desire that my life not be prolonged under any of
the following conditions, and do hereby further declare:
1. If I should, at any time, have an incurable condition caused by any disease or illness, or by any accident or injury, and be determined by any two or more
physicians to be in a terminal condition whereby the use of "heroic measures” or the application of life-sustaining procedures would only serve to
delay the moment of my death, and where my attending physician has determined that my death is imminent whether or not such "heroic measures"
or life-sustaining measures are employed, I direct that such measures and procedures be withheld or withdrawn and that I be permitted to die
naturally.
2. In the event of my inability to give directions regarding the application of life-sustaining procedures or the use of "heroic measures", it is my intention
that this directive shall be honored by my family and physicians as my final expression of my right to refuse medical and surgical treatment, and my
acceptance of the consequences of such refusal.
3. I am mentally, emotionally and legally competent to make this directive and I fully understand its import.
4. I reserve the right to revoke this directive at any time.
5. This directive shall remain in force until revoked.
IN WITNESS WHEREOF, I have hereto set my hand and seal this _____ day of __________, 20___.
Signed: __________
Declaration of Witnesses
The declarant is personally known to me and I believe him to be of sound mind and emotionally and legally competent to make the herein contined
Directive to Physicians. I am not related to the declarant by blood or marriage, nor would I be entitled to any portion of the declarant's estate upon his
decease, nor am I an attending physician of the declarant, nor an employee of the attending physician, nor an employee of a health care facility in
which the declarant is a patient, nor a patient in a health care facility in which the declarant is a patient, nor am I a person who has any claim against
any portion of the estate of the declarant upon his death.
Signed: _____________
https://www.texaslivingwill.org/

6. ©2009 The McGraw-Hill Companies, Inc. All rights reserved.
LIFE, DEATH, AND HEALTH CARE
 Euthanasia: the act of painlessly
ending the lives of individuals
who are suffering from an
incurable disease or severe
disability
 Passive euthanasia: treatment
is withheld
 Active euthanasia: death
deliberately induced
 Trend is toward acceptance of
passive euthanasia in the case of
terminally ill patients
 Experts do not agree on the
boundaries or mechanisms by
which treatment decisions should
be implemented
 Active euthanasia was made famous by
Dr. Jack Kevorkian in the U.S. as
“assisted suicide”
 Active euthanasia is a crime in most
countries and in the U.S. (except Oregon)
 Patients who have a desire for euthanasia
are often:
 Less religious
 Have been diagnosed with depression
 Have a lower functional living status

7. ©2009 The McGraw-Hill Companies, Inc. All rights reserved.
LIFE, DEATH, AND HEALTH CARE
 Hospice: a program committed to
making the end of life as free
from pain, anxiety, and
depression as possible
 Palliative care: reducing pain
and suffering, helping individuals
die with dignity
 Makes every effort to include the
dying patient’s family members
 Includes home-based programs
today, supplemented with care for
medical needs and staff
 Family members report better
psychological adjustment to the
death of a loved one when
hospice care is used
A “good death” involves physical comfort,
support from loved ones, acceptance, and
appropriate medical care.

8. ©2009 The McGraw-Hill Companies, Inc. All rights reserved.
ATTITUDES TOWARD DEATH
 Death of a parent is especially difficult for
children
 Most psychologists believe that honesty is
the best strategy in discussing death with
children
 Depends on the child’s maturity level
 Terminally ill children may distance
themselves from their parents as death
approaches
 Most adolescents:
 Avoid the subject of death until a loved one or
close friend dies
 Describe death in abstract terms and have
religious or philosophical views about it
 Often think that they are somehow immune to
death

9. ©2009 The McGraw-Hill Companies, Inc. All rights reserved.
ATTITUDES TOWARD DEATH
 Concerns about death increase as one ages:
 Awareness usually intensifies in middle age
 Middle-aged adults often fear death more than young
adults or older adults
 Older adults are more often preoccupied by it and
want to talk about it more
 One’s own death usually seems more appropriate
in old age, possibly a welcomed event, and there is
an increased sense of urgency to attend to
unfinished business

10. ©2009 The McGraw-Hill Companies, Inc. All rights reserved.
KÜBLER-ROSS’S STAGES OF DYING
 Denial and Isolation: “It
can’t be!”
 Anger: “Why me?”
 Bargaining: “Just let me
do this first!”
 Depression: withdrawal,
crying,
and grieving
 Acceptance: a sense of
peace comes

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PERCEIVED CONTROL AND DENIAL
 Perceived control may be an adaptive strategy
for remaining alert and cheerful
 Denial insulates and allows one to avoid
coping with intense feelings of anger and hurt
 Can be maladaptive depending on extent

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CONTEXTS IN WHICH PEOPLE DIE
 More than 50% of
Americans die in hospitals
 Nearly 20% die in nursing
homes
 Hospitals offer many
important advantages:
 Professional staff members
 Technology may prolong life
 Most individuals say they
would rather die at home

13. ©2009 The McGraw-Hill Companies, Inc. All rights reserved.
GRIEVING
 Grief: emotional numbness, disbelief, separation anxiety, despair, sadness,
and loneliness that accompany the loss of someone we love
 Grief is a complex, evolving process with multiple dimensions
 More like a roller-coaster ride than an orderly progression of stages
 Cognitive factors are involved in the severity of grief
 Good family communications and grief counselors can help grievers cope
with feelings of separation and loss
 Prolonged Grief: approximately 10%–20% of survivors have difficulty
moving on with their life after 6 months have passed
 Disenfranchised Grief: an individual’s grief involving a deceased person
that is a socially ambiguous loss that can’t be openly mourned or supported
 Examples: ex-spouse, abortion, stigmatized death (such as AIDS)

14. ©2009 The McGraw-Hill Companies, Inc. All rights reserved.
GRIEVING
 Dual-Process Model:
 Loss-oriented stressors: focus on the deceased
individual
 Can include grief work and both positive and negative
reappraisal of the loss
 Restoration-oriented stressors: secondary stressors
that emerge as indirect outcomes of bereavement
 Changing identity and mastering new skills
 Effective coping involves cycling between coping
with loss and coping with restoration

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GRIEVING
 Impact of death on
surviving individuals is
strongly influenced by
the circumstances under
which the death occurs
 Traumatic, violent, or sudden
deaths are likely to have more
intense and prolonged effects
 Can be accompanied by
PTSD-like symptoms

16. ©2009 The McGraw-Hill Companies, Inc. All rights reserved.
GRIEVING
 Cultural Diversity:
 Some cultures emphasize
the importance of breaking
bonds with the deceased
and returning quickly to
autonomous lifestyles
 Beliefs about continuing
bonds with the deceased
vary extensively
 There is no one right, ideal
way to grieve

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LOSING A LIFE PARTNER
 Widows outnumber widowers 5 to 1
 Women live longer than men
 A widowed man is more likely to remarry
 Widows usually marry older men
 Widowed women are probably the poorest group in
America
 Women tend to do better than men because women
typically have better networks of friends and relatives
 Older women do better than younger women
 Religiosity and coping skills are related to well-being
following the loss of a spouse in late adulthood

18. ©2009 The McGraw-Hill Companies, Inc. All rights reserved.
FORMS OF MOURNING
 Approximately 80%
are buried; 20% are
cremated
 Funerals are an
important aspect of
mourning in many
cultures
 Cultures vary in how
they practice
mourning