chapter 13

Question 1

grief

Answer 1

distress caused by loss

– The sorrow, hurt, anger, guilt, confusion, or other feelings that arise after a loss

Question 2

bereavement

Answer 2

term used to talk about loss of loved one

– The state or condition caused by loss through death

Question 3

thanatology

Answer 3

study of death, dying, Grieg, bereavement, social attitudes towards these issues

Question 4

Sociocultural Definitions of Death
– All cultures have their
– Mourning rituals and states of bereavement also
– Death can be a truly

Answer 4

– All cultures have their own views.
– Mourning rituals and states of bereavement also vary in different cultures.
– Death can be a truly cross-cultural experience, such as when major tragedies occur. (natural disasters)

Question 5

Clinical death

Answer 5

Lack of heart beat and respiration

Question 6

Whole-brain death

Answer 6

is most widely accepted today.
1. The person is in a coma and the cause of the coma is known.
2. All brainstem reflexes have permanently stopped working.
3. Breathing has permanently stopped. (breathing machine must be used)
▪ Brain death is also controversial from some religious perspectives.

Question 7

– Persistent vegetative state

Answer 7

occurs when cortical functioning ceases. while brainstem activity continues

• does not permit decoration of death
• not conscious heart beat nd breath spontaneously

Question 8

• Ethical Issues

– Bioethics

Answer 8

▪ Examines the interaction between human values and technological advances
▪ The most important bioethical issue is euthanasia. o The practice of ending life for reasons of mercy

-benefit must overweigh the suffering from treatment to keep person alive

Question 9

– Two types of euthanasia

Answer 9

▪ Active euthanasia
o Deliberately ending someone’s life through some sort of intervention or action
▪ Passive euthanasia
o Ending someone’s life by withholding treatment

Question 10

• Physician-assisted suicide

▪ Death with Dignity Act

Answer 10

– Provides for people to obtain prescriptions for self-
administered lethal doses of medication
– Allowed in several countries and in several states
including Oregon, California, and Washington
▪ Death with Dignity Act-> first physician-assisted suicide law in the country, permit people to obtain lethal dose

Question 11

– The Patient Self-Determination Act

Answer 11

requireshealthcarefacilitiesreceivingMedicare money to inform patients about their right to prepare advance directives stating their preferences for terminal care

Question 12

A Life-Course Approach to Dying

young adults vs. middle-aged adults vs. older adults

Answer 12

– Young adults report a sense of being cheated by death. (have a sense of immortality)
– Middle-aged adults begin to confront their own mortality and undergo a change in their sense of time lived and time until death.
▪ When their parents die, people realize they are the oldest generation.
– Older adults are more accepting of death.

Question 13

• Dealing with One’s Own Death
– Kübler-Ross’s theory
▪ Includes five stages:

Answer 13

o Denial
o Anger
o Bargaining
o Depression
o Acceptance
o These stages can overlap and be experienced in a different order.
o Individual differences are great.

Question 14

• A Contextual Theory of Dying

-Corr identified four dimensions of tasks that must be faced.

Answer 14

– Emphasizes the tasks and issues that a dying person must face, and although there may be no right way to die, there are better or worse ways of coping with death

-Corr identified four dimensions of tasks that must be faced.
▪ Bodily needs, psychological security, interpersonal attachments, and spiritual energy and hope

Question 15

– Kastenbaum and Thuell (1995) argue that

Answer 15

Kastenbaum and Thuell (1995) argue that what is needed is a contextual theory that can incorporate the wide range of differences in reasons people die and the places that people die.

-what is needed is an even broader contextual approach that is more inclusive

Question 16

• Death Anxiety

Answer 16

People’s anxiety or fear of death and dying

Question 17

Terror management theory

Neuroimaging research

Answer 17

addresses why people engage in certain behaviors to achieve particular psychological states based on their deeply rooted concerns about mortality, go to great lengths to make sure we stay alive (plastic surgery)

Neuroimaging research supports the use of this theory in understanding death anxiety.
-amygdala brain activity greater when talking about death

Question 18

– Death anxiety consists of several components that can be accessed at the

Answer 18

– Death anxiety consists of several components that can be accessed at the public (how we talk about death), private (how we feel about death when we are alone), and nonconscious levels.

Question 19

Demographics and personality variables
-Older adults engage in “life review”

• Men show
• Some cultures, death anxiety is linked to
• Death anxiety may have a

Answer 19

Older adults engage in “life review”
– Have different perspective of time
– Higher religious involvement

• Men show greater fear of the unknown; women specific fear of the dying process
• Some cultures, death anxiety is linked to the health condition (relapsing such as cancer)
• Death anxiety may have a beneficial side

Question 20

• Learning to Deal with Death Anxiety

Answer 20

– Living life to the fullest is one way to cope with death anxiety.
– Koestenbaum proposes exercises to increase one’s death awareness.
– An increasingly popular way to reduce anxiety is death education.

Question 21

• Creating a Final Scenario
– End-of-life issues
– A final scenario:

Answer 21

▪ Managing the final aspects of life
▪ After-death disposition of the body and how one is memorialized
▪ Distribution of assets

Making choices about what people do
and do not want done when their lives are ending
▪ A crucial aspect of the final scenario is the process of separation from family and friends.
– Bringing closure to relationships

Question 22

• The Hospice Option
– Hospice is an approach to assisting dying people that emphasize
– Hospice care emphasizes 
▪ The goal is a de-emphasis on the
– The role of the staff is to

Answer 22

– Hospice is an approach to assisting dying people that emphasizes pain management (palliative care) and death with dignity.
– Hospice care emphasizes quality of life rather than quantity of life.
▪ The goal is a de-emphasis on the prolongation of death for terminally ill patients.
▪ Both inpatient and outpatient hospices exist.
– The role of the staff is to be with patients, not to treat the patient.

Question 23

• Two types of hospices exist:

Answer 23

– Inpatient hospices provide all care for clients.

– Outpatient hospices provide services at the person’s home. at a lower cost

Question 24

• The role of the staff is
– A client’s _____ is always maintained.
-Increasingly, hospice support includes the option for

Answer 24

• The role of the staff is to be with patients, not to treat patients.
– A client’s dignity is always maintained.
– Increasingly, hospice support includes the option for death doulas who help ease the passage through death.

Question 25

How do people decide to explore the hospice option? Several considerations:

Answer 25

1. Is the person completely informed about the nature and prognosis of his or her condition?
2. What options are available at this point in the progress of the person’s disease?
3. What are the person’s expectations, fears, and hopes?
4. How well do the people in the person’s social network communicate with each other?
5. Are family members available to participate actively in terminal care?
6. Is a high-quality hospice care program available?
7. Is hospice covered by insurance?

Question 26

Living will:

Answer 26

A person simply states his or her wishes

about life support and other treatments.

Question 27

Health care power of attorney

Answer 27

An individual appoints someone to act as his or her agent for health care decisions

Question 28

The purpose of both living will and health care power of attorney is

Answer 28

to make one’s wishes about the use of life support known in the event one is unconscious or otherwise incapable of expressing them.

Question 29

Do Not Resuscitate (DNR)

Answer 29

medical order which is used when cardiopulmonary resuscitation is needed.
prohibits it

Question 30

• Patient self-determination and competency evaluation
▪ Health care facilities must provide

▪ Two types of determination
about whether a person can make decisions:

▪ Surrogate decision

Answer 30

▪ Health care facilities must provide information in writing about patients’ rights.

– Capacity to make decisions (clinical)
– Competency (legal)

Surrogate decision-makers are often wrong about what patients really want.
-can make decisions on their behalf if they lack capacity

Question 31

• Mourning

Answer 31

the way we express our grief
▪ Mourning is heavily influenced by cultural norms.
-wearing black

Question 32

• The Grief Process
– Grief is an
– A person must:
– Grieving is an ______process.

Answer 32

– Grief is an active coping process.
– A person must:
▪ Acknowledge the reality of the loss
▪ Work through the emotional turmoil
▪ Adjust to the environment where the deceased is absent
▪ Loosen ties to the deceased
– Grieving is an individual process. The amount of time people need to grieve should not be underestimated. Recovery may take several years.

Question 33

– Risk factors in grief

▪ Sudden death versus prolonged death

Answer 33

▪ Sudden death versus prolonged death (diff grief process)

Question 34

Risk factors in grief
– Anticipatory grief
-Strength of attachment makes a difference

Answer 34

death is anticipated, buffers the impact of loss
o People tend to disengage from the dying person.

o Strong attachment and sudden death causes greater grief.
o Secure attachment results in less depression due to less guilt over unresolved issues.

Question 35

risk factors of grief

▪ Gender differences

Answer 35

– Men have higher mortality rates after losing a spouse.

– Women have higher rates of depression after losing a spouse.

Question 36

Typical Grief Reactions
– Grief work
-– Grief involves
– How people show grief varies across 
– Physical health may
– Anniversary reaction

– Grief over time
▪ Grief work tends to peak within
▪ People can grieve

Answer 36

– Grief work: the psychological side of coming to terms with bereavement
– Grief involves coping, affect, change, narrative, and relationship.
– How people show grief varies across ethnic groups.
– Physical health may decline while grieving.
– Anniversary reaction
▪ Grief that often returns around the anniversary of the death
– Grief over time
▪ Grief work tends to peak within the first six months. ▪ People can grieve many years after the loss.

Question 37

• Coping with Grief
– Numerous theories have been proposed to account for the grieving process.
– The four-component model
▪ Understanding grief is based on four things:

Answer 37

▪ The context of the loss
▪ Continuation of subjective meaning associated with loss
▪ Changing representations of the loss relations over time
▪ The role of coping and emotion-regulation process

Question 38

Grief work as rumination hypothesis:

Answer 38

▪ Grief work as rumination hypothesis: extensive grief processing may actually increase distress, they don’t move on from those feelings, need to distract yourself from grief but not avoid it think more positively

Question 39

– The dual process model (DPM)

Answer 39

▪ Considers two broad types of stressors:
▪ Loss-oriented stressors-concerns the loss itself
▪ Restoration-oriented stressors-involves adapting to the survivors new life situation

-go back and forth between grief and improvement

Question 40

• The Model of Adaptive Grieving Dynamics

Answer 40

– MAGD is based on two sets of pairs of adaptive grieving dynamics (lamenting and heartening and integration and tempering).
▪ Lamenting: experiencing and/or expressing grieving responses that are distressful, disheartening, and/or painful
▪ Heartening: experiencing and/or expressing grieving responses that are gratifying, uplifting, and/or pleasurable
▪ Integrating: assimilating internal and external changes catalyzed by a grief- inducing loss, and reconciling differences in past, present, and future realities in light of these changes
▪ Tempering: avoiding chronic attempts to integrate changed realities impacted by a grief-inducing loss that overwhelm a griever’s and/or community’s resources and capacities to integrate such change

Question 41

• Ambiguous Loss

Answer 41

– Ambiguous loss refers to situations of loss in which there is no resolution
or closure.

▪ The first type refers to a missing person who is physically absent but still very present psychologically to family and friends.
▪ A second type of ambiguous loss involves a loved one who is psychologically absent but who is still physically present (dementia, Alzheimer’s).
– Closure is not possible and ambiguous grief is especially difficult to deal with.

Question 42

• Complicated or Prolonged Grief Disorder – What distinguishes prolonged grief is:

Answer 42

▪ Symptoms of separation distress
o Preoccupation with the deceased to the point that it interferes with everyday
functioning

▪ Symptoms of traumatic distress
o Feeling disbelief about the death
o Mistrust, anger, and detachment from others as a result of the death o The experience of physical presence of the deceased

Question 43

complicated grief

Answer 43

characterized by persistent and intrusive feelings of grief lasting beyond the expected period of adaptation to loss, and its associated with separation and traumatic distress

Question 44

Adult Developmental Aspects of Grief
– Complicated grief is common in
– Death of one’s child

Answer 44

– Complicated grief is common in young adulthood.
▪ Young adult widows report level of grief does not diminish significantly until five to ten years after the loss.

Death of one’s child
▪ The death of a child is thought to be one of the most traumatic type of loss,
especially if the loss is sudden.
o Some parents never recover from the loss.
▪ Cross-culturally, grief is universal and intense.
▪ Death of child before birth (e.g., miscarriage) causes great grief for mothers and fathers.

Question 45

• Death of one’s parent

Answer 45

– The death of a parent serves to remind people of their own mortality and
deprives them of a very important person in their lives.
– The feelings of losing an older parent reflect a sense of letting go. ▪ Loss of a buffer against death
▪ Better acceptance of one’s own eventual death
▪ A sense of relief the parent’s suffering is ove

Question 46

• Disenfranchised Grief

o Stems from the

Answer 46

– A loss that appears insignificant to others and is highly consequential to the person who suffers the loss gives rise to disenfranchised grief.
o Stems from the social expectations we place on people to “move on” after loss o Failure on the part of others to understand and empathize with the personal
impact of loss, for example, the loss of a pet

Question 47

– Conclusion
▪ Death is the
the ultimate

Answer 47

▪ Death is the last life-cycle force we encounter, the ultimate triumph of biological forces limiting the length of life.