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Death and Dying
Epilogue, Part 2
Many states have attempted to increase personal choice about death even as they stop short of legalizing medical assistance to bring it about.
A massive effort in Hawaii to inform people about end-of-life issues resulted in less support for physician-assisted suicide, but more support for advance directives (an individual’s instructions regarding end-of-life medical care, written before such care is needed).
LIVING WILLS AND HEALTH CARE PROXIES
A document that indicates what kinds of medical intervention an individual wants or does not want if he or she becomes incapable of expressing those wishes.
Living wills include phrases such as “incurable,” reasonable chance of recovery” and “extraordinary measures”
Health Care Proxy
A person chosen by another person to make medical decisions if the second person becomes unable to do so.
Only about 25% of all North Americans have both a living will and health care proxy, although they are recommended for everyone
Living wills and health care proxies (cont’d.)
Even with a Living Will and a Health Care Proxy, the care provided may not be what the person wants:
The person who has been chosen as proxy often finds it difficult to choose death for a loved one
Doctors and nurses may object to the specifics of an advance directive, yet they must take the final action
A study in Europe found a discrepancy in the views of doctors, patients and families. Doctors were more likely than family members to choose quality of life over length of life
The need for advance directives
Terry Schaivo case
Terry was 26 years old in 1990 when her heart stopped beating and anoxia destroyed some brain cells
Terry didn’t have advance directives
Case received nationwide attention
After 11 years of surviving on life support, her husband was granted health care proxy and decided to have her feeding tube removed
Terry’s parents filed an appeal, but lost
Florida legislature passed “Terry’s Law” requiring that the tube be reinserted. This law was deemed unconstitutional
After 3 more years of legal battle, the U.S. Supreme court ruled that the lower courts were correct
Congress passed a law requiring that artificial feeding be reinstated. This law, too, was deemed unconstitutional
Finally, feeding tube was removed and Terry died.
Advance directives could keep this from happening
Grief, Mourning and Bereavement
As we consider how some people may react to death, some distinctions are in order.
Bereavement & grief
Bereavement -The sense of loss following a
Grief and mourning are aspects of bereavement, but they differ from each other.
Grief - The powerful sorrow that an individual feels at the death of another
Highly personal emotion
Anguish that overtakes daily life
Irrational and delusional thoughts
Mourning – The ceremonies and behaviors that a religion of culture prescribe for people to employ in expressing their bereavement after a death:
Informal shrines at the place where gestures of friends who may send cards, bring food and stay near the bereaved family
Mourning customs are designed to move grief towards reaffirmation.
For this reason, eulogies emphasize the dead person’s good qualities
Memories often remain on the anniversary of a death. So mourning includes rituals such as:
Visiting a grave or lighting a candle
Having specific time, prayer and place for remembering the dead, such as a gravesite
This helps bereaved people express grief without being overwhelmed by it
Placing blame and seeking meaning
A common impulse after death is for the survivors to assess blame, such as:
Medical measures not taken
Laws not enforced
Unhealthy habits not changed
The bereaved sometimes blame the dead person, themselves and distant others. For public tragedies, nations may blame one another
Normal grief reaction is intense and irrational at first, but gradually eases as time, social support and tradition help first with the initial search for meaning and reaffirmation
No mourning allowed
As mourning rituals diminish, many bereavement counselors have noted specific problems that may become pathological
Absent Grief – in which a bereaved person does not seem to mourn at all. This may be the first reaction as some people cannot face the reality of death. Some physical or psychologically symptoms may include:
Trouble breathing or walking
Sudden panic attacks
Absent grief may be more common in modern society. People who live or work where no one know their personal lives have no community or recognized custom to help them grieve.
Disenfranchised Grief - People who feel grief are not allowed to mourn publicly because of cultural customs or social restrictions
Unmarried lovers, former wives or husbands, young children and close friends at work may be excluded from saying goodbye to the dying person, viewing the corpse or participating in the aftermath of death
Incomplete grief - A situation in which circumstances, such as police investigation or an autopsy interfere with the process of grieving, these include:
An autopsy complicates grieving for those who believe that the body will rise again or the soul does not leave the body immediately
The inability to recover a body, as happens with soldiers missing in action or some victims of fire or flood
All of these impede mourning and hence halts a bereaved person’s progress towards reaffirmation
Diversity of reactions
Bereaved people depend on the customs and attitudes of their community, as well as on their social network to guide them through their irrational thoughts and grief. Examples of this behavior are:
Mourners who keep the dead person’s possessions (shoes, clothing, etc.)
Mourners who talk to the deceased
Diversity OF REACTIONS (CONT.)
Childhood experiences also affect bereavement:
Adults whose parents died when they were children are more distraught by death
Older adults who were securely attached may be more likely to experience normal grief
Those whose attachment was insecurely-avoidant may experience absent grief
Those who were insecure-resistant may become stuck, unable to find meaning in the living and dying of someone they love and thus perhaps unable to reaffirm their own lives
Research on grief
Reaffirmation does not mean forgetting the dead person; many continuing bonds are evident years after death.
There is a
“…lack of empirical support for the presumed necessity of working though loss (which) has prompted a reversal of the historical trend in bereavement theory; moving away from the traditional focus on severing the attachment bond”
Field & Fredericks, 2006
This implies that bereavement theory once held that everyone should do grief work and then move on realizing that the dead person is gone forever
It was thought that if this type of grieving did not happen, pathological grief could result with the person:
Not grieving enough (absent grief)
Grieving too long (incomplete grief)
Research on grief (cont’d.)
Scientists began new research on mourning with mourners (people who had recently lost a loved one).
Some experienced absent grief, some disenfranchised grief and some were overcome by unremitting sadness many months after the loss - they found that such mourners were not typical and more research was needed.
RESEARCH ON GRIEF (CONT’d.)
A greater variety of grief reactions were evident in longitudinal study that began by interviewing and assessing married older adults living in Detroit. Over several years, 319 became widows or widowers.
Reactions to the spouse’s death were clustered into five categories
50% were resilient. Sad at first but by 6 months they were about as happy and productive as they had been before the death
11% experienced some grief with increased depression for 6 months, but recovery by 18 months
18% were less depressed after the death than before, perhaps because they had been their ill partner’s caretaker
11% were slow to recover, functioning poorly even at 18 months. By 4 years after the death, however, they functioned almost as well as they had before the death
10% were depressed at every assessment before and after the death. If this research had begun only after the death, it might seem that the loss caused the depression,. However, this suggests these people were chronically depressed and not stuck in grief
This research designed to help someone who is grieving or who knows someone in mourning
The first step is to be aware that powerful, complicated and unexpected emotions are likely. A friend should listen and sympathize, never implying that the person is too grief-stricken or not grief-stricken enough
The bereaved person might or might not want to visit the grave, light a candles, cherish a memento, pray or sob
Absent grief is OK and might be appropriate for that individual
The opposite reaction of absent grief, when people want to talk about their loss, gathering sympathy, ascribing blame and finding meaning, may also be appropriate
Emotions in action
Joining a bereavement group
Protesting some government policy
Planting a garden
Running or biking to raise money for some cause
Remember no matter what rituals are followed or what pattern is evident in human reactions to death, the result may give the living a deeper appreciation of themselves as well as the value of human relationships
ng and hence halts a bereaved person’s progress towards reaffirmation
18% were less depressed after the death than before,