Death Dying and grieving (Ch 13)


Defining death and Life/Death issues

brain death  - neurological definition of death that states that a person is brain dead when all electrical activity of the brain has ceased for a specified period of time

brain’s lower portions monitor heartbeat/respiration; when higher brain areas die, person may continue to breathe/have a heartbeat

definition of brain death currently followed by most physicians includes death of higher cortical functions/lower brain stem functions


medical assistance in dying (MAID) or euthanasia - process by which an individual experiencing intolerable suffering incurable medical condition may legally end life with assistance of physician/nurse practitioner 

study: 61% of dying patients in pain in the last year of life; nearly one-third had symptoms of depression and confusion prior to death

for some, good death involves accepting impending death/not feeling like burden to others. Three frequent themes:

preference for dying process (94 percent of reports)

pain-free status (81 percent)

emotional well-being (64 percent) (Meier & others, 2016)

advanced-care planning helps individuals and loved ones make treatment choices known

decision maker designated, loved ones/health-care providers informed of the patient’s preferences (e.g. do-not-resuscitate)

Hospice - program committed to making the end of life as free from pain, anxiety, depression as possible

palliative care - reducing pain and suffering and helping individuals die with dignity

Death in Sociohistorical and cultural contexts

cultural variations characterize the experience of death and attitudes about death

individuals are more conscious of death in times of war, famine and plague

for some, death means loneliness; for others, death is a quest for happiness

in most societies, death is not viewed as the end of existence

Elisabeth Kübler-Ross (1969), divided behaviour and thinking of dying persons into five stages:

Denial and isolation - person denies death is going to happen The

Anger  - person recognizes denial can no longer be maintained; gives way to anger, resentment, rage, envy

Bargaining  - person develops hope death can be postponed

Depression  - person comes to accept the certainty of death

Acceptance - person develops a sense of peace; acceptance of fate; perhaps desire to be left alone; feelings/physical pain may be absent

stages not fixed; may go from denial to anger, back to denial, then depression


Facing one’s own death

perceived control - may work as an adaptive strategy for some older adults who face death. Individuals led to believe they can influence and control events ( prolong their lives) may become more alert and cheerful

denial - way for some individuals to approach death - can be adaptive or maladaptive


Psychologists believe both dying individual/significant others know death is imminent; interact and communicate based on mutual knowledge 

Four advantages of open awareness for the dying individual:

  1. allows individuals to close their lives in accord with their own ideas about proper dying
  2. could complete plans and projects, make arrangements for survivors, participate in decisions about a funeral and burial
  3. opportunity to reminisce/talk with others who have been important to them, and to end life conscious of what life has been like
  4. dying individuals have more understanding of what is happening

Coping with someone else’s death

Death can be powerfully intimate, as in cases of the prolonged death of a spouse from cancer or heart disease or it can be a very sudden shock.

Bereavement encompasses a myriad of complex emotions.

Suicide and accidents are ranked among the top two or three causes of death between the ages of 15 and 44. Indigenous youth suicide five - six times higher than non-Indigenous

Grief is the emotional numbness, disbelief, separation anxiety, despair, sadness and loneliness that accompany the loss of someone we love.

A sense of separation anxiety and loss may continue to the end of one’s life, but most finally come to terms and carry on

Grief from sudden death can strike family members, loved ones, friends, and even communities hard and lead to posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) - mental disorder that often causes vivid nightmares/flashbacks; often creates feelings of nervousness and irritability. Long-lasting PTSD may result in disruptive unhealthy behaviours 

Complicated grief or prolonged grief - sufferers feel numb/detached, believe life is empty without the deceased, feel future has no meaning

Disenfranchised grief - grief that is a socially ambiguous loss that can’t be openly mourned or supported  (ex-spouse, abortion, affair etc.)

impact of death on survivors influenced by circumstances of death and who dies

grieving may stimulate attempt to make sense of their world   

Four meaning-making processes:

  1. sense making (explanations/blame)
  2. benefit finding (possible positive consequences)
  3. continuing bonds (reminiscing, photographs)
  4. identity reconstruction

After death of an intimate partner, many suffer profound grief, may endure financial loss; loneliness; increased physical illness; psychological disorders, including depression 

Lower income / poorer and less educated people who lose spouses tend to be lonelier

Bereaved are also at increased risk for many health problems