Death & Dying

• Clinical Death:

  • Lack of heartbeat
  • Lack of respiration
• Brain Death:

  • No spontaneous movement in response to any stimuli
  • No spontaneous respirations for at least one hour
  • Total lack of responsiveness to even the most painful stimuli
  • No eye movements blinking, or pupil responses
  • No postural activity, swallowing, yawning, or vocalizing
  • No motor reflexes
  • A flat electroencephalogram (EEG) for at least 10 minutes
  • No change in any of these criteria when they are tested again 24 hours later
  • The lack of brain activity must prevail both in the brainstem and in the cortex
• • Brainstem involves the vegetative functions such as heartbeat and respiration
  • Cortex involves higher processes such as thinking
• Persistent Vegetative State:

  • Involves the deliberate ending of someone's life, which may be based on a clear statement of the person's wishes or a decision made by someone else who has the legal authority to do so
  • Examples include administering a drug overdose, disconnecting a life-support system
• Active Euthanasia:

  • Involves allowing a person to die by withholding available treatment
  • Examples include withholding chemotherapy from a cancer patient, not performing a surgical procedure, withdrawing food
• Passive Euthanasia:

  • Death can occur at any point in the human life cycle
  • Examples include miscarriages or stillborn births
• Sudden Infant Death Syndrome (SIDS):

  • The sudden death of an apparently healthy infant
  • Usually occurs between 2 - 4 months of age
  • The cause is not yet known
• Causes of Death & Expectations About Death:

  • Childhood: accidental deaths (drowning, poisoning, fire, fall from a high place, automobile accidents)
  • Adolescence: suicide, motor vehicular accidents secondary to alcoholism
  • Adults: younger adults and middle-aged adults may die of accidents and diseases
  • Older adults: more likely to die from chronic diseases
• Ideas About Death Through Life Span:

  • Childhood: preschool-age children tend to believe that death is temporary and magical
  • Adolescence: clearly understand the realities of death, reluctant to discuss death and dying
  • Young Adulthood: intense feelings toward death, lessening feeling of immortality
  • Middle Age: confront the death of their parents, realization of their own mortality
  • Late Adulthood: less anxious about death, joy of living diminishing
• Forces in Action:

  • Biological forces
  • Psychological forces
  • Magical Approach (transcendent and transforming)
• Understanding Death:

  • Proposed by Elizabeth Kubler-Ross
  • Five stages: Denial, Anger, Bargaining, Depression, Acceptance
• Stage Theory of Dying:

  • Denial Stage: shock and disbelief
  • Anger Stage: hostility, resentment, frustration
  • Bargaining Stage: depression, deep loss, guilt, shame
  • Depression Stage: acceptance, detachment, peace
  • Acceptance Stage: series of discrete stages
• Phase Theory of Dying:

  • Acute Phase: awareness of terminal condition, anxiety, denial, anger, bargaining
  • Chronic Living-Dying Phase: withdrawal from the world
  • Terminal Phase: complicated process of dealing with death, denial and acceptance
• Death & Dying:

  • People are uncomfortable thinking about their own death
  • Self-reflective exercise on death: writing own obituary, reflecting on lifetime accomplishments, considering impact on others