The Final Passage

Sociocultural Definitions of Death

Different cultures view death in diverse ways
Customs and expectations also differ in
rituals of bereavement and mourning
Even within a culture there is diversity in the
view of death, mourning, and bereavement

There Are at Least 10 Ways Death Can

Be Viewed
Death as an image or
object
Death as a statistic
Death as an event
Death as a boundary
Death as a state of
being

Death as a thief of
meaning
Death as an analogy
Death as fear and
anxiety
Death as reward or
punishment

Legal and Medical Definitions

The traditional definition of clinical death was a lack
of heartbeat and respiration
Today, brain death is the most used definition:
No spontaneous movement to stimulation
No spontaneous respiration for 1 hour
Lack of response to pain
No eye movements, blinking, or pupil responses
No postural activity, swallowing, or yawning
No motor reflexes
A flat EEG for 10 minutes
No change in any of these in 24 hours

Legal and Medical Definitions (Cont)

All eight criteria must be met and other
possible conditions ruled out
In most hospitals, the lack of brain activity
must extend to the brainstem and cortex
Activity only in the brainstem is called a
persistent vegetative state, from which the
person does not recover

Ethical Issues
Bioethics is the study of the combination of
human values and technological advances
Bioethics grew from the increasing concern
for respect for individual freedom and the
difficult task of defining morality in medical
care

Euthanasia
Euthanasia is the practice of ending life for
reasons of mercy
Extends from the advances that allow for
life to be extended by extraordinary means,
and the concern for quality of life and
respect for the individual

Active Euthanasia
Active euthanasia is the deliberate ending of
someones life
Moral and religious concerns are involved in
the issue of active euthanasia
Physician-assisted suicide has become an
increasingly controversial issue
Some states have passed laws specifically
making physician-assisted suicide legal,
others have banned it

Passive Euthanasia
Allowing a person to die by withholding
available treatment is called passive
euthanasia
A survey in England showed that caregivers
agreed that dementia patients should not
receive treatments when critically ill
Most cases of passive euthanasia end up in
court which has asserted that without
advance directives, nourishment cannot be
stopped

Making Your Intentions Known

There are two ways to tell others of your
choice about final decisions
A living will in which a person states their
preferences and intentions in the event
that they may be unable to make their
intentions known
A durable power of attorney names an
individual who will have the legal
authority to make decisions and speak
for the person

A durable power of attorney, like the one shown here, is a way to make you end-of-life wishes
known to others.

A Life Course Approach to Dying

Young adults integrate feeling and emotions
with their thinking about death, lessening their
feelings of immortality
Middle-age adults think about their own death
as they deal with the death of their parents
Older adults are less anxious about death
because of achievement of ego integrity and
because of declining joy of living

Dealing With Ones Own Death

Reactions to impending death can vary in its
development, especially with different causes
of terminal illness
Diseases such as cancer may have a
terminal phase in which a patient may be
able to predict and prepare for death
Some diseases that do not have a terminal
phase may create a condition in which a
persons death could occur at any time

Kubler-Ross Theory
Elisabeth Kubler-Ross began working with
terminally ill patients
During this time, terminally ill patients were
not always told they were dying, and death
was not generally a topic of discussion.
Her research was controversial
Kubler-Ross began to study patients
reactions to their terminal illness and found
that most people experienced certain
emotional states

Kubler-Ross Stages of Dying

Denial: Shock and disbelief

Anger: Hostility and resentment
Bargaining: Looking for a way out
Depression: No longer able to deny, patients
experience sadness and loss
Acceptance: Acceptance of the inevitability of
death with peace and detachment
Though not all people experience all stages in
the same order, discussion of death helps to
move toward acceptance

A Contextual Theory of Dying

Stage theories imply order to the transition
toward acceptance that may not exist
Stage theories do not state what moves a
person through the stages
Observations suggest that people vary greatly
in the duration of a particular stage
There is no single correct way to die
Each persons own view of their death and
need for health care may impact their
movement through the stages

Death Anxiety
Terror management theory asserts that the
continuation of ones life is the primary motive
behind all behavior. Fear of dying is
consistent with this motive
Research suggests that death anxiety
includes pain, body malfunction, humiliation,
rejection, etc. Each of these factors can be
assessed in any of three levels: public,
private, and unconscious

Death Anxiety (Cont)

Death anxiety may be lower in older adults
due to ego integrity and a positive life review.
Emotional problems are predictive of higher
death anxiety

Learning to Deal with Death Anxiety

Adolescents engage in more risk-taking
behavior which suggests less death anxiety
Reduction can be achieved by contemplating
ones own death by writing ones own
obituary, planning ones own funeral, etc.
Death education strives to address death
anxiety by presenting factual information
about death and reducing sensitivity to the
issues involved

Creating a Final Scenario

Discussions of the issues of management of
the final phase of life and the after-death
disposition of their body are called end-of-life
issues
Hospitals and nursing homes teach about
advance directives like durable power of
attorney and living wills
Making ones choices known and providing
information about how one wants their life to
end is called a final scenario

The Hospice Option

An alternative to going to a hospital or
nursing home during a terminal illness is
hospice care. This involves assisting dying
people with pain management and a death
with dignity
The emphasis of hospice is on quality of life
The primary goal of hospice is to make the
person comfortable and peaceful, not to delay
an inevitable death

The Hospice Option (Cont)

St. Christophers Hospice in England was
founded by Dr. Cicely Saunders and is the
model for modern hospices
When no treatment or cure is possible,
hospice care is requested. The family and the
patient is viewed as a unit
May be inpatient or outpatient
An emphasis is placed on patient dignity
Patients show less anxiety and depression

The Hospice Option (Cont)

Key questions about the possible use of hospice
services:
Does the person know the truth about their
condition?
What options are available for patient care?
What are the patients expectations?
How well do the people in the persons social
network communicate?
Are family members available to provide care?
Is a high-quality hospice care program available?

The Grieving Process

Bereavement is the state or condition caused
by loss through death
Grief is the sorrow, hurt, anger, guilt,
confusion, and other feelings that arise after
suffering a loss
Mourning is the way in which we express our
grief
Mourning rituals can be fairly standard across
a culture. Grief varies greatly