Death and Dying

Development Across the Life Span

• Death is a universal experience, one that we will
all eventually face
• Despite this, the topic has only recently begun to
be studied by developmental psychologists
• Some things that are being explored:
– What is death, and what does it mean at
different life stages?
– How do people face the idea of their own
death?
– How do survivors react to death?
– How can people prepare for and cope with
death?
Defining Death: Determining the Point at Which
Life Ends
• Defining death is a complex process.
• Medicine’s definition changes; people who would
have been considered dead a few years ago now
would be considered alive
 FUNCTIONAL DEATH is the absence of a heartbeat and
breathing.
• NOT as straightforward a definition as it seems!
– People can be resuscitated after they have stopped
breathing.
– People can be kept alive by a machine
 Because of the vagueness of what “functional death”
is, medical doctors now use brain functioning to
determine death

 BRAIN DEATH, where brain activity is

measured, has become the medical
measure of death (no possibility of restoring
brain function).
• There is still some question about using
only brain waves as the death definition.
• It emphasizes only biology not the qualities
that make people human (thinking, feeling,
etc.).
Death Across the Lifespan: Causes & Reactions

• We associate death with old age, but death occurs

throughout the life span.
• Infant and Childhood Deaths: the US has a high infant
mortality rate.
– Parents dealing with infant death have a very hard
time and depression is a common reaction.
– Prenatal death (Miscarriage) is also difficult,
especially since others do not attribute much
meaning to a miscarriage so parents feel isolated.
• In SUDDEN INFANT DEATH SYNDROME (SIDS), a
seemingly healthy baby stops breathing and dies.
• SIDS usually strikes between 2-4 months, suddenly.
• There is no known cause for SIDS so parents often
feel intense guilt (and acquaintances may be
suspicious).
• Accidents are the most frequent cause of death in
childhood but there are a substantial number of
homicides (4th leading cause of death between ages 1
& 9).
• For parents the loss of a child is profound.
• Children do not have a realistic view of death.
• Before age 5, children see death as temporary,
like sleeping.
– Possibility of waking up (like Sleeping
Beauty)
• Misunderstanding may have emotional
consequences
– Kids may blame themselves, their behavior
• By age 5 children have begun to accept death
as universal and final.
 Death in Adolescence
• Adolescents‘ views of death are also unrealistic & often highly
romantic.
– Personal Fable (beliefs that they are unique & special) lead
to a sense of invulnerability
• The most frequent cause of adolescent death is accidents
(usually motor vehicle)
• Other frequent causes include homicide, suicide, cancer, AIDS
• Adolescents tend to feel invulnerable so confronting a terminal
illness can be difficult; they often feel angry and "cheated".
 Death in Young Adulthood
• Death in young adulthood is particularly difficult
because it is the time in life when people feel most
ready to begin their own lives.
• Young adults facing death have several concerns.
• Developing intimate relationships and one's
sexuality.
• Future planning (e.g., marry or not? have children?).
• Like adolescents, young adults are outraged at
impending death and may direct anger toward their
care providers.
 Death in Middle Adulthood
• Life-threatening disease is the most
common cause of death in middle-aged
adults.
• These adults are more aware and
accepting of death but also have a lot of
fears (more than any other time in
lifespan).
• Most frequent causes are heart attack or
stoke - both of which are sudden
 Death in Late Adulthood
• The prevalence of death and losses around
older adults makes them less anxious about
dying than at any other time of life.
• Suicide rate increases with age for men.
• Caucasian men over age 85 have the
highest rate of suicide.
• A major issue for seniors with a terminal
disease is whether their lives still have value
and how much of a burden they are.
Adding Years If the major causes of death in late
adulthood were eliminated, the
average 70-year-old would live
another 7 years.
• Most people know when they are dying; it is caretakers
who tend to have more difficulties communicating about
it.
• Research shows that physicians usually prefer to avoid
telling dying patients that their illnesses are terminal
• Not all people want to know the truth about their condition
or know they’re dying
• Individuals react to death differently, in part due to
personality factors
 A high general anxiety level has been linked to a
higher concern about death
 Cultural differences
 The Stages of Death: Understanding the
Process of Dying
• No researcher has had a greater influence
on our understanding of death and dying
than Elizabeth Kubler-Ross
• Her stage theory of death and dying was
created from extensive interviews with
people that were dying and those that cared
for them
A. Elisabeth Kubler-Ross identified five stages
of coping with death.
 Moving Toward the End of Life

The steps toward death, according to

Elizabeth Kubler Ross (1975)
 Kubler-Ross’ 5 stages of death

1) Denial
• Denial is resisting the whole idea of
death ("No I'm not or she's not").
• Denial is a form of defense
mechanism to allow one to absorb
difficult information at one's own pace
2) Anger
• "Why me/her?" "Why not you?"
• In this stage people may be very difficult to be around.

3) Bargaining
• At this stage individuals are trying to negotiate their way
out of the death.
• Typically, people try to "make deals" with God.
• Sometimes the bargain creates an event or date until
which the person can hold on to (such as a grandchild's
wedding, or a 100th birthday).
 (Kubler-Ross’ 5 stages of death, continued)

4) Depression
• The individual at this stage is overwhelmed
by a deep sense of loss.
• Reactive depression is a type of depression
based on what has already occurred, such
as loss of dignity, health, etc.
• Preparatory depression is the anticipation of
future losses, such as the loss of a
relationship.
 (Kubler-Ross’ 5 stages of death, continued)

5) Acceptance
• People are fully aware that death is
impending
• In this stage individuals near death make
peace with death and may want to be left
alone.
• Persons in this stage are often unemotional
and uncommunicative.
 Criticisms of Kubler-Ross's model
• The theory does not apply to people who are not sure
they are going to die - when the prognosis is
ambiguous.
• The stages are not universal, nor do people go through
them in progression.
• Anxiety, especially about pain, is omitted in her stages
and this is an important concern for cancer patients.
• There are still a lot of differences in peoples' reactions
to death related to family, culture, finances, personality,
etc.
However, Elisabeth Kubler-
Ross is still influential and is
credited with being the first
person to bring the
phenomenon of death into
public awareness.
Choosing the way one dies: people now have choices

 The letters "DNR" (Do Not Resuscitate)

mean that medical personnel should
not go to extraordinary or extreme
efforts to save the terminally ill patient.
• The terms "extraordinary" or "extreme"
are difficult to define.
• No one likes to make this decision.
• It is sometimes difficult to get medical personnel
to follow these directives

– Claim unawareness of wishes

– Intentionally left off chart by medical doctors

• Survey of dying patients

• 1/3 asked not to be resuscitated, but only only

47% of physicians reported knowing their patients
wishes

• Only listed on the charts of 49% of patients

 To gain more control over decisions regarding their death,
increasing numbers of people are signing living wills

• LIVING WILLS, legal documents designating what

medical treatments people want or do not want if
they cannot express their wishes are a method of
letting people gain control over their deaths.
– Often comas are not covered, since they may
be considered "non-terminal".
– Some living wills specify a health-care proxy to
act as a person's representative in making
health-care decisions.
A
Living
Will
 (Choosing death, continued)
 Assisted suicide is a death in which a person provides the
means for a terminally ill patient to commit suicide.
• Dr. Jack Kevorkian is best known for this role and has
been prosecuted in the U.S.
• Laws are more accepting in other countries.
• Assisted suicide is one form of EUTHANASIA, the practice
of assisting terminally ill people to die more quickly.
• Euthanasia is highly controversial since it centers on
decisions about who should control life.
 Decisions About Ending Life…
• Some people argue that we should have the
absolute right to be in control of our own lives
– Freedom as an ideal in our society
– Absolute right to create life (creating children),
why not ending own?
• Opponents
– Morally wrong
– Physicians are not accurate in predicting
outcomes
• SUPPORT Study, next slide
How Long Do “Terminal” Patients Really Live?

SUPPORT study: A significant percentage of a group of 3,693

patients told they had no more than a 50% chance of living
for 6 months survived well beyond this period. Why do you
think this happened?
Caring for the terminally ill: The Place of Death

• Most people in the United States die

in hospitals.
• For the terminally ill, hospitals may
not be the best places to die.
• Hospitals are impersonal, expensive,
and designed to make people better
and many people die alone.
 Several alternatives to hospitalization have become
increasingly popular in the last few decades…
 In HOME CARE, an alternative to the hospital,
people stay in their homes and receive comfort
and treatment from their families and visiting
medical staff.
• Many people prefer to die in familiar
surroundings with the people and things they
have loved around them.
• Home care can be very difficult for the family.
 HOSPICE CARE, care provided for the dying in institutions
devoted to those who are terminally ill.
• The term "hospice" comes from the middle ages where
hospices were places that provided comfort and hospitality to
travelers.
• The focus of hospice care is not to try and cure patient, but to
make their final days pleasant, meaningful, and pain free.
• Some hospice workers allow the terminally ill to live at home.
• Research shows that hospice patients seem to be more
satisfied with their care than hospital patients.
 Grief and Bereavement

~ After the death of a loved one, a painful

period of adjustment follows, involving
bereavement and grief
• BEREAVEMENT is the acknowledgment
of the objective fact that one has
experienced a death.
• GRIEF is the emotional response to that
loss
 There are some general stages people in Western societies
go through in adjusting to loss.
• The first stage typically entails shock, numbness, disbelief, or
outright denial.
– Can be beneficial allows a person to function in coping with
death (funeral, etc.) without being overwhelmed.
• In the second stage, people begin to confront the death and
fully realize the extent of their loss.
– They fully experience their grief and yearn for the
individual.
– Eventually the person moves through the pain and
depression to a realistic review of the relationship and start
to let go.
• In the final stage, people reach an accommodation stage
where they pick up the pieces of their lives and move on.
• Ultimately, most people are able to live new lives,
independently from the person who has died
– Form new relationships
– Become more self reliant and appreciate of life
• Not everyone passes through the stages of grief in the the
same order or in the exact same way
– Personality differences
– Relationship with the deceased
– Opportunities available for continuing their lives
Differentiating Unhealthy Grief from Normal
Grief
~ Differentiating unhealthy grief from healthy
grief is difficult and many of the common
assumptions are wrong.
• There is no time table; many people take
longer than 1 year.
• Not everyone experiences deep depression.
• People who do not show deep initial grief do
not necessarily have problems later
The Consequences of Grief and Bereavement
~ Studies show that people experiencing bereavement and
grief increase their chances of death as much as 7 times
during the first year following the death of a spouse.
• At particular risk are men, but remarriage helps lower the
risk.
• Some factors affecting survivor difficulties are:
• Anxious, lonely, dependent people don't cope as well.
• If the relationship was ambivalent or dependent, there is
poorer adjustment.
• Sudden, unprepared-for deaths are more difficult
 Death Education
Developmental psychologists and thanatologists have
suggested the importance of death education
– THANATOLOGISTS, people who study death, suggest
that death education be part of everyone's schooling
since we are all affected
• DEATH EDUCATION includes programs that teach about
death dying and grief, and are designed to help all people
successfully deal with death and dying
– Important because we hide death in Western societies!
(removed from everyday life because we are
uncomfortable discussing it)
 Several types of death education programs
have been developed…
• Crisis intervention education
– Psychologists and therapists provide counseling intervention
on an emergency basis (Oklahoma City bombing, for example)
• Routine death education
– Course work in grade school, colleges becoming increasingly
common
• Death education for members of the helping professions
– Now increasingly included for medical schools, nursing, etc.
Most successful programs explore feelings, not just
intellectual aspects
 Mourning & Funerals: Final Rites

• Funerals are a big business.

– Average funeral costs $4000.
– Vulnerability of those planning a big
factor
– Social norms and customs also
contribute
• Death represents an important passage
for the individual and the society, so the
associated rite are important.
• Funerals are also recognition of everyone's
ultimate mortality and an acceptance of the
cycle of life.
• Western funeral rituals typically include:
– Preparation of the body
– A religious ritual
– A eulogy
– A procession
– A wake or Shiva
• Military funerals include firing weapons and a flag on
the coffin
• Some cultures have extreme rituals
– Shave their head as a sign of grief, hire mourners to
wail, suttee (Hindu practice where widow threw
herself on the fire that consumed her husband’s
body)
• Funeral patterns are differ in different cultures but all
have the same function: to mark the endpoint of the life
of the person who has died and the starting point for
the survivors, from which they can resume their lives.