Death & Dying

Chapter 13

Biological Definition of Death

Total brain death; being totally unresponsive to stimuli, showing no movement in response to noxious stimuli, having no reflexes, and registering a flat EEG

Death as a Continuum

Surge of electricity into the brain before death; After death, you may be ‘aware’ that you are dead

Euthanasia (active vs passive)

Active Euthanasia: actively taking steps to end someone's life.

Passive Euthanasia: Withdrawing medical treatment with the intention of causing death.

Assisted Dying

Helping someone to end their life

Living Will

A legal document that expresses a person's wishes regarding medical treatment, especially in circumstances where they are no longer able to express such wishes themselves.

Life Expectancy of Infants Born in 2013-2015

Males 80.4 years; Females 84.4 years

Infant causes of death

Birth complications and congenital abnormalities

Children & Adolescents causes of death

Unintentional injuries or accidents, cancer

Young to middle-aged adults causes of death

Accidents and suicides, chronic disease

Older adults causes of death

Chronic, mental and neurological diseases

Programmed Theories

Genetic makeup and environmental factors

Hayflick Limit

Limit to the number of times each cell can divide

Damage or Error Theories

Damage to cells / organs – ‘wear and tear’

Kübler-Ross’ ‘stages of dying’

1.Denial and isolation

2. Anger,

3. Bargaining

4. Depression

5. Acceptance

Parkes/Bowlby Attachment Model of Bereavement

Numbness, Yearning, Disorganisation and despair, Reorganisation

Phases not stages

Dual-process model of bereavement

Move between coping with emotions and practical challenges; Loss-oriented vs restoration-oriented coping; Over time, shift from loss to restoration-oriented

Child Concept of Death - 5-7 year olds

Finality/irreversibility, Non-functionality, Universality, Causality

Theories of Ageing

Programed theories, hayflick limit, damage/error theories

Criticisms to Kubler-Ross stages of dying

Emotional responses not stage-like, nature/course of an illness affects reactions, individuals differ in responses, ignores focus on living & hope

The dying child

Aware of what is happening to them

Same emotions as adults but express differently

Bereaved Children support includes

Caregivers communicate that they are loved, talk & share grief and maintain own mental health to keep secure relationship with child

Babies/Toddlers concept of death

No concept of death, at 8 months sense of loss, withdrawn or inconsolable

2-5 year olds concept of death

Don’t understand that it is forever, questions, seperation anxiety, disrupted sleep, altered appetite, less interest in play, regression in language, toilet and sleep

Older children/teens concept of death

“Magical thinking” their thoughts/actions caused death and they can bring back

Make up/fill gaps in knowledge, react/tantrum to attract punishment they feel they deserve

Teens concept of death

Isolated, want independence but vulnerable, withdraw, act out or over commit, some take on responsibility - develop a supernatural view of death

The dying child - preschool

Guilt/shame they believe they are being punished

The dying child - school aged

Anxiety & fear of the unknown

Death of a child VS parent for Adults

Death of a child is harder as parent is expected

Grief work perspective

Confront loss, experience painful emotions & move towards detachment from deceased

Criticism of grief work perspective

Cultural contex, not everyone suffers, some show resilience without perspective, some benefit from continuing attachment bonds

Risks of complicated grief

Insecure attachment styles, neurotic personalities/limited coping skills, close/dependent relationship to the deceased, if loved one died violently/suddenly, lack of social support, face additional stressors

Help dying cope

Hospice/pallative care

Help bereaved cope

Individual therapy, family therapy, mutual support groups