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A Topical Approach to
LIFE-SPAN DEVELOPMENT
Chapter Seventeen:
Death, Dying, and
Grieving
John W. Santrock
© 2010 The McGraw-Hill Companies, Inc. All rights reserved.
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The Death System and Cultural Contexts
• Components of the system
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People: involvement of self and others
Places or contexts
Times
Objects: associated with death (e.g. caskets)
Symbols: last rites, arm bands, etc.
• Most societies have
– Philosophical/religious beliefs, rituals/rites
© 2010 The McGraw-Hill Companies, Inc. All rights reserved.
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The Death System and Cultural Contexts
• Cultural variations of the death system
– Death not as common in United States as
elsewhere
• Conditioned early in life to live as if immortal
– Other countries
• Daily death on streets of Calcutta, India
• African villages — death by disease and malnutrition
• Young orphans from tsunami in Indonesia
– Individuals more conscious of health and death in
times/places of war, poverty, disease
© 2010 The McGraw-Hill Companies, Inc. All rights reserved.
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The Death System and Cultural Contexts
• Cultural variations of the death system
– Some members of society
• Embrace death
• Fear it, see it as punishment
– Death can mean
• Loneliness, happiness, redemption
– Most societies do not view death as an end to life
• Gond culture of India
• Tanala culture of Madagascar
© 2010 The McGraw-Hill Companies, Inc. All rights reserved.
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The Death System and Cultural Contexts
• Cultural variations of the death system
– U.S. Denial and Avoidance of Death
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Funeral industry emphasizes lifelike qualities
Euphemisms — softening language for death
Persistent search for “fountain of youth”
Rejection and isolation of aged
Concept of pleasant and rewarding afterlife
Medical emphasis — prolonging life, not easing suffering
© 2010 The McGraw-Hill Companies, Inc. All rights reserved.
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The Death System and Cultural Contexts
• Changing Historical Circumstance
– Death becoming increasingly complex
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When to determine death has occurred
Life expectancy has increased
Most die apart from families
Care for dying shifted away from family
Minimized exposure to death and its pain
© 2010 The McGraw-Hill Companies, Inc. All rights reserved.
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Defining Death and Life/Death Issues
• Issues in Determining Death
– Brain death — neurological definition of death
• All electrical activity of brain has ceased for a
specified period of time
• Flat EEG recording
• Some medical experts argue criteria for death
should include only higher cortical functioning
© 2010 The McGraw-Hill Companies, Inc. All rights reserved.
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Defining Death and Life/Death Issues
• Issues in Determining Death
– Natural Death Act and Advanced directive
• Patient in coma, living will
• Physicians concerns over malpractice lawsuits
– Euthanasia: painless ending, “mercy killing”
– Passive euthanasia: withholding treatments or
life sustaining equipment
– Active euthanasia: deliberately induced
© 2010 The McGraw-Hill Companies, Inc. All rights reserved.
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Defining Death and Life/Death Issues
• Issues in Determining Death
– Technical advances and issues of quality of life
• Terri Schiavo case
• Extraordinary medical procedures that may be used to
sustain life when medical situation becomes hopeless
– Publicized controversy: assisted suicide
• Dr. Jack Kavorkian in Michigan
• Legal in State of Oregon
• Legal in Netherlands and Uruguay
© 2010 The McGraw-Hill Companies, Inc. All rights reserved.
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Defining Death and Life/Death Issues
• Needed: Better Care for Dying Individuals
– Death in United States: often lonely, prolonged,
painful
– Plan for a “good” death
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Make a living will
Give someone power of attorney
Give your doctor specific instructions
Discuss desires with family and doctor
Check insurance plan coverage
© 2010 The McGraw-Hill Companies, Inc. All rights reserved. 10
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Defining Death and Life/Death Issues
• Needed: Better Care for Dying Individuals
– Hospice — humanized program committed to
making the end of life as free from pain, anxiety,
and depression as possible
• Palliative care — reducing pain and suffering and
helping individuals die with dignity
• Movement rapidly growing in United States
• 90% of care in person’s home
• Aided by Visiting Nurse Associations
© 2010 The McGraw-Hill Companies, Inc. All rights reserved. 11
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A Developmental Perspective on Death
• Causes of death
– Death can occur at any point in human life span
• Prenatal — miscarriage, stillborn
• Infants — SIDS: leading cause of infant death in United
States
• Childhood — accidents or illness
• Adolescence — motor vehicle accidents, suicide, and
homicide
• Older adults — chronic diseases
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A Developmental Perspective on Death
• Attitudes toward death at different points in
the life span
– Honesty may be best way to discuss death with
children
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Don’t see death same as adults do; don’t understand it
About age 9 — sees finality and universality of death
Explain in simple physical/biological terms to preschooler
Be sensitive/sympathetic, encourage feelings/questions
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A Developmental Perspective on Death
• Attitudes toward death at different points in
the life span
– Adolescents
• Often view death as remote idea; not relevant to them
• Some show concern for death; seeking meaning
• More abstract in conceptions than children
– Death described in terms of darkness, transition, etc.
• Develop religious and philosophical views of death and
life afterwards
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A Developmental Perspective on Death
• Attitudes toward death at different points in
the life span
– Adulthood
• Middle-aged adults fear death more than young adults or
older adults; older adults think about death more
• Increased awareness accompanies aging
• Older adults think and talk about it more in conversations
– Experience it more directly through loss of friends
• Older dying adults – accepting; younger dying adults feel
cheated
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A Developmental Perspective on Death
• Attitudes toward death
– Suicide
• Many factors create risks of suicide
• Cultural differences in suicide exist
• Gender:
– Highest female rates in Sri Lanka and China
– Lowest female rates in Caribbean, Egypt, Syria
– Highest male rates in Lithuania and Russia
– Lowest male rate in Dominican Republic
© 2010 The McGraw-Hill Companies, Inc. All rights reserved. 16
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Suicide Risk Factors
• Serious physical illness
• Feelings of disparity,
isolation, failure, loss
• Serious financial
problems
• Drug use or prior suicide
attempts
• Antidepressant links
• Rare in childhood, risk
increases in adolescence
• Most adolescent attempts
fail
• Linked to genetic and
situational factors
• Gay and lesbian links not
clear
© 2010 The McGraw-Hill Companies, Inc. All rights reserved. 17
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A Developmental Perspective on Death
• Attitudes toward death
– Suicide in adolescence
• Third leading cause of death in ages10-19
• 17% of high school students seriously considered or tried
suicide in last twelve months
• Females more likely to attempt it, males more successful
at attempts
• Males use more lethal means
• Female Native Americans have highest risk; while
females have lowest risk
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A Developmental Perspective on Death
• Attitudes toward death
– Adulthood and aging
• Stable rates in early, middle adulthood; increases in late
adulthood
• Highest rates among white older males
• Male rates higher than female rates
• Older adults
– Less likely to tell about suicide plans
– More successful attempts
– Use more lethal weapons
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Facing One’s Own Death
• Knowledge of death
– Most dying individuals want to make decisions
regarding their life and death
• Complete unfinished business
• Resolve problems and conflicts
• Put their affairs in order
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Facing One’s Own Death
• Kubler-Ross’ stages of dying
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Denial and isolation: denial of coming death
Anger: denial turns to anger, resentment, rage
Bargaining: hopes death can be postponed
Depression: accepts certainty of one’s death
Acceptance: develops sense of peace and may
desire to be left alone
© 2010 The McGraw-Hill Companies, Inc. All rights reserved. 21
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Facing One’s Own Death
• Kubler-Ross’ stages of dying
– Criticisms of her work: stages may be reactions
• Can experience many emotions at once
• Emotions wax and wane
– How one lived determines how one accepts death
– Spirituality buffers severe depression
• As one nears death, s/he becomes more spiritual
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Facing One’s Own Death
• Perceived control and denial
– Perceived control is adaptive strategy
• When individuals believe they can influence and control
events, they may become more alert and cheerful
• Denial can be adaptive or maladaptive
– The Contexts in Which People Die
• Most would rather die at home but worry over being a
burden, limited space, altering relationships, competency
and availability of emergency medical treatment
© 2010 The McGraw-Hill Companies, Inc. All rights reserved. 23
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Coping with the Death of Someone Else
• Communicating with a dying person
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Establish your presence, eliminate distraction
Limit visit time, don’t insist on acceptance
Allow expressions of guilt or anger
Discuss alternatives, unfinished business
Ask if there is anyone s/he would like to see
Encourage reminiscing, express your regard
Talk with the individual when s/he wishes to talk
© 2010 The McGraw-Hill Companies, Inc. All rights reserved. 24
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Coping with the Death of Someone Else
• Grieving
– Grief: emotional numbness; a complex emotional
state of…
• Disbelief, despair, separation anxiety
• Sadness, loneliness
• More a roller-coaster of ups and downs than progressive
stages
• Becomes more manageable over time
– Prolonged grief
– Disenfranchised grief
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Coping with the Death of Someone Else
• Models of Coping
– Dual-process model for effective coping
• Loss-oriented stressors
• Restoration-oriented stressors
– Coping and type of death
• Sudden or violent deaths have more intense and
prolonged effects
• Many such deaths accompanied by PTSD
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Coping with the Death of Someone Else
• Cultural diversity in healthy grieving
– Persistent holding on to deceased may be
therapeutic
• Hopi of Arizona forget quickly
• Egyptians dwell on grief
• Bali – mourners encouraged to be joyful and laugh
– Healthy coping involves
• Growth
• Flexibility
• Appropriateness within the cultural context
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Coping with the Death of Someone Else
• Making Sense of the World
– Grieving stimulates many to try to make sense of
their world — positive themes linked to hopeful
future and better adjustment
– Effort to make sense of it pursued more vigorously
when caused by an accident or disaster
© 2010 The McGraw-Hill Companies, Inc. All rights reserved. 28
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Coping with the Death of Someone Else
• Making Sense of the World
– Grieving stimulates many to try to make sense of
their world — positive themes linked to hopeful
future and better adjustment
– Effort to make sense of it pursued more vigorously
when caused by an accident or disaster
© 2010 The McGraw-Hill Companies, Inc. All rights reserved. 29
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Coping with the Death of Someone Else
• Losing a Life Partner
– Those left behind after the death of an intimate
partner suffer profound grief and often endure
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Financial loss
Loneliness linked to poverty and education
Increased physical illness
Psychological disorders, including depression
© 2010 The McGraw-Hill Companies, Inc. All rights reserved. 30
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Coping with the Death of Someone Else
• Adjustment to Widowhood
– Women live longer
– Widowed men more likely to remarry
– Measures of older women’s health
• Physical and mental health
• Health behaviors and outcomes
– Overall, women adjust better than men
• Older widows do better than younger widows
• Support programs aid adjustment
© 2010 The McGraw-Hill Companies, Inc. All rights reserved. 31
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Coping with the Death of Someone Else
• Forms of mourning
– Approximately 67% of corpses are disposed of by
burial, the remaining 33% by cremation
– Funeral industry is source of controversy
– Funeral is important aspect of mourning in many
cultures
– Cultures vary in how they practice mourning
© 2010 The McGraw-Hill Companies, Inc. All rights reserved. 32
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Coping with the Death of Someone Else
• The Amish, Traditional Judaism, and
Mourning
– Amish
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Conservative group; family-oriented society
Live same unhurried pace as ancestors
Time of death met with calm acceptance
Neighbors notify community; funeral at home
High level of support to family for one year
© 2010 The McGraw-Hill Companies, Inc. All rights reserved. 33
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Coping with the Death of Someone Else
• The Amish, Traditional Judaism, and
Mourning
– Traditional Judaism
• Mourning in graduated time periods; each with
appropriate practices
• First period: Aninut — between death and burial
• Second period: Avelut period — mourning proper
– Shivah period — seven-day begins at burial
– Sheloshim period — thirty-day period after burial
– Mourning for parents lasts another eleven months
© 2010 The McGraw-Hill Companies, Inc. All rights reserved. 34
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The End
© 2010 The McGraw-Hill Companies, Inc. All rights reserved. 35
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