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KKD 3103
HUMAN GROWTH AND DEVELOPMENT

THE FINAL PASSAGE

Chapter 16

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 OUTLINE
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1) Socialcultural definitions of death

2) Legal and medical definitions
3) Ethical issues
4) A life-course approach to dying
5) Dealing with one’s own death
6) Death anxiety
7) Creating a final scenario
 OUTLINE (continue)
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8) The hospice option

9) The grief process
10) Normal grief reactions
11) Coping with grief
12) Complicated or prolonged grief disorder
13) Dying and bereavement experiences across
the lifespan
 [1] SOCIOCULTURAL DEFINITIONS OF DEATH
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 Cultures differ in how they view and deal with

death
 Criteria for a “good” vs. “bad” death
 Funeral customs
 Death icons
 Mourning and bereavement rituals
 The “afterlife”
 How do you view death?
 Legal and Medical Definitions
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 Clinical death: lack of heartbeat and respiration

traditionally signified death
 Today, whole brain death is required
 No spontaneous movement to stimulation; no
spontaneous respiration for more than one hour
 Lack of response to even extreme pain
 No eye movements
 Legal and Medical Definitions (cont’d.)
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 No swallowing, yawning, or vocal or postural activity

 No motor reflexes
 A flat EEG for at least 10 minutes
 No change in any of these after a 24-hour retest
 Legal and Medical Definitions: Requirements
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 All eight criteria must be met

 Must rule out conditions mimicking death
 In most hospitals, the lack of brain activity must
extend to the brainstem (vegetative functions) and
cortex (higher processes)
 Persistent vegetative state: irreversible lack of
cortical functioning, but continued brainstem
activity
 Cannot be ruled dead
 Presents ethical dilemmas
 [2] ETHICAL ISSUES
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 Bioethics: study of interface between human values

and technological advances in the health and life
sciences
 Grew out of respect for individual freedom and the
difficulty of establishing what is moral through
common sense or rational argument
 Decisions must:
 Honor the importance of individual choice
 Weigh a treatment’s relative benefit vs. harm to a patient
 Euthanasia
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 Euthanasia: merciful ending of life

 Poses the moral dilemma of deciding under which
circumstances to end a person’s life
 Must consider the morality of “killing” a person vs.
“letting” the person die
 Dilemma often arises when the person
 is being kept alive by a machine
 suffers from a terminal illness
 Active and Passive Euthanasia
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 Active euthanasia: deliberately ending life (e.g., by a

drug overdose)
 Based on person’s clear statement of this desire; made by
someone in legal authority
 Passive euthanasia: allowing a person to die by not
giving available treatment (e.g., withholding a cancer
patient’s chemotherapy)
 Validity of this distinction is actively debated
 Both raise moral and religious concerns and are highly
politicized
 Physician-Assisted Suicide
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 Oregon and Washington passed laws allowing

physician-assisted suicide
 Require physicians to inform of terminal illness and
to describe alternative options
 Give people the right to self-administer lethal doses
obtained by prescription
 Require people to be mentally competent, to make
two oral requests separated by 15 or more days, and
to make a written request
 [4] A LIFE-COURSE APPROACH TO DYING
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 The shift from formal-operational to postformal

thinking helps young people integrate
emotions/thoughts about death
 Parents’ death helps middle-aged adults think about
their own death
 Older adults are generally less anxious about death and
accept it more
 Attachment theory is the best framework for
understanding how adults deal with death and how
they grieve
 [5] DEALING WITH ONE’S OWN DEATH
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 Dying “trajectories” vary across diseases, causing

different reactions to impending death
 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 person’s death could
occur at any time
 Kübler-Ross’s Theory
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 Elisabeth Kübler-Ross pioneered stages in the

dying process beginning with her 1960s’ interviews
with terminally ill patients, who
 Were not always told they were dying
 Experienced five distinct emotional reactions
 The five reactions can overlap, unfold in different
sequences; there are individual differences in each
stage’s duration and each emotion’s intensity
 Kübler-Ross’s Stages of Dying
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 Denial: shock, disbelief

 Anger: hostility, resentment (“Why me?”)
 Bargaining: looking for a way out
 Depression: no longer able to deny, patients
experience sorrow, loss, guilt, and shame
 Acceptance: acceptance of death’s inevitability
with peace and detachment
 Discussion of death helps to move toward
acceptance
 A Contextual Theory of Dying
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 Stage theories do not state what moves a person

through the stages
 There is no single correct way to die
 People vary in how they approach Corr’s four
“tasks” or issues for the dying
 Bodily needs
 Psychological security
 Interpersonal attachments
 Spiritual energy and hope
 [6] DEATH ANXIETY
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 Death anxiety: diffuse anxiety about death

 Terror management theory: our deeply rooted fear
of mortality makes not dying the primary motive
underlying all behaviors
 Older adults represent existential threats to younger
and middle-aged adults
 Death anxiety consists of several components
 Men have more death anxiety than women
 Women are more fearful of the dying process
 Learning to Deal with Death Anxiety
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 Enjoy what you do have without many regrets

 Adolescent risk-taking is correlated with less death
anxiety
 Increasing one’s death awareness (e.g., writing
one’s obituary, planning one’s funeral)
 Death education can significantly reduce fear
 Presents factual information about death, dying, and
advanced directives; increases sensitivity to others
dealing with death
 [7] CREATING A FINAL
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SCENARIO
 End-of-life issues: discussing and formalizing
management of life’s final phases, after-death
disposition of one’s body, and lawful distribution of
assets (e.g., through a will)
 Baby-boomers are far more proactive and matter-of-
fact about these issues
 Final scenario: making one’s choices known and
providing information about how one wants his/her
life to end, including the process of separating from
family and friends
 [8] THE HOSPICE OPTION
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 Hospice: assisting dying people with pain

management and a dignified death (as opposed
to hospitals or nursing homes)
 Provide palliative care: focused on relief from pain
or other disease symptoms
 Emphasize quality of life
 Goal is to make the person comfortable and
peaceful, but not to delay an inevitable death
 Making End-of-Life Intentions Known
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 Living will: stating one’s wishes about life

support and other treatments
 Durable power of attorney for healthcare: person
appoints someone to act as an agent for his/her
healthcare decisions
 Life-support interventions when the person is
unconscious or otherwise incapable of expressing
wishes
 Organ donation and other healthcare options
 Making End-of-Life Intentions Known: The DNR
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 Do not resuscitate (DNR): should the heart or

breathing stop, there is to be no cardio or
pulmonary resuscitation
 Inform medical personnel that you have a DNR
 Let your relatives know what your wishes are and
where you keep all relevant documents
 [9] THE GRIEVING PROCESS
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 Bereavement: the state or condition caused by loss

through death
 Grief: the sorrow, hurt, anger, guilt, confusion, and
other feelings that arise after suffering a loss (varies
greatly)
 Mourning: culturally approved ways in which grief
is expressed (fairly standard within a culture)
 The Grieving Process
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 Grief involves choices in how we cope and actively

involves:
 Acknowledging the loss’s realty
 Working through the emotional turmoil
 Adjusting to an environment where the deceased is
absent
 Loosening ties to the deceased
 The Grieving Process (cont’d.)
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 Grief is a process
 No two people grieve alike
 We must not underestimate how long people need to
deal with various issues (at least 1 year is needed
and 2 years are not uncommon)
 We learn to live with the loss and move on, rather
than “recovering” from it
 Risk Factors in Grief
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 Purported risk factors are kinship relationship,

social support, mode of death, age, personality,
religiosity, and gender
 Older people suffer fewer health problems, but
social support reduces this age effect
 Anticipatory grief: going through a period of
anticipating a loved one’s death, which supposedly
buffers its impact
 [10] NORMAL GRIEF
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REACTIONS
 Grief reactions vary in intensity, such as sadness-
anger-hatred, confusion-helplessness-emptiness,
loneliness-acceptance-relief
 Most common are sadness, denial, anger, loneliness,
and guilt
 Grief work: psychological facets of coming to
terms with bereavement
 People need space and time, and others should give
them these
 Normal Grief Reactions: Five Themes of Grief and
the Anniversary Reaction
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 Five themes of grief

 Coping: what people do to deal with grief
 Affect: emotional reactions and triggers
 Change: how life changes, including growth
 Narrative: survivors’ stories about deceased
 Relationship: kind of person the deceased was and
survivor’s ties with him/her
 Normal Grief Reactions:
Physiological Reactions
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 Physiological reactions to grief?

 Widows: sleep, neurological, and circulatory problems
 Illness, declining physical health and use of services
 Severe depression in some cases, which SSRIs can
help
 Normal Grief Reactions: Expressions of Grief
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 Expressions of grief differ with ethnicity and

culture
 Ex.: Latino – more than European-American men –
express grief behaviorally
 Some cultures construct a “relationship” with the
deceased (e.g., “ghosts,” appearances in dreams)
 Grief normally peaks 6 months after death, but
can continue 5 and even 50 years later
 [11] COPING WITH GRIEF
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 Four-component model
 The context of the loss
 The continuation of subjective meaning associated
with loss
 The changing representations of the lost relationship
over time
 The role of coping and emotion-regulation
processes
 Coping with Grief
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 Dual-process model (DPM)

 Loss-oriented stressors: stressors related to the loss
itself (e.g., grief work)
 Restoration-oriented stressors: stressors present when
adapting to the survivor’s new life situation (e.g.,
finding new relationships and activities)
 Dynamic process in which bereaved cycle back and
forth between the two processes, ultimately balancing
the two
 More on the Four-Component Model
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 Two implications of four-component model

 A need to make meaning from the loss
 Extensive grieving is helpful, whereas avoiding
grieving is harmful
 Grief work as rumination hypothesis: extensive
rumination may actually increase distress
 Resilient people use effective coping methods, such
as automated processes (distraction, attending to
positive emotions)
 [12] COMPLICATED OR PROLONGED GRIEF
DISORDER
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 Two types of distress distinguish this disorder

from normal grief and depression
 Separation distress: isolation; preoccupation with,
upsetting memories of, longing for the deceased to
the point of interfering with everyday functioning
 Traumatic distress: disbelief and shock about the
death, experiencing the deceased’s presence;
mistrust, anger, and detachment from others
 [13] DYING AND BEREAVEMENT
EXPERIENCES ACROSS THE LIFESPAN
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 Childhood
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 Preschoolers: death is temporary and magical

 5-7 years: death is permanent, eventually
happens to everyone; reflects the shift to
concrete-operational thought
 Older children: problem-focused coping and a
better sense of personal control appears
 Children flip back and forth between grief and
normal activity
 Adolescence
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 40-70% experience the loss of a family member or

friend during the college years
 Their first experience of death is particularly
difficult and its effects severe, especially if
unexpected
 Chronic illness, lingering guilt, low self-esteem, poorer
school & job performance, substance abuse,
relationship problems, and suicidal thinking
 Adulthood
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 Young adults may feel that those who die at this

point are cheated out of their future
 Loss of a partner in young adulthood is very
difficult because the loss is so unexpected; grief
can last for 5-10 years
 Losing a spouse in middle adulthood results in
challenging basic assumptions about self,
relationships, and life options
 Death of One’s Child in Young Adulthood
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 Mourning is intense; some never reconcile the

loss, and parents may divorce
 Young parents who lose a child to SIDS report
high anxiety, more negative view of the world,
and guilt
 Loss of a child during childbirth is traumatic due
to strong attachment, even though society expects
a quick recovery
 Death of One’s Child in Middle Adulthood
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 Middle-aged parents’ loss of a young adult child is

equally devastating, causing anxiety, problems
functioning, and difficulties in relationships with
surviving siblings
 Death of One’s Parent
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 When a parent dies, the loss hurts but also causes

the loss of a buffer between ourselves and death
 Death of a parent may result in a loss of a source
of guidance, support, and advice
 The loss of a parent may result in complex
emotions including relief, guilt, and a feeling of
freedom
 Losing a parent due to Alzheimer’s disease may
feel like a second death
 Late Adulthood
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 Older adults are often less anxious about death and

more accepting of it
 Elders may feel that their most important life tasks
have been completed
 Older adults are more likely to have experienced
loss before
 Death of One’s Child or Grandchild in Late Life
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 Older bereaved parents may feel guilty about how

their pain about losing one child affected
relationships with surviving children
 Many grieving parents report that the relationship
with the deceased child was the closest they ever
had
 Bereaved grandparents tend to hide their grief
behavior in an attempt to shield the grieving
parents from more pain
 Death of One’s Partner
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 U.S. society expects the surviving spouse to mourn

briefly, but older bereaved spouses may grieve for
30+ months
 Depressed survivors’ memories of the relationship
are positively biased, whereas those of the non-
depressed are more negative (may reflect pre-death
quality of the relationship)