17_Death, Dying, Grieving

Lecture Objectives

  • Define death
  • Describe the Parkes/Bowlby Attachment Model
  • Explore MAID procedures in Canada
  • Describe Kübler-Ross’s Stages of Dying

Defining Death

  • The complexity of determining when life ceases and death occurs.
  • Functional death: absence of heartbeat and breathing.
  • Medical experts now measure brain functioning to establish death.
Brain Death
  • Definition: “Permanent cessation of brain function, observable by the absence of consciousness and brainstem reflexes, including independent breathing.” (Shemie et al., 2023)
  • All electrical activity of the brain stops.
  • Higher brain centers (conscious awareness) often die sooner than lower brain centers (heartbeat & respiration).

Death & Dying Across the Lifespan

  • Various perspectives include:
  • Coping with the death of others.
  • Facing one's own death.
  • Euthanasia & Medical Assistance in Dying (MAID).
  • Kübler-Ross’s Stages of Dying.

Perspectives on Bereavement

  • Bereavement: state of loss.
  • Grief: emotional response to loss.
  • Mourning: culturally prescribed ways of displaying reactions to death.

The Parkes/Bowlby Attachment Model

  1. Numbness
  • Initial daze and disbelief after death.
  • Emotional emptiness may mask painful feelings.
  1. Yearning
  • Pangs of grief and acute separation anxiety.
  • Bereaved individuals may seek reminders of the deceased.
  • Emotional intensity peaks 5-14 days post-death.
  1. Disorganization & Despair
  • Intense grief wanes into apathy.
  • Difficulty managing daily life.
  1. Reorganization
  • Bereaved start to reinvest in life and new relationships.
  • Transitioning identity from spouse to widow/widower.

Dimensions of Grieving

  • Grief can involve:
  • Circumstances of the deceased's passing.
  • Longing or yearning for the lost person.
  • Anxiety related to separation.

Types of Grief

  • Anticipatory grief: grieving before death occurs.
  • Complicated grief: experienced for 6+ months; may worsen health.
  • Disenfranchised grief: mourning that cannot be openly supported or recognized.

The Grief Work Perspective

  • Adaptive coping requires:
  • Confronting loss.
  • Experiencing and working through painful emotions.
  • Psychologically detaching from the deceased.
  • Common misconceptions:
  • There’s one right way to grieve.
  • The need to work through grief is universal.

Who Copes and Who Succumbs?

  • Factors influencing coping:
  • Personal resources of the individual.
  • Nature of the loss.
  • Supportive context and presence of stressors.

Euthanasia & Aid in Dying (MAID) in Canada

  • MAID: legal assistance in ending life under specific conditions.
  • Legalized as of June 2016 through Bill C-14.
  • Revised in March 2021 under Bill C-7, removal of natural death foreseeability requirement.
Types of MAID Permitted
  • Directly administered lethal substances by a physician/nurse.
  • Prescription for self-administered lethal substances.
Eligibility for MAID
  • Must meet all criteria:
  1. Eligible for government-funded health insurance.
  2. Minimum age of 18 or possess decision-making capacity.
  3. Have a grievous and irremediable condition.
  4. Voluntary request, free from external pressure.
  5. Informed consent.
Grievous & Irremediable Conditions
  • Serious illness, disease, or disability.
  • Advanced state of decline—predictive trajectory towards death.
  • Unbearable suffering not relieveable under acceptable conditions.
Upcoming Changes to MAID Eligibility
  • As of March 2027, those with solely mental illness will be eligible under specific conditions, excluding neurocognitive disorders.

Kübler-Ross’s Stages of Dying (1969)

  • Identified emotional responses in terminally ill patients, encompassing:
  1. Denial and Isolation: Initial shock and disbelief.
  2. Anger: Resentment and displacement of anger onto care team.
  3. Bargaining: Attempts to negotiate for more time.
  4. Depression: Reflective sadness about the impending death.
  5. Acceptance: Peaceful acknowledgment of the death.
Key Considerations
  • The model presents stages as emotional reactions rather than strict chronological steps.
  • Individual personality influences how one experiences dying.