Death & Afterlife Beliefs (Unit 13)

Changes in Causes of Death

• prior to 20th centry often infections → sharp drop after vaccines, anitbiotics, sanitation

• change in leading causes as people lived longer → diseases still most common in devloping

3 common causes:

1. coronary heart disease

2. stroke

3. cancer

Coronary Heart Disease

• leading death cause worldwide (esp after 65)

• atherosclerosis: plaque build up on walls of arteries

• angina pectorsis: severe pain in neck, chest, left arm from severe plaque build up

• heart attack from dying heart tissue (lack of blood supply)

• HA symps: acute pain, weak, dizzy, confusion, shortness of breath (may be mild→ not know)

• half die before reaching hospital, smoking highest risk

Stroke

• 2nd most common cause

• blood clot blocking blood flow to brain → not removed = vessel bursts (severe brain damage/death)

• can remove w surgery/dissolve w drugs (best if removed within 6hrs)

• more common/severe in W

• risks: obesity, hyperten, smoking (ethnic differences)

• once bursts, death likely

FAST recognition

• Face drooping

• Arm weakness

• Speech difficulties

• Time to call 911

Biology of Aging & Death: Cellular Clock, Hayflick Limit & Telomeres

CC: intrinsic limit to # of times cells can replicate

HF: limit for how many times most human cells can replication (50ish)

T: end of chromosome, becomes shorter w division (eventually so short replication cant occur)

• shortening helps prevent mutation (limits # of rep)

• shortened lead to diseases (cancer)

• 100+ wo heart disease/diabetes/cancer/etc.: longer telomeres than those w 2/more of

Biology of Aging & Death: Free Radicals & Antioxidants

FR: unstable molecules damage dna/structures needed for cell func → contributes to prim aging

• play roles in fatal diseases @ old age

A: absrob extra electron in free radicals → prevent them from damaging cells

• in animals: ↑ phys func/life expectancy

• injections in humans: lack benefits/harmful

• reseach into genes that could produce enzymes acting as antioxidants

Biology of Aging & Death: Human Growth Hormones (hGH)

= critical contributor to phys growth in early decades, steady decline after mid 20s (contributes to prim aging)

• give to animals/humans → short term improvements (side effects: liver damage, excess hair, abnorm growth of hands/feet/face bones)

DHEA: hormone for bone growth, muscle density, cardiovascular func

• declines after 30

• benefits in mice (improved activity/learning speed) not humans

Suicide

• major in devloped

• most common in late life (80+ → low life quality)

• cross cultures W more likely attempt, M more likely die

• M use lethal methods (gun shots) vs. W (overdose)

• ethnic differences in rates/ages → ↑ caucasian (DoD)

• lowest among african american W (religious)

End of Life Choices

hospice: alt to hospital care, emphasizes phys, em, social, spiritual needs of dying person/families

pallative care: terminally ill, focuses on relieving patients pain/suffering, die w dignity

• when med interventions extending life stop, 6mos less to live

• area of hospital, home, diff facility (most common is home= die w family)

• better for family mems psychological wellbeing

Included in Hospice Care

1. interdisciplinary care team (med personnel, counsellors, volunteers)

2. psychological/spiritual counselling for patient/family

3. housekeeping support

4. psychological support/comfort for dying person

5. berevament care for family/friends after death

• programs expanding in deploved (cheaper than norm hospital care)

• median length of 20 days

• family, patient, physicicans may be reluctant to stop care

Euthanasia

= end life of person suffering from incurable disease/severe disabiltiy

• passive legal some places, not active

2 types:

1. passive: stop med interventions prolonging persons life, allows death to occur wo causing

2. active (assisted suicide): stop treatment + take steps to hasten death (lethal injection/meds)

Euthanasia: Laws

• legal in canada

• netherlands 1st to legalize (2001) → terminally ill cancer patients, some legal conditions bypassed, sometimes not ill elderly

features of active euthanasia laws:

1. patient clearly indicate desire to die

2. phys/mental suffering severe/unlikely to improve

3. 2nd doctor constulted + confirms conditions met

Advanced Directives

= written/oral instructions concerning end of life care

living will: specifys treaments person does/doesnt want w terminal illness, coma, brain death

do not resucitate (DNR): in LW, medical dont want attempt to prolong life if heart/breathing stops

health care proxy: usually family mem, designated to make treatment decisions on behaf of dying person

• physicans may be unaware of

• ethnic differences in use (ed, awarness of option, religion)

Bereavement & Grief

B: losing a loved one

G: psychological response accompanying B, intense/complex em experience

• intial response: shock, numb, disbelief → intense desire to see/hear person

• followed by powerful/unsettling/shifting ems

• state similar to depression (lethargy, aimlessness, confusion, disorg, sleep provlems, lose appetite)

• loss of identity relevant roles from death (changes in self perception)

Prolonged Grief Disorder

=intense/prolonged grief symps w some func impairment beyond 6mo post loss

• peroccupation w loss, difficulty trusting, believe life empty/meaningless

• controversial diagnosis → pathologizing norm em reactions to life altering loss

Intensity of Grief and Bereavement

influences who died/death cause → most intense losing parent, spouse, child

• parent loss: depression, em problems in children short/long term, depends on age of child, quality of relationship w parent, social support

• child loss: em distress lasting yrs for parents, ↑ divorce, reduces attention to surviving child

• spouse loss: ↑ death risk in yrs following, depression, anxiety, substance abuse, mem loss

Grief: Sudden Deaths

• more intense grief

• damages individuals view of world: unjust, unsafe (long lasting psychological impact)

• suicide esp damaging → feel guilt/shame w grief (potential anger at dead)

anticipatory grief: accept death of severly ill loved one inevitable, begin to adapt to it em before it occurs (may feel relief after)

Stages Theory of Dying

= by kubler-ross, reacting to own terminal diagnosis

1. denial: debate over whether to discourage to ensure proper preps for death vs. denial as temp state to perserve ego integrity while em processing

2. anger: injustice towards situation, directed towards diff people

3. bargaining: directed towards god/spiritual entity, bargin for more time

4. depression: realize death approacing + cant do anything

5. acceptance: result in sense of peace/little em reaction, want to spend time w loved ones

Stages Theory of Dying Research

• not supported by later research

• may experience some/none stages

• ignores common fear reaction

• cultural impacts → care of term ill patients, ideas of death, explain grief reactions

Childrens Understanding of Death

• 3/4 have some passing experience w death

• understand deaths perm

• middle childhood realize death inevitable

• b/w middle + adolescence realize own morality

• cross culturally use euphemisms w young children → prevent fear

• learn cultural afterlife beliefs early

• better to be honest w terminally ill child/adolescents about their condition

Death Anxiety

• peaks in emerging, declines w age (lowest in late adult) → unachieved goals when young, late sense of achieved personal goals

• often have death associated fears (ex. pain, loss of control, impact on love ones)

• life review: late adult when people reflect on life they lived → accept good/bad

• highest in unsure believers (religious involvement reasurring) → dont feel reassured of afterlife

Death Anxiety: Young vs. Middle Adulthood

• ya: focus on children (survival/impact on them)

• ma: prompts reexamination of life/changes to make most of remaining yrs

• encounter more death in late (friends/parents/siblings) → think/talk about death more (helps cope em/adress practicalities)

Afterlife Beliefs

• part of all major religious traditions → believe some aspect of person continues after death

• death as moral event (experience judgement for life)

• what happens to soul based on conduct while alive → heaven, hell, reincarnation, progress towards nirvana

• fewer individuals identifying w specific religions/non belivers → belief in after death higher in low SES, more religious countries

• non religious sometimes report belief in afterlife

• individual variation in beliefs in faith

Hinduism Mourning Rituals

• reincarnation: souls returns to earth in diff humanly form (main afterlife belief)

• mourning rituals by survivours play role in status of soul in next life

• often die at home

• tie thumbs/big toes together, religious pics turned to wall, mirros covered

• cremate body (only M go to cremation site) → spread in holy water

• discourages prolonged mourning

Buddhism Mourning Rituals

• reincarnation & cremation

• period after death very important (lessen souls suffering & time b/w death & rebirth)

• monks arrive when death near + involved in service

• feast on evening of cremation ritual (banish sorrow/fear) → continue chants (benefit soul of deceased)

Judaism Mourning Rituals

• once dead: eyes closed, body covered + on floor, candles lit

• someone remains beside body at all times (dont eat/drink in same room)

• meal of condolence after for family only (bread/eggs)

• hear of death = tear your clothing

• after burial 7 day period (sitting shiva) → no shave, bathe, work, sex, change clothes

• then schloshim (thirty) → further period lasting yr after parents death

Christianity Mourning Rituals

catholic:

• ill/near death: anointing of the sick ritual (bring comfort to sick person, anguished family mems, forgive sins of sick, prepare soul for passing to eternal life)

• after death vigil

• day after vigil = requiem mass

protestant:

• less standardized/ritualized, more variable

Islam Mourning Rituals

• near death recite verses from Koran → make comfy + encourage reciting of words

• burial shortly after death (body not allowed to be disturbed)

• place body on right side → facing mecca

• 3 day mourning period (widows committed to mourning of 4mo + 10 days)