Death, Dying, Grieving

Defining Death

  • Defining the point at which life ceases & death occurs is complex.

  • Functional Death: absence of heartbeat & breathing.

  • Medical experts now measure brain functioning as well.

Brain Death

  • Considered the permanent cessation of brain function, observable by:

    • Absence of consciousness.

    • Absence of brainstem reflexes, including the ability to breathe independently.

  • Occurs when all electrical activity of the brain has ceased.

  • Higher brain portions, responsible for conscious awareness, often die earlier than lower centers, responsible for heartbeat and respiration.

Death & Dying Across the Lifespan

  • Coping with death: involves facing one’s own death and the death of others.

  • Includes Euthanasia & Aid in Dying (MAID).

Perspectives on Bereavement

  • Bereavement: state of loss.

  • Grief: emotional response to loss.

  • Mourning: culturally prescribed way of displaying reactions to death.

The Parkes/Bowlby Attachment Model

  • Stages include:

    1. Numbness

    2. Yearning

    3. Disorganization & Despair

    4. Reorganization

Stage 1: Numbness

  • Occurs in the first few hours or days after death.

  • The bereaved feel dazed, gripped by a sense of unreality, disbelief & lack of feelings.

  • Painful emotions may occasionally break through as the bad news has not fully registered.

Stage 2: Yearning

  • Characterized by acute separation anxiety & efforts to reunite with the deceased.

  • Examples:

    • Hearing a loved one’s voice.

    • Seeking out their favorite belongings.

  • Grief manifests in waves, often most intense 5 to 14 days post-death.

Stage 3: Disorganization & Despair

  • Intense grief & yearning become less frequent, but feelings of despair and apathy increase.

  • The bereaved struggle to manage daily life post-loss.

Stage 4: Reorganization

  • The bereaved begin to reinvest in living attachments and activities.

  • Transition includes moving from a widow/widower identity to forming new relationships.

Grieving

  • Grief is characterized by emotional numbness, disbelief, and feelings of separation anxiety, sadness, and loneliness.

  • Dimensions of grieving include the circumstances of death and the longing for the lost person.

Types of Grief

  • Anticipatory Grief: grieving before death occurs.

  • Complicated Grief: lasts 6+ months, linked to negative health consequences.

  • Disenfranchised Grief: loss that cannot be openly mourned.

The Grief Work Perspective

  • To cope adaptively with death, bereaved individuals must:

    • Confront their loss.

    • Experience and work through painful emotions.

    • Psychologically detach from the deceased.

Misconceptions in Grief Work

  • Common misconceptions include the idea of one right way to grieve, working through all grief, and the need to break bonds with the deceased.

Coping Factors

  • Factors affecting how individuals cope with loss include:

    • Personal resources.

    • Nature of the loss.

    • Supportive context and stressors.

Medical Assistance in Dying (MAID)

  • Definition: process in Canada allowing individuals to receive medical assistance in ending their life if they are eligible.

  • Legal Context:

    • Legal since June 2016 (Bill C-14).

    • Revised in March 2021 (Bill C-7)—no longer requiring natural death to be foreseeable.

Types of MAID in Canada

  • A physician or nurse practitioner can:

    • Directly administer substances to cause death.

    • Provide a substance for patients to self-administer.

Eligibility Criteria for MAID

  • Must fulfill:

    1. Eligible for government health insurance.

    2. Age 18+ or possess decision-making capacity.

    3. Present a grievous and irremediable condition.

    4. Make a voluntary request not influenced by external pressures.

    5. Provide informed consent.

Grievous and Irremediable Conditions

  • Conditions qualifying include serious illness, an irreversible state of decline, and unbearable suffering.

Mental Illness and MAID Eligibility

  • As of March 17, 2027, individuals with solely mental illness who meet other criteria will also be eligible for MAID, excluding neurocognitive & neurodevelopmental disorders.

Safeguards for MAID Requests

  • Requirements include:

    • Medical assessments by two independent practitioners.

    • Written requests signed & witnessed.

    • Final consent before the MAID procedure.

Waiver of Final Consent

  • Audrey’s Amendment allows previously approved individuals to receive MAID even without consent capacity at the time of the procedure.

Kübler-Ross’s Stages of Dying (1969)

  • Stages Overview:

    • DABDA: Denial, Anger, Bargaining, Depression, Acceptance.

  • Each stage is a common emotional reaction to terminal illness.

Stage 1: Denial

  • Common initial reaction, serving as a coping mechanism. Temporary in nature.

Stage 2: Anger

  • Characterized by anger and resentment, often directed at caregivers and family.

Stage 3: Bargaining

  • Involves hoping to delay death through negotiations with a higher power.

Stage 4: Depression

  • Represents profound sadness and contemplation of one's impending death.

Stage 5: Acceptance

  • Acceptance of the fatal outcome, leading to a sense of peace.

Evaluating Kübler-Ross’s Theory

  • It is emphasized that the dying process should be seen as emotional reactions rather than fixed stages.

  • The model overlooks individual personality influence and how patients approach living.