Death, Dying, and Bereavement
Thanatology is the study of “death and dying, especially of the social and emotional aspects” (Berger, 2010, p. 565). Death actually consists of three stages: 1) a person can be successfully resuscitated from clinical death (cessation of breathing and heart rate), whereas 2) brain death means that the person’s body can be kept alive, even while he/she is in a vegetative state. 3) The third stage, organ death, means that the tissues and organs have deteriorated past the point of no return (“First Aid Topics,” 2010). Since 1980, brain death has been the favored definition of death (Corr, Nabe, & Corr, 2005; Berger, 2010).
Several authors have written of people’s attempts to delay/forestall death (for example, see Becker’s Pulitzer-prize-winning book, The Denial of Death). One controversial attempt to cheat death is cryonics, in which a person’s body is frozen and preserved shortly after death. As of August, 2010, 98 humans and 62 pets have been placed in cryostasis (Cryonics Institute, 2010). To avoid controversies like the Terri Schiavo case (Terri Schindler Schiavo Foundation, 2010) or the “mercy killings” (also called physician-assisted suicides) of Dr. Jack Kevorkian (“Jack Kevorkian,” 2008), each person could draw up a living will. Passive euthanasia (allowing the patient to die with DNR − Do Not Resuscitate − instructions) can be mandated by a living will; however, active euthanasia (actively ending the patient’s life to prevent further suffering) is currently considered murder in all states except Oregon (Corr et al., 2000).
Many societies believe in an afterlife, and nearly all religions have customs and rituals associated with death. Many people have reported near-death experiences (NDEs), where they report that they have actually gone to their next destination before being resuscitated. Examples of books in this area include Raymond Moody’s (2005) Life After Life and Don Piper’s (2004) 90 Minutes in Heaven (Piper & Murphy, 2004). Frequently, people who experience NDE’s experience a sense of well being, detachment from their physical body, and, in some cases, a light (Corr, et al., 2000). However, not all visits to the afterlife are pleasant; one nursing student at Grand Canyon University shared an experience of witnessing a clinically-dead hospital patient suddenly sit up and scream, “I’m burning! I’m burning!” He then collapsed back onto the bed, dead (Dr. Larry Barron, personal communication, 2010). Children may experience the death of a grandparent, as well as other important individuals in their lives (e.g. pets). These experiences with death are unique to each child (Corr et al., 2000).
Maria Nagy has researched three stages of death understanding. In the reversibility stage, preschool children see death as reversible; they do not understand its permanence. In the second stage, personification, death is seen as a person who swings a scythe and cuts people down. This stage occurs from 6 to 9, and overlaps with Piaget’s concrete operational stage. The highest stage, developing around age 9, sees death as universal: the child realizes that everyone, including himself/herself, will eventually die. When asked what causes death, 6-year-olds responded with a concrete, graphic array of answers, including “guns, knives, and big rocks.” Eleven-year-olds responded with answers such as “old age and disease.” It is important that adults tell children the truth about a loved one’s death. Euphemisms such as “Daddy has gone on a long trip” or “Daddy is asleep” can scar the child about traveling or sleeping. Also, one’s religious concepts should be used, but stated carefully; statements like “God took Daddy” can create anger towards God (adapted from Harris, 1991).
Kubler-Ross (1969) has reported five stages of death and dying for both the terminally ill person and his/her family (see Berger’s discussion of these stages on page 575). After the person’s death, the survivors may go through several of these stages again (a process called bereavement). Lamers has a similar theory by describing survivors’ reactions of grief as constituting 1) loss, 2) protest (similar to Kubler-Ross’s stages of denial and anger), 3) despair (similar to depression), and 4) recovery, which usually takes 6-12 months. Complicated (or atypical) grief is much more serious, and may occur if the person is experiencing prolonged grief (of several years), severe depression (with thoughts of suicide), some sort of psychosomatic disorder, and/or over-activity (being active is good, but the person needs time to deal with the reality of the death) (“Hospice of Keokuk County,” 1981).
Hospice is a relatively new, alternative method of helping dying clients and their families. Hospice care may occur in the patient’s home, in hospitals, or in special facilities called hospices. The purpose is not to prolong life by any means, but to provide palliative care (by controlling pain and helping the person’s last few months to be as comfortable and meaningful as possible). The program is designed to meet the “physical, psychological, social, and spiritual needs” of both terminally ill patients and their families (“Hospice of Mahaska County,” 1981).
Several critical issues relevant to senior citizens were discussed in this module, including retirement, grandparenting, life satisfaction, death of a spouse, and frail elderly. The topic of death and dying was also discussed, with a focus on definitions of death, near-death experiences, Nagy’s stages, Kubler-Ross’s stages, and hospice care. The examination of the life cycle has ended. It is hoped that this course will help to make your own journey through life’s stages more meaningful.