Chapter 13 Dying, Death, and Bereavement I.   Death Anxiety              1.  Death anxiety is common in the general public, usually higher in women, and peaks in intensity in young adulthood and declining afterward. II.   End-of-Life Decisions                A.    Advance Directives                 1.   Advance directives  refers to various types of legal documents detailing wishes of individuals regarding end-of-life concerns.                 2.  Advance directives, such as living wills and durable power of attorney for health care, are designed to make the wishes of an individual known when that individual is incapacitated or cannot communicate.                 B.  Palliative Care and Hospice Programs                 1.   Palliative care is focused on treating symptoms and keeping an individual comfortable (American Cancer Society, 2008; NCI, 2000).                 2.      Hospice care               a)   A type of palliative care                   C.   Euthanasia and Physician-Assisted Death                 1.    Passive euthanasia                  a)  Allows “nature to take its course”                       2.    Active euthanasia                 a)    Involves taking direct action to shorten a patient’s life                 b)    Is illegal                3.     Physician-assisted suicide                a)  Could be simply responding to a patient’s questions and explaining the dosage requirements or combinations of drugs that would cause death               b) Could involve the physician actually writing the prescription for such drugs (AGS, 2005)              c) Although active euthanasia is illegal, physician-assisted suicide is legal in Oregon and in some parts of the world III.      Close to Death                     A.  End-of-Life Research Issues                  1.  End-of-life research projects face numerous challenges              a).  Including convincing an IRB that the study is worth the potential Discomfort              b)  Locating qualified and willing participants                     B.  Psychological Changes                  1.  Kubler-Ross’ five stages of dying (denial, anger, bargaining, depression, and acceptance) was the standard portrayal of the dying experience, but it has fallen out of favor with those in the social and health sciences.                     C.   Interacting with Those Who are Dying               1.  When interacting with someone who is dying it is important to allow honest conversation about important matters, even if it is very emotional or in some other way uncomfortable.               2.  Rather than looking for an individual to follow a stage pattern, loved ones and health care professionals are encouraged to be present, listen, and be willing to engage in the difficult and emotional conversations.                      D. Physiological Changes                 1.  As an individual approaches death, there are expected physiological signs, such as less social interaction, decrease in.

1. Chapter 13 Dying, Death, and Bereavement
I. Death Anxiety
1. Death anxiety is common in the general public,
usually higher in women, and peaks in intensity in young
adulthood and declining afterward.
II. End-of-Life Decisions
A. Advance Directives
1. Advance directives refers to various types of
legal documents detailing wishes of individuals regarding end-
of-life concerns.
2. Advance directives, such as living wills and
durable power of attorney for health care, are designed to make
the wishes of an individual known when that individual is
incapacitated or cannot communicate.
B. Palliative Care and Hospice Programs
1. Palliative care is focused on treating symptoms
and keeping an individual comfortable (American Cancer
Society, 2008; NCI, 2000).
2. Hospice care
a) A type of palliative care
C. Euthanasia and Physician-Assisted Death
1. Passive euthanasia
a) Allows “nature to take its course”
2. Active euthanasia
a) Involves taking direct action to shorten a
patient’s life

2. b) Is illegal
3. Physician-assisted suicide
a) Could be simply responding to a patient’s
questions and explaining the dosage requirements or
combinations of drugs that would cause death
b) Could involve the physician actually writing the
prescription for such drugs (AGS, 2005)
c) Although active euthanasia is illegal, physician-
assisted suicide is legal in Oregon and in some parts of the
world
III. Close to Death
A. End-of-Life Research Issues
1. End-of-life research projects face numerous
challenges
a). Including convincing an IRB that the study is
worth the potential Discomfort
b) Locating qualified and willing participants
B. Psychological Changes
1. Kubler-Ross’ five stages of dying (denial, anger,
bargaining, depression, and acceptance) was the standard
portrayal of the dying experience, but it has fallen out of favor
with those in the social and health sciences.
C. Interacting with Those Who are Dying
1. When interacting with someone who is dying it is
important to allow honest conversation about important matters,
even if it is very emotional or in some other way uncomfortable.
2. Rather than looking for an individual to follow a
stage pattern, loved ones and health care professionals are
encouraged to be present, listen, and be willing to engage in the
difficult and emotional conversations.
D. Physiological Changes
1. As an individual approaches death, there are
expected physiological signs, such as less social interaction,
decrease in appetite and bladder and bowel control, cool limbs,
noisy breathing, muscle contractions, and an irregular heartbeat.

3. IV. Transitions
A. Marking the End of Life
1. Following death, decisions need to be made
regarding burial or cremation and, if desired, the type of
funeral, memorial service, or public recognition of the
deceased.
B. Bereavement
1. During the bereavement process individuals
must learn to cope with the gap in their lives left by the
deceased.
2. For most people, the symptoms of bereavement
start to ease and significant healing takes place in the first 6
months.
3. Generally, individuals in bereavement pass
through phases of shock, avoiding separation, disorganization
and despair, and reorganization and recovery, although there
may be many individual differences and circumstances that may
influence one’s thoughts, behaviors, and coping skills.
C. Complicated Grief
1. Some individuals experience depression,
anxiety, and prolonged and intense grieving called complicated
grief.
In Assignments
Post Discussion: A few questions to ponder this week: what are
your thoughts on death anxiety? Why do we distinguish between
complicated grief and bereavement? What could be the impact
on those individuals closest to the person experiencing
complicated grief? And, on a personal level, how do you think
you would respond if you discovered that someone you work
closely with has a life ending situation (cancer, for example)

4. but insists on continuing working until the last possible
moment? Would you react differently if this was a family
member (who wanted to continue working until the end)? These
[personal] questions are not to pry but for you to have an
opportunity to evaluate your own feelings on the subject.
Chapter 13 Dying, Death, and Bereavement
I. Death Anxiety
1. Death anxiety is common in the general public,
usually higher in women, and peaks in intensity in young
adulthood and declining afterward.
II. End-of-Life Decisions
A. Advance Directives
1. Advance directives refers to various types of
legal documents detailing wishes of individuals regarding end-
of-life concerns.
2. Advance directives, such as living wills and
durable power of attorney for health care, are designed to make
the wishes of an individual known when that individual is
incapacitated or cannot communicate.
B. Palliative Care and Hospice Programs
1. Palliative care is focused on treating symptoms
and keeping an individual comfortable (American Cancer
Society, 2008; NCI, 2000).
2. Hospice care
a) A type of palliative care
C. Euthanasia and Physician-Assisted Death

5. 1. Passive euthanasia
a) Allows “nature to take its course”
2. Active euthanasia
a) Involves taking direct action to shorten a
patient’s life
b) Is illegal
3. Physician-assisted suicide
a) Could be simply responding to a patient’s
questions and explaining the dosage requirements or
combinations of drugs that would cause death
b) Could involve the physician actually writing the
prescription for such drugs (AGS, 2005)
c) Although active euthanasia is illegal, physician-
assisted suicide is legal in Oregon and in some parts of the
world
III. Close to Death
A. End-of-Life Research Issues
1. End-of-life research projects face numerous
challenges
a). Including convincing an IRB that the study is
worth the potential Discomfort
b) Locating qualified and willing participants
B. Psychological Changes
1. Kubler-Ross’ five stages of dying (denial, anger,
bargaining, depression, and acceptance) was the standard
portrayal of the dying experience, but it has fallen out of favor
with those in the social and health sciences.
C. Interacting with Those Who are Dying
1. When interacting with someone who is dying it is
important to allow honest conversation about important matters,
even if it is very emotional or in some other way uncomfortable.
2. Rather than looking for an individual to follow a
stage pattern, loved ones and health care professionals are
encouraged to be present, listen, and be willing to engage in the
difficult and emotional conversations.

6. D. Physiological Changes
1. As an individual approaches death, there are
expected physiological signs, such as less social interaction,
decrease in appetite and bladder and bowel control, cool limbs,
noisy breathing, muscle contractions, and an irregular heartbeat.
IV. Transitions
A. Marking the End of Life
1. Following death, decisions need to be made
regarding burial or cremation and, if desired, the type of
funeral, memorial service, or public recognition of the
deceased.
B. Bereavement
1. During the bereavement process individuals
must learn to cope with the gap in their lives left by the
deceased.
2. For most people, the symptoms of bereavement
start to ease and significant healing takes place in the first 6
months.
3. Generally, individuals in bereavement pass
through phases of shock, avoiding separation, disorganization
and despair, and reorganization and recovery, although there
may be many individual differences and circumstances that may
influence one’s thoughts, behaviors, and coping skills.
C. Complicated Grief
1. Some individuals experience depression,
anxiety, and prolonged and intense grieving called complicated
grief.
In Assignments
Post Discussion: A few questions to ponder this week: what are
your thoughts on death anxiety? Why do we distinguish between

7. complicated grief and bereavement? What could be the impact
on those individuals closest to the person experiencing
complicated grief? And, on a personal level, how do you think
you would respond if you discovered that someone you work
closely with has a life ending situation (cancer, for example)
but insists on continuing working until the last possible
moment? Would you react differently if this was a family
member (who wanted to continue working until the end)? These
[personal] questions are not to pry but for you to have an
opportunity to evaluate your own feelings on the subject.