DEATH & DYING

Prepared by:
Jonna Karla C. Bien, RN, MP
 DEATH

Death as an
Image/Object
Death as a Statistic
DEATH

Death as an
Event
 DEATH

Death as State of
Being
 DEATH
Death as an
Analogy
 DEATH

Death as a Mystery
 DEATH
Death as a Boundary
Death as a Thief of meaning
 DEATH

Death as Fear
and Anxiety
 DEATH

Death as Reward or Punishment

 DEATH

Death as Reward or Punishment

LEGAL & MEDICAL
DEFINITIONS

CLINICAL DEATH
- lack of heartbeat
- lack of respiration
 LEGAL & MEDICAL
DEFINITIONS

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
 LEGAL & MEDICAL
DEFINITIONS

- 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
 LEGAL & MEDICAL
DEFINITIONS

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

It is possible for a
person’s cortical
functioning to cease
while brainstem
activity continues.

The person does not

recover.
BIOETHICAL ISSUES

EUTHANASIA

- The practice of ending life

for reasons of mercy.
- The act of painlessly
putting to death persons
who are suffering from an
incurable disease or severe
disability.
- Sometimes called “mercy
ACTIVE EUTHANASIA

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:
- Administering a drug overdose
- Disconnecting a life – support system
 PASSIVE EUTHANASIA
- Involves allowing a person to die by withholding
available treatment.

- Example:
- Withholding chemotherapy from a cancer
patient
- Not performing a surgical procedure
- Withdrawing food
 CAUSES OF DEATH &
EXPECTATIONS ABOUT
DEATH

Death can occur at any

point in the human life
cycle.

PRENATAL
DEVELOPMENT
- Miscarriages or
stillborn births

BIRTH PROCESS
 CAUSES OF DEATH &
EXPECTATIONS ABOUT
DEATH

SIDS
Sudden Infant Death Syndrome

- The sudden death of an

apparently healthy infant.
- Usually occurs between 2-4
months of age.
- The infant immediately stops
breathing and the cause is not
yet known.
 CAUSES OF DEATH &
EXPECTATIONS ABOUT
DEATH

CHILDHOOD

- Death occurs most often

because of accidental deaths
(drowning, poisoning, fire,
fall rom a high place,
automobile accidents)

- May also be due to some

illnesses.
 CAUSES OF DEATH &
EXPECTATIONS ABOUT
DEATH
ADOLESCENCE

- Death occurs most often

because of suicide,
motor vehicular
accidents secondary to
alcoholism.
 CAUSES OF DEATH &
EXPECTATIONS ABOUT
DEATH

ADULTS

Younger adults and middle-aged

adults may die of accidents and
diseases.

Younger adults who are dying often

feel cheated more than do older
adults who are dying.
 CAUSES OF DEATH &
EXPECTATIONS ABOUT
DEATH

ADULTS

Younger adults are more

likely to feel they have not
had the opportunity to do
what they want to with their
lives.

They might perceive they

are losing what they might
achieve.
 CAUSES OF DEATH &
EXPECTATIONS ABOUT
DEATH

ADULTS

Older adults are more likely

to die from chronic
diseases.

Their diseases often

incapacitate before they
kill, which produces a
course of dying that slowly
leads to death.
IDEAS ABOUT DEATH THROUGH LIFE
SPAN

INFANTS
Researchers believe that infants
do not have even a rudimentary
concept of death.

As infants develop an attachment

to a caregiver, they can experience
loss or separation and an
accompanying anxiety.

The reappearance of the caregiver

provides a continuity of existence
and a reduction of anxiety.
IDEAS ABOUT DEATH THROUGH LIFE
SPAN
CHILDHOOD

Preschool-age children tend to believe

that death is temporary and magical.

3 – 5 years of age have little or no

idea of what death really means.
They may confuse death with sleep.

They believe that the dead can be

brought back to life spontaneously by
magic or by giving them some food or
medical treatment.
 IDEAS ABOUT DEATH THROUGH LIFE
SPAN

CHILDHOOD

Children’s perception
of death
(Nagy, 1948)

3-5 years of age: Denied

that death exists
6-9 years of age: Believed
that death exists
selectively
9 years & older:
 DEATH & DYING

A child’s experiences of death and loss may

become life-long memories for the adult.

- George Dickinson
 IDEAS ABOUT DEATH THROUGH LIFE
SPAN

FIRST EXPERIENCES

The first tie a child experiences the death of a relative or a

pet, they are vulnerable.

Some find it highly traumatic, whereas others appear less

affected.

Adults must be sensitive to children’s needs at the time of

a death.
How adults handle such situations could later help the
child deal with the death of a relative.
 IDEAS ABOUT DEATH THROUGH LIFE
SPAN

It is important for children to know that it is okay for them to feel

sad, to cry, or to show their feelings in whatever way they want.

This will help children deal with their confusion at adult’s

explanations of death.

Understanding death can be particularly difficult for children

when adults are not open and honest with them.

It is best to deal with children on their terms.

Euphemisms must not be used.
Example: “Mommy is only sleeping”
 IDEAS ABOUT DEATH THROUGH LIFE
SPAN

ADOLESCENCE

They clearly understand the realities of death.

With the onset of formal operational thinking, their understanding of
death becomes eve more adult like.

Adolescents may be more concerned with the quality of their live

than with how long will they live.

Reluctant to discuss death and dying.

They have a sense that they are immortal, that nothing bad will
happen to them.
 IDEAS ABOUT DEATH THROUGH LIFE
SPAN

YOUNG ADULTHOOD

Because young adults are just beginning to pursue the

family, career, and personal goals they have set, they tend
to be more intense in their feelings toward death.

Characterized by a lessening of the feeling of immortality

as young adults begin to integrate personal feeling and
emotions with their thinking.
 IDEAS ABOUT DEATH THROUGH LIFE
SPAN

MIDDLE AGE

Midlife is the time when most people confront the death of

their parents.

People tend not to think much about their own death.

Once their parents have died, people realize that they are now
the oldest generation of their family.

As a result of this growing realization of their own mortality,

middle-aged adults’ sense of time undergoes a subtle yet
profound change.
 IDEAS ABOUT DEATH THROUGH LIFE
SPAN

LATE ADULTHOOD

Older Adults are less anxious about death.

For many adults, the joy of living is

diminishing.

They may feel that their most important life

tasks have been completed.
 UNDERSTANDING
DEATH

FORCES IN ACTION

- Biological forces
- Psychological forces
- Magical Approach (transcendent
and transforming)
 STAGE THEORY OF DYING

Proposed by Elizabeth Kubler-Ross

-Most dying people follow a sequence of emotional
reactions.

FIVE STAGES:

DENIAL
ANGER
BARGAINING
DEPRESSION
ACCEPTANCE
 DENIAL STAGE

- Shock and disbelief

- Normal part of getting ready to die
ANGER STAGE
People Express hostility,
resentment and envy
toward other people.

Expresses great deal of

frustration.

“Why ME?!”

Feels that life is so unfair.

BARGAINING
STAGE

People look for a way

out.

Maybe a deal can be

struck with someone
(perhaps God) to allow
survival
 DEPRESSION STAGE

People feel depressed

when the illness can
no longer be denied.

People experience
feeling of deep loss,
sorrow, guilt and
shame over their
illness and its
consequences.
ACCEPTANCE STAGE

The person accepts the

inevitability of death.

He or she often seems detached

from the world and at complete
peace.

It is as if the pain is gone, the

struggle is over, and there
comes a time for the final rest
before the journey.
 PHASE THEORY OF DYING

Kubler-Ross viewed dying as a series of discrete

stages. In contrast, some writers view dying as a
continuous process.

THREE PHASES:

ACUTE PHASE
CHRONIC LIVING-DYING PHASE
TERMINAL PHASE
 ACUTE PHASE

This begins when the individual becomes

aware that his or her condition is terminal.

Marked by a high level of anxiety, denial,

anger and even bargaining.

In time, the person adjusts to the idea of

being terminally ill, and anxiety gradually
declines.
 CHRONIC LIVING-DYING
PHASE

A person generally has many contradictory

feelings that must be integrated.

Fear of loneliness, fear of the unknown, and

anticipatory grief over the loss of friends, of body,
of self-control, and of identity.

These feelings of fear and grief exist

simultaneously or alternate with feelings of hope,
determination, and acceptance.
 TERMINAL PHASE

The individual starts to withdraw

from the world.
The shortest phase and ends with
death.
 DEATH & DYING

Theories of dying agree that how people deal

with their won death is a complicated process.

Denial and acceptance can take many forms

and may even occur simultaneously.

People must stay in touch with the dying

person’s (and their own) feelings and be
available for support.
 DEATH ANXIETY PERVADES
SOCIETY

People are uncomfortable thinking about their

own death.

A self-reflective exercise on death:

1. In 200 words or less, write your own obituary.
Be sure to include your age and cause of death.
List your lifetime accomplishments. Don’t
forget to list your survivors.
2. Think about all the things you will have done
that are not listed in your obituary. List some of
them.
3. Think of all the friends you will have made and
how you will have affected them.