DYING AND BEREAVEMENT

Sociocultural Definitions of Death

- Although death is one of the few truly universal experiences, each culture has its own ways of
thinking about, defining, and ritualizing it. All cultures have their own views. Some cultures
ritually pull their hair as a sign of grief. Melanesians have a term, mate, that includes the
extremely sick, the very old, and the dead; the term toa refers to all other living people. Other
cultures believe the life force leaves the body during sleep or illness, or involves reaching a
certain age. Still other cultures view death as a transition to a different type of existence that still
allows interaction with the living, and some believe there is a circular pattern of multiple deaths
and rebirths . In Ghana people are said to have a “peaceful” or “good” death if the dying person
finished all business and made peace with others before death, and implies being at peace with
his or her own death.

Legal and Medical Definition

- Determining when death occurs has always been subjective. For hundreds of years, people
accepted and applied the criteria that now define clinical death: lack of heartbeat and
respiration. Today, however, the definition used in most countries is whole-brain death. In 2010,
the American Academy of Neurology proposed new guidelines for determining brain death. The
goal in this revision of the criteria was to provide guidelines that were based on research.
According to the guidelines, there are three signs that a person's brain has permanently stopped
functioning. First, the person is in a coma, and the cause of the coma is known. Second, all
brainstem reflexes have permanently stopped working. Third, breathing has permanently
stopped, so that a ventilator, or breathing machine, must be used to keep the body functioning.

ETHICAL ISSUE

● BIOETHICS
- Grew from two bases: respect for individual freedom and the impossibility of
establishing any single version of morality by rational argument or common sense. Both of these
factors are increasingly based on empirical evidence and cultural contexts (Priaulx, 2013;
Sherwin, 2011). In practice, bioethics emphasizes the importance of individual choice and the
minimization of harm over the maximization of good.
-In the arena of death and dying, the most important bioethical issue is euthanasia.

● EUTHANASIA
-Active euthanasia involves the deliberate ending of someone’s life, that may be
based on a clear statement of the person’s wishes or be a decision made by someone else who
has the legal authority to do so.
-Passive euthanasia, involves allowing a person to die by withholding available
treatment.

● PHYSICIAN-ASSISTED SUICIDE
 -Process in which physicians provide dying patients with a fatal dose of medication
that the patient self-administers.
-Several countries—including Switzerland, Belgium, the Netherlands, and
Colombia—have legalized physician-assisted suicide. In Netherlands has five criteria
must be met before a terminally ill person can request physician-assisted suicide as an
option:

1. The patient’s condition is intolerable with no hope for improvement.

2. No relief is available.
3. The patient is competent.
4. The patient makes a request repeatedly over time.
5. Two physicians review the case and agree with the patient’s request.

● THE PRICE OF LIFE-SUSTAINING CARE

-A growing debate in the United States, particularly in the aftermath of the Affordable
Care Act passed in 2010, concerns the financial, personal, and moral costs of keeping
people alive on life-support machines and continuing aggressive care when people have
terminal conditions. Debate continues on whether secondary health conditions in
terminally ill people should be treated.

A LIFE-COURSE APPROACH TO DYING

-Midlife is the time when most people in developed countries confront the death of
their parents. Until that point, people tend not to think much about their own death; the fact their
parents are still alive buffers them from reality. After all, in the normal course of events, our
parents are supposed to die before we do. Once their parents die, people realize they are now
the oldest generation of their family—the next in line to die. Reading the obituary pages, they
are reminded of this, as the ages of many of the people who died get closer and closer to their
own.

DEATH ANXIETY
-Death anxiety refers to people’s anxiety or even fear of death and dying. Death anxiety is tough
to pin down; indeed, it is the ethereal, unknown nature of death, rather than something about it
in particular, that makes us feel so uncomfortable.

TERROR MANAGEMENT THEORY

-Terror management theory addresses the issue of why people engage in certain
behaviors to achieve particular psychological states based on their deeply rooted concerns
about mortality.
Learning to Deal with Death Anxiety
These questions serve as a basis for an increasingly popular way to reduce anxiety:

“What circumstances would help make my death acceptable?”

“Is death the sort of thing that could happen to me right now?”

End-of-Life Issues

-When given the chance, many adults would like to discuss a variety of issues, collectively
called end-of-life issues: management of the final phase of life, after-death disposition of their
body, memorial services, and distribution of assets (Moeller et al., 2010).
-Making such choices known about how they do and do not want their lives to end constItutes a
final scenario.

HOSPICE OPTION

-Hospice is an approach to assist dying peo-ple emphasizing pain management, or palliative

care, and death with dignity. The emphasis in a hospice is on the dying person’s quality of
Life.

-An approach to care based on an ethic of controlling and relieving pain or other symptoms and
not on attempting to cure disease is called palliative care. Hospice is the leading provider of
such care,but palliative care is also adopted in other settings.

Hospice is the leading provider of such care,but palliative care is also adopted in other settings.
The differences are evident in the principles that underlie hospice care (Knee, 2010):

● Clients and their families are viewed as a unit, clients should be kept free of pain, emotional
and social impoverishment must be minimal;

● Clients must be encouraged to maintain competencies, conflict resolution and fulfillment of

realistic desires must be assisted; and

● Clients must be free to begin or end relationships, an interdisciplinary team approach is used,
and staff members must seek to alleviate pain and fear.

Two types of hospices:

- Inpatient hospices provide all care for clients.
- Outpatient hospices provide services to clients who remain in their own homes.

Families should ask several key questions:

● Is the person completely informed about the nature and prognosis of his or her condition? Full
knowledge and the ability to communicate with healthcare personnel are
essential to understanding what hospice has to offer.

● What options are available at this point in the progress of the person’s disease? Knowing
about all available treatment options is critical. Exploring treatment options also requires
healthcare professionals to be aware of the latest approaches and be willing to disclose them.
● What are the person’s expectations, fears, and hopes? Some older adults, like Jean,
remember or have heard stories about people who suffered greatly at the end of their
lives. This can produce anxiety about one’s own death. Similarly, fears of becoming
dependents play an important role in a person’s decision making. Discovering and discussing
these anxieties help clarify options.

● How well do people in the person’s social network communicate with each other? Talking
about death is taboo in many families. In others, intergenerational communication is
difficult or impossible. Even in families with good communication, the pending death
of a loved relative is difficult. As a result, the dying person may have difficulty express-
ing his or her wishes. The decision to explore the hospice option is best made when it
is discussed openly.

● Are family members available to participate actively in terminal care? Hospice relies
on family members to provide much of the care that is supplemented by professionals
and volunteers. Having a family member who is willing to accept this responsibility is essential
for the hospice option to work.

● Is a high-quality hospice care program available? Hospice programs are not uniformly
good. As with any healthcare provider, patients and family members must investigate
the quality of local hospice programs before making a choice.

● Is hospice covered by insurance? Hospice services are reimbursable under Medicare in

most cases, but any additional expenses may or may not be covered under other forms
of insurance.

Making Your End-of-Life Intentions Known

There are two ways to make one’s intentions known:

1. In a living will, a person simply states his or her wishes about life support and other
treatments.
2. In a healthcare power of attorney, an individual appoints someone to act as his or her
agent for healthcare decisions

-A do not resuscitate (DNR) order means cardiopulmonary resuscitation (CPR) is not started
should one’s heart and breathing stop.

Patient Self-Determination and Competency Evaluation

To aid healthcare providers in this process, the Patient Self-Determination Act, passed in 1990,
requires most healthcare facilities to provide information to patients in writing that they have the
right to:

● Make their own healthcare decisions.

● Accept or refuse medical treatment.
● Make an advance healthcare directive.

There are two types of determination:

1. the capacity to make decisions, that is a clinical determination.
2. a com-petency decision, made legally by the court.

Surviving the Loss: 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 concerns the ways we express our grief.

The Grief Process

● Acknowledge the reality of the loss. We must overcome the temptation to deny the
reality of our loss; we must fully and openly acknowledge it and realize it affects every
aspect of our life.

● Work through the emotional turmoil. We must find effective ways to confront and
express the complete range of emotions we feel after the loss and must not avoid or repress
them.

● Adjust to the environment where the deceased is absent. We must define new patterns of
living that adjust appropriately and meaningfully to the fact the deceased is not present.

● Loosen ties to the deceased. We must free ourselves from the bonds of the deceased in order
to reengage with our social network. This means finding effective ways to say
good-bye.

GROUP MEMBERS: G9
Nujapa, Fevelyn
Pamen, Winsome
Sorvida, Mark Andrey