Psy210 Death and Dying

Death and Dying
Sarah Hammett, Ruth Dennison,
and Roman Liskevich

Death
 “No one wants to die. Even people who want to go
to heaven don’t want to die to get there. And yet
death is the destination we all share. No one has
ever escaped it. And that is as it should be, because
Death is very likely the single invention of Life. It is
Life's change agent. It clears out the out the old to
make way for the new”. Steve Jobs

Death and Dying
 As medicine progressed there were newer guidelines for
being termed dead.
 Not having a heartbeat and respiration didn’t qualify someone for
being dead.
 New technology allowed a person to have his his/her heart and
circulatory system to be sustained on a ventilator and feeding tubes to
give nutrients to the individual.
 Sometimes people who were plugged up to these machines never
regained consciousness, so we had to find a new term for being dead.

What is Death
 In the first edition of the Encyclopedia Britannica, death was
defined as “the separation of the soul and the body.”
 The latest definition of death is three times as long and the
more we learn about death the harder it gets to defining it
 About three centuries ago it was fairly simple to determine
if someone was dead.
 If someone was thought to have died the family would have called the
priest to come and make sure.
 The priest would come and do some simple tests like put a mirror
right by their mouth see if it clouded up by breathing
 If the family needed further proof he would put feather on the nose to
see if it moved. O things were so simple back in the day.

Brain Death
 Doctors started to use terms like “persistent vegetative
state”, and “irreversible coma” to describe people who had
been in some kind of traumatic injury were they had brain
damage that was irreversible.
 Medicine could now keep people alive when their own brain
couldn’t, but a persons consciousness , his personality was
gone forever
 Brain death or the irreversible end of all brain activity due to
total necrosis of the the cerebral neurons following loss of
brain oxygenation.

Cause of Brain Death
 Technically everybody dies of brain death, a young person
might suffer a gunshot to the brain or an older person might
suffer a stroke and doesn't get oxygen to the brain,
eventually we all die of brain death.
 The brain can be without oxygen for six minutes after the
heart stops, severe brain damage occurs after 6 minutes
without oxygen.
 There is a difference between brain damage leading to death
and brain damage leading to a comma.

Coma VS Brain Death
 Being brain dead and being in a coma is not the same thing.
 Patients who suffer brain death are not in a coma.
 Patients in a coma may or may not progress to brain death
 Patients in a coma may come out of it and wake up but
patients who are brain dead will never wake up again.
 A patient can only be either in a vegetative state or brain
dead, there's no such thing as almost brain dead, its yes or
no.

Determining Brain Dead
 The patient must pass all of these tests to be determined brain dead
 There are several tests done to determine if a patient is brain dead.
1. The patient has no response to command
2. The patient is flaccid, with areflexic extremities
3. The pupils are nonreactive
4. Patient has no oculocephalic reflex
5. The patient has corneal reflex
6. The patient has no response to supra orbital stimulation
7. The patient has no oculovestibular reflex
8. The patient has no gag reflex
9. The patient has no spontaneous respiration.

Assistant living
 Assistant living is for senior who are in some need of help
with some daily assistance.
 Assistant living differs from nursing homes in that patients in
assistant living can do most thing themselves, and they don’t
need intensive care.
 The benefit of assistant living is the trained staff that can
help patients who cant do something because of a illness.
 The national average for assistant living is $3,300 a month
and in Huntsville its $1,900.

Nursing Home
 Nursing homes are for patients who don’t need to be in a
hospital but cant be at home.
 Nursing homes are not only for the elderly but for anyone
who requires 24 hour care.
 The cost in the of nursing home care has risen 4 percent in
the last year with a private room being $84,000 a year or
$229 a day.
 The average cost in Huntsville is $179 per day.

Death and Burial
 A person can have a will made out telling how he/she wants
to be buried.
 Most people in the US want to be buried in a casket but there
are many(mostly in the Pacific and Asia) who prefer to be
cremated.
 Religious and cultural beliefs also play a role in how a
person want to be buried(or cremated).

Funeral Home
 The price of a funeral can cost depends on how much you
want to spend.
 The basic service for a funeral with staff is $1495
 Embalming costs another $595 and cosmetics are another
$295
 The casket costs anywhere from $900 to over $10,000!
 The burial costs another $1000
 Cremation is a lot cheaper and cost only $1,345.

Hospice care is end-of-life care by medical professionals and volunteers who give
medical, psychological and spiritual support. The goal is to help those dying have
peace, comfort and dignity. The caregivers try to control pain and other symptoms
so a person can remain as alert and comfortable as possible. This type of care is
called palliative care Hospice programs also provide services to a patient's family.
Hospice patients are usually expected to live 6 months or less. Hospice care can
take place
At home
At a hospice center
In a hospital
In a skilled nursing facility
Source Cited: National Cancer Institute

Hospice Care:
“Hospice is covered by Medicare nationwide and Medicaid is covered in Alabama. Most
insurance providers also cover the cost of hospice care. Medicare covers the full scope of
medical and support services provided by hospice. There is little to no expense to the
patient.” -Hospice of North Alabama


Hospice of North Alabama (aging and terminally ill patients)
Hospice Family Care(terminally ill patients and families)
Commercial

Hospice Care options in Huntsville Area
(patients must be referred by a doctor) :

Patients have the right to choose where they get their hospice services, and what
services they use. Most hospice centers offer patients the following services:
Case Manager (nurse): Periodically visits the patient to check patient's physical,
emotional, and spiritual health. The case manager then decided what can be done
for the patient to make them as comfortable as possible.
Hospice Aide: Visits patient at scheduled times. Assists in bathing/grooming,
recording vitals. Aide regularly reports the patient's status to the Case Manager.
Social Worker: Coordinates patient's resources.
Chaplains: Provides pastoral care, often gives patient their last rites.
Volunteers: Provide care when family members are unable to, provides
companionship for patient. Generally helps the family when needed (grocery
shopping, errands, etc) so that the family may spend their time with the patient.
Source: Hospice of North Alabama

What Hospice Does

Advance Directives

What are Advance
Directives?
Legal documents that
express an individuals'
desires regarding their end-
of-life care.
Living Wills express what procedures an individual does or
does not want to extend their life. This includes; dialysis
and breathing machines, if an individual wants to be
resuscitated if heart or lungs stop, whether a feeding tube
can be used on an individual, and whether the individual
would like to donate organs or tissues upon death.

Advanced Directives in Alabama
(Source: caringinfo.org)
If you wish to revoke the
Advanced Directives you have
three options:

Destroy the legal document.

Write a formal revocation with
your signature and date.

Orally express your desire to
revoke the order to an
individual over the age of 19.
This individual must then write
and sign confirmation that they
heard you revoke your
directives.
Under Alabama law Advance
Directives that prohibit the use
of feeding tubes, and life-
sustaining treatments for
patients that are pregnant will
be ignored.
Under Alabama law,
separate documents are
needed to prevent
ambulance and emergency
room personnel from
providing CPR.

Expected Lifespan:
48
65
73
79
81
46
61
67
72
76
40
52
64
76
88
100
1900 1940 1960 1990 2013
Source:
http://demog.berkeley.edu/~andrew/1918/figure2.html
This shift from family care to professional care has
minimized our exposure to the painful circumstances
surrounding the death of a loved one. Even though
the news exposes us to stories of death, because
there is often no personal connection we are allowed
to have distance from death. Because of this, we are
not as death-obsessed or as fearful of death as
previous generations.
Source: Santrock
THEN (Early
1900's
TODAY
One out of two
children died
before age 10. By
adulthood,
children had lost
one parent (on
average).
Death mostly
occurs amongst
aging adults.
Most people died
at home, cared for
by family.
80% of deaths
occur in hospitals
or care
institutions.

Leading Causes of Death:
1900
1. Pneumonia
2. Tuberculosis
2013
1. Heart Disease
2. Cancer
Source: cdc.gov
1937
1. Heart Disease
2. Pneumonia
1850
1. Tuberculosis
2. Cholera

Death in a Digital Age
Google recently introduced its “Inactive
Account Manager”, which allows users
to determine whether they want to
open accounts to loved ones, or have
the information deleted after their
passing (this is determined by a
selected amount of inactivity).
Online profiles (i.e. facebook) often become makeshift memorials after someone dies,
with the bereaved writing on their wall or tagging them in images to pay their
respects. Some sites even offer a service that sends an email to a loved one of your
choosing after you die. One such site, deathswitch.com is designed to send loved
ones important account numbers, passwords, and short messages after your passing.
It regularly prompts you to enter a password via email, and when you miss several
reminders, it determines that you are either dead or disabled. Many funeral homes
now offer “streaming” services so loved ones that are deployed, or unable to travel
can view the funeral.

Also known as “Stages of Loss” because it applies
to both accepting your own death as well as
grieving the loss of a loved one.
Cyclical. Even though a
person may go through the
stages several times before
finally reaching true
acceptance. There is no set
time frame to the stages of
grief, they can last years.
Many people who have
gone through the stages
say that it comes in
“waves”.
Image: Shutterstock
Text:Santrock, J.W. (2007). A
Topical Approach to Life-Span

Stage 1: Denial and Isolation
Person denies that they are going
to die. “No. This couldn't
happen to me.” Common
reaction to terminal illness. Is
only temporary, and is usually
“cured” when a person is
confronted with evidence of
their illness; doctor bills, failing
health, etc.
This is a natural coping mechanism
that gives an individual time to
process the idea of their
imminent death.
This period is marked by:
Avoidance, Confusion,
Fear, Numbness, and
Blame.
Source: Santrock &

Stage 2: Anger
Happens when they are forced to face
the fact that they are dying, and
denial is no longer possible. It
becomes harder for medical staff,
loved ones, and other
professionals to care for the dying
person as their anger will become
displaced onto those around them.
Dying persons may become
increasingly resentful and jealous
of others in good health.
This stage is marked by:
Frustration, Anxiety,
Irritation,
Embarrassment, and
Shame.
Source: Santrock & Kubler-
Ross, 1968
Image:
mesothelioma.com

Stage 3: Bargaining
The hope that death
can be postponed.
Some will try to
bargain-most often
with a higher power-
to delay their death.
This stage is often
marked by: Reaching
out to others, Desire
to tell their story,
Struggle to find
meaning.
Source:
Santrock

Stage 4: Depression
The dying person accepts that they
are going to die. They become
silent, and may refuse visitors.
They spend much of the time
crying, and grieving their own
death. This behavior should not be
discouraged, as it is necessary for
the dying person to prepare
themselves. This is a defense
mechanism, in which the dying
person is distancing themselves
from loved ones in order to save
them from the pain of their
eventual death. “Cheering them
up” can lead to them feeling guilt
or shame, which may only further
the depression.
Lack of energy,
Helplessness.
Text: Santrock
Image: xkcd.com

Stage 5: Acceptance
The dying person
becomes at peace
with their death.
However, they may
still want to be left
alone. Feelings and
pain may be absent
by this stage.
Exploring options
(“bucket lists”),
Finalizing plans, and
Making amends.Source: Santrock
Image: www.dcmetrotheaterarts.com

Kubler-Ross Stages of Dying
Robot Chicken's Stages of Loss
Cons of the 5 Stages:
-Not enough research
support.
-Ignores individual
circumstances.
Pros:
-Helps individuals cope
with dying.

Perceived Control and Denial
Perceived Control:
Coping mechanism.
When led to believe
that they are in
control of their fate,
aging or dying adults
may become happier
and more active.
“I have cancer, cancer
does not have me.”
Denial is also an effective coping tool.
It can be adaptive (eases the initial
shock) or maladaptive (prevents
individual from truly facing their
death). Denial can not be classified
as good or bad, but judged on a
case by case basis.

Ben has been told that he
has a cancerous tumor
that can be removed by a
simple operation. Ben
refuses the operation,
saying that “the tumor is
small, so it's not worth
the risks of surgery”.
You Decide: Maladaptive or Adaptive?
Bobby has been given six
months to live. He
begins to make plans to
complete his bucket
list. He even spends
most of his savings on a
trip that will take place
after his “expiration
date”.

To Review
In this clip:
Perceived Control (shaving head, instead of
waiting for hair to fall out from chemo, using it
as a dating strategy, etc.)
5 Stages.

4/4/13
Communicating with a Dying Person
Psychologists believe it’s best for the terminally ill
patient to know that they are dying. Advantages:
1.Close their lives in accord with their own ideas,
getting closure and saying their good-byes
2. Complete plans or projects, make arrangements
for survivors and participate in funeral and burial
decisions
3. Reminisce and converse with important people
in their life
4. Understand what is happening within their body
and what the medical staff is doing
Source: Essential of Life-Span Development

4/4/13
How should I talk with a loved one who is dying?
Love: Communicate love through verbal and non-verbal
expressions
Identity: Focus on the relationship between the living and
the dying
Spirituality: Statements of religious faith and experiences
Everyday Talk: Sharing the mundane
Source: How Should I Talk with a Loved One Who is Dying?
http://www.natcom.org/CommCurrentsArticle.aspx?id=862

What is Grief?
"Grief is a natural response to loss. It’s the
emotional suffering you feel when something or
someone you love is taken away. The more
significant the loss, the more intense the grief will
be. You may associate grief with the death of a
loved one—which is often the cause of the most
intense type of grief—but any loss can cause grief.“
Grief is also described as "The emotional
numbness, disbelief, separation anxiety, despair,
sadness, and loneliness that accompany the loss of
someone we love."

Prolonged Grief
Type of grief that involves enduring despair and is still
unresolved over an extended period of time.
Negative Consequences of prolonged grief
Physical health: Fatigue, sleeping problems, loss of
appetite, and pain
Mental health: loss of motivation and anxiety
symptoms
Disenfranchised Grief
an individual's grief over a deceased person that is a
socially ambiguous loss that can't be openly mourned
or supported.

Widowhood Effect
the increased probability of
death among grieving mates
within weeks or months of their
spouses passing.
“

4/4/13
Steps for Coping with Grief and Loss
Get Support
1. Turn to Family & Friends
2. Join a Support Group
3. Go to a Grief Counselor
4. Draw Comfort from your Faith
Source: Help Guide
http://www.helpguide.org/mental/grief_loss.htm

4/4/13
Steps for Coping with Grief and Loss Cont.
Take Care of Yourself
1. Face Your Feelings
2. Express Your Feelings (Journaling)
3. Look after your Physical Health
4. Don’t let anyone tell you how to feel
5. Plan ahead for “Grief Triggers”
Source: Help Guide
http://www.helpguide.org/mental/grief_loss.htm

Right to Die Debate
Does a person have the right to choose to die? To commit suicide?
Euthanasia: Doctor-Assisted Suicide
“The laws of the Netherlands and Belgium define
euthanasia as ‘the act, undertaken by a third party, which
intentionally ends the life of a person at his or her request,
and in both countries euthanasia can only be effected by a
doctor’.”
Two Criteria for Euthanasia in Belgium & Netherlands:
1.After getting a second opinion, patient has to be capable
of letting their wishes clearly known repeatedly over a
period of time
2. Patient must be suffering from "unbearable physical or
psychological pain“
Source: The International
http://www.theinternational.org/articles/307-bringing-death-to-light-is-there-a-righ

4/4/13
Marc and Eddy Verbessem
Deaf from Birth
Going Blind
“Nothing to Live For”
Loss of Independence
Something to think about
Source: Google Image
http://www.google.com/image

4/4/13
Dr. Ezekiel J. Emanuel, an oncologist and former White
House adviser, wrote in The Atlantic that providing assisted
suicide to those not suffering unbearable physical pain is a
slippery slope: “Once legalized, physician-assisted suicide
and euthanasia would become routine. Over time doctors
would become comfortable giving injections to end life
and…comfort would make us want to extend the option to
others who, in society’s view, are suffering and leading
purposeless lives.” He continues to say, “Physician-
assisted suicide and euthanasia should not be performed
simply because a patient is depressed, tired of life, worried
about being a burden, or worried about being dependent.
All these may be signs that not every effort has yet been
made.”
Source: The International
http://www.theinternational.org/articles/307-bringing-death-to-light-is-there-a-righ

4/4/13
Oregon Death with Dignity Act (1997)
1st
U.S. State to Pass Death with Dignity Law
Proponents: Argued that mentally competent, terminally ill adults have
the right to request their physician's aid in hastening their dying.
Opponents: Violates religious teachings on the sanctity of life and leads
to a "slippery slope" toward euthanasia.
*Washington and Montana now also allow physician-assisted suicide.
Source: U.S. Supreme Court Upholds Oregon's Right-to-Die Law
http://www.beliefnet.com/News/2006/01/U-S-Supreme-Court-Upholds-Oregons-Right-To-Die-Law.aspx
Time USA
http://www.time.com/time/nation/article/0,8599,2075644,00.html

4/4/13
Dr. Jack Kevorkian
A.K.A. Doctor Death
Said he assisted in over 130 deaths
His work spurred the debate on ethics of euthanasia in U.S.
Served 8 years for Second-Degree Murder
Sources:
Google Images http://www.google.com/images
Bio.True Story http://www.time.com/time/nation/article/0,8599,2075644,00.html

4/4/13
Cultural Differences in Death
Most Cultures: Death is not viewed as the
end of existence – though the biological
body has died, the spirit is believed to live
on (Hedayat, 2006).
Grief, whether in response to the death of a loved one, to the loss of a
treasured possession, or to a significant life change, is a universal
occurrence that crosses all ages and cultures.
South America: Hispanics are family oriented, end of life care given by family
members and strong support system
Anticipatory Grief: feelings of loss before loved one has died.
Ireland: Irish Wake with music and dancing, pre-planning funerals
Hawaii:
Ancient Burial Method, Buried in a Cave or Sand Dunes or Burial at Sea
Modern Method, In Casket in Ground, mourners wear brightly-colored garments
as black is not worn at funerals.
Sources: Death in Cultures Around the World
http://dying.lovetoknow.com/Category:Death_in_Cultures_Around_the_World

4/4/13
Israel: Rend or Tear Clothing at news of death or at the funeral, sometimes
rabbi will give family a torn ribbon to wear to signify the loss.
Shiva: Seven day mourning period, turn mirrors backwards or cover, sit and
reminisce.
India: Most are Buddhist. Monks chant verses to them while they are dying and
while the person is being ready for funeral fire (cremation). Monks attend
funeral with family and are given food and candles by the family.
United States: Death Avoiders and Death Deniers. Funeral homes prepare
body. Visitation, Funeral, Graveside
Sources: Death in Cultures Around the World and Buddha.net
http://dying.lovetoknow.com/Category:Death_in_Cultures_Around_the_World
http://www.buddhanet.net/d_cermon.htm

The Death and Dying Group
Recommends (for further interest)
Ben Breedlove: My Story
“The Last Lecture”
Elizabeth Kubler-Ross on Dying
Joan Didion, “The Year of
Magical Thinking”

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