Module 1 Flashcards
How was death seen in early societies
- As a community event
- Lots of rituals to help protect society from uncontrollable nature and malevolent gods
- The dead could be dangerous if they weren’t returned under specified occasions and conditions
Aries four psychological themes surrounding attitudes towards death
- Awareness of the individual
- The defense of society against untamed nature
- The belief in an afterlife
- Belief in the existence of evil
The invisible death
- With the medicalization of death, it is no longer seen as a sacred passage, but just a failure of the machine
- We like to be distanced from death
- We don’t talk about death much, but this is changing
Attitudes
- Our action tendencies
Beliefs
- Our worldview
- Ex: Fatalism
Personal Experience
- Influences our attitudes, beliefs, and feeling
- Ex: Experiencing a personally significant death changes us
How does state of mind affect death-related behaviour
- Reluctance to complete a living will
- Hesitancy to sign an organ donor card
- Engaging in high-risk behaviours
- People with higher risk behaviours were more likely to have contemplated suicide, and expressed greater frustration with life
- Patients who were secure in their faith experienced less pain and distress following heart surgery, so faith based coping styles can help
Baby Boomers
- Born within 1946 and 1964
- Now in retirement age
- The sandwich generation: caring for both children and elderly parents
- Not the first generation who wants to stay young, but the most dynamic in trying to accomplish this
- All of this influences the way we view death
Why do we talk about death
- It affects us all
- Learning about what comes after
- To create a plan for our death/dying
- Practical reasons: funeral prep, wills, knowing what people want, how to cope with death, etc.
Death challenges with our moral and ethical codes
- Legal system and society is grappling with the issue of medical assistance in dying
- Long term care
- Families coping with hospitals and LTC
Potential choices we must make while dying
- Organ donation
- Die at home or in an institution
- To continue or end treatment
- Medical assistance in dying continue with illness
- Burial, cremation, or freezing
- Etc.
Goals of education on death, dying, and dereavement
- Enrich personal lives
- Inform and guide individuals for their public roles as citizens
- Help prepare individuals for their public roles as citizens
- Help prepare and support individuals in their professional and vocational roles
- Enhance the ability of individuals to communicate effectively about death-related topics
Average life expectancy
- An estimate of the average number of years members of a group of people are projected to live
- 79.12 for Canadian males
- 83.58 for Canadian females
- Both in 2022
Death Rates
- Numbers of death among members of a given population group divided by the total number of those in the group
- Affected by a lot of factors like age of population
- 7.8/1000 in Canada in 2022
How is death changing in Canada
- All childhood deaths are dropping
- More people are dying later
Top 5 causes of death across all aged from 2019 to 2022 in Canada
- Cancer
- Heart disease
- Covid
- Accidents
- Cerebrovascular disease
- Note: heart disease used to be first but we’re good at treating it now
Why is life expectancy in women declining
- They’re working more
- There are more older women
- LTCs and other places filled with women were hit harder during the pandemic
- A lot of women are care takers and that was dangerous during covid
Big picture changes from 2019 to 2022 in death rates in Canada
- We have sig. increases in overall mortality and standardized death rates
- Life expectancy continues to decline (covid and death among younger groups)
- Covid and respiratory illnesses are reshaping mortality patterns
Highest cause of death for infants
- congenital abnormalities
Highest cause of death for youth (1-24)
- Accidents, cancer, and suicide
Highest cause of death for middle age (45-64)
- Cancer, accidents
Highest cause of death for older adults (65+)
- Heart disease and cancer
What is premature death in Canada
- Death that occurs before the age of 75 is considered premature
- Death that could be prevent with lifestyle changes or treatable
- From public health stand point, we want to avoid this
Leading causes of premature death in Canada
- Accidents
- Substance related deaths
- Suicide and violence
- Can also be connected to socio economic status
What is the trajectory of a sudden death
- Unexpected
- Little to no decline in function
- Pretty immediate
- Can be traumatic for love ones because they are so sudden
- Little opportunity for planning
What is the trajectory of a terminal illness death
- Gradual and predictable
- Allow people time to process and get things done
- Can still be traumatic
What is the trajectory of an organ failure death
- Slow
- May included multiples crises that end you up in the hospital
- May need palliative care
- Can be in denial thinking they’ll find a cure
What is the trajectory of a frailty death
- Slow and steady decline typically related to age
- May have many issues combined making them frail
- Anything can be life threatening to them
- Typically need longer term care
- Need emotional and physical support
- Can have palliative care
- Time to prepare
Where do Canadians die
- Hospitals
- Home Deaths
- LTCs
- Hospice and palliative care
Factors influencing location of death
- Age
- Illness type
- Access to care
- Cultural and personal preferences
Historical death practices: common customs
- Covering the eyes of the deceased close the window between the living and spirit world
- Moving bodies feet-first out of homes discourage spirits from returning
Historical death practices: victorian mourning practices
- Women wore black for extended periods to blend in as a shadow, reducing the risk of being beckoned by their deceased husbands
- Creating mourning jewelry from hair of the deceased
Historical practices of body disposal
- Bodies left in caved, placed in trees, or mountaintops
- Burning on pyres, cremation, and burial in catacombs
- Traditional ground burials and burials under mounds of earth
Historical death practices: Early Italian Farmers
- Bodies were placed in caves after being defleshed and broken into pieces
Historical death practices: anglo-saxons
- Used organized graveyards with small burial mounds as markers
- Built large barrows to honour high-status individuals like kings
Death in North America
- Community event
- Bodies placed in the home or dining table for viewing
- Simple burial practices
- Strengthening social bonds
Societal changes in death practices
- Increased life expectancy
- Medicalization of Death
- Funeral Industry
Consequences of societal changes in death practices
- Decreased exposure to death
- Fear and avoidance of death
- Loss of communal grieving
Indigenous perspectives on death
- Cultural diversity and spiritual beliefs
- Colonization affected their rituals
- Emphasis on the cycle of life and the continuation of the spirit after death
Oral traditions
- Storytelling, songs, dances, art
- Pass down cultural and spiritual knowledge about death
The Medicine Wheel
- Represents the natural transition in the cycle of life
- Connecting the
- Spiritual: White
- Physical: Yellow
- Mental: Red
- Emotional: Black
Impact of colonization on Indigenous death practices
- Suppression and forced conversion
- Traditional practices were banned or erased
- There was the fusion of some cultures with christian beliefs
Traditional death-related practices
- End of life rituals that focus on healing the spirit for the spirit world
- Ceremonies help the deceased’s spirit transition and offer comfort and healing for the community
- Practices vary across nations but share a common goal of maintaining balance and connection with ancestors
Terror management theory
- Suggests that humans manage existential fear of death by clinging to cultural worldviews and boosting self esteem
- Ex: clinging to religious beliefs and having kids to continue our legacy
Core components of TMT
- Mortality Salience: Awareness of inevitable death
- Cultural worldviews: Provide meaning, order, and symbolic immortality
- Self Esteem: Acts as a buffer against death anxiety
Dual-Process Defense Mechanism of TMT
- Proximal defenses
- Distal defenses
Proximal defenses
- Immediate, conscious efforts to suppress or rationalize death-related thoughts
- Ex: Taking vitamins to stay healthy
- Triggered when death related thoughts are conscious
Distal Defenses
- Unconscious, long-term strategies like reinforcing cultural beliefs and boosting self-esteem to reduce death anxiety
- Ex: Having kids
- Triggered when death related thoughts are unconscious but active
Mortality Salience (MS) Hypothesis
- Reminders of death (MS) trigger psychological defenses
- There are universal psychological responses observed across cultures, age groups, and contexts
- Leads to a stronger defense of cultural worldviews
Empirical Supports for TMT
- Increased in group favoritism
- Heightened prejudice
- Higher self esteem that reduced anxiety
- Protective mechanisms
Death anxiety
- Emotional distress, insecurity tension, and apprehensiveness
- Women typically have higher levels
- High in adolescence and in middle age, but declines in your seventies (higher self-esteem?)
Denial
- A response that rejects certain key features of reality in an attempt to avoid or reduce anxiety
Acceptance
- Coming to terms with death and easing anxiety
- Different from resignation or depression
Religion and death anxiety
- Good relationship with religion lowers it
- Scared to die because of religious things increases death anxiety
Trait anxiety
- Anxiety as the trait
- Ex: you are an anxious person
Situations that can increase death anxiety
- Transitional situations, like divorce
- Exposure to death
- Life threatening illness
- Etc.
The Existential Challenge
- Awareness of our mortality is a basic source of anxiety
- Society’s primary function is to help us pretend that life will never end
Selective attention
- Redirecting attention to whatever seems most salient in the immediate situation
- Focusing away from thinking about death
Selective response
- The individual feels this is not the time of place to discuss death, or the person may be working very hard at completing tasks in full awareness that time is running out
- Not wanting to talk about death or trying to do things really quickly knowing death is going to happen
Compartmentalizing
- Much of the dying and death reality is acknowledged, but the person stops short of realizing the situation by putting all the information together
Deception
- Deliberately giving false information to others for whatever reason
Resistance
- The individual comprehends the reality of the situation but chooses to fight for life as long as possible
Denial
- A primitive defense mechanism that totally rejects the existence of threat or death-laden reality
Edge Theory
- Distinguishes between everyday low level of death anxiety and the vigilant state of arousal when we encounter danger
- Emphasizes that a little death anxiety is important for survival
Catholics after death
- Belief in the after life
- Funeral: Vigil of the deceased, requiem mass, rite of committal
Christians after death
- Death only occurs once and they trust they will go to heaven
- Funeral: casket, bury, creamated
Buddhists after death
- Belief in rebirth
- Cremation is preferred
Hindus after death
- Belief in reincarnation
- Cremation preferred within 24 hours of death and the body can’t be left alone until after cremation
Jehovah’s Witnesses after death
- They will enter a kind of sleep until God resurrects them from the dead
- Funeral held at the Kingdom hall the deceased went to
Jews after death
- Death if a part of life and what happens depends of your denomination
- Open caskets are not permitted
Muslims after death
- There is an afterlife where the soul goes
- Body must face Mecca/East and cannot be cremated
Religious and philosophical definitions of death
- Depends because everyone is different
- A lot of them talk about the soul
Death as symbolic construction
- Our concept of death is a symbolic construction and is influenced by all aspects of her life
- Ex: Media, life experiences, etc.
Biomedical Definitions of Death
- Typically through heart or lung function (tech has changed this)
- Failure to respond to stimuli
- lower body temp and stiffness, followed by bloating and decomposition
Karen Ann Quinlan
- Fell into a deep coma
- Parents wanted to take her off the vent, but the doctors said they couldn’t
- Had to go to the supreme court where the parents won
- They took her off and she stayed alive in her coma for years
Using eyes to see if your dead
- Checked for segmentation and interruption of blood circulation
- Haziness of the cornea
- Appearance of homogeneity and paleness
Harvard criteria for brain death
- Unreceptive and unresponsive
- No movements or reflexes
- A flat EEG
- No circulation within the brain
- Consistency over time
- Exclusion of reversible causes like hypothermia or sedatives
Canadian physicians definition of death
- The permanent cessation of brain function
- Observable by the absence of consciousness and brainstem reflexes including breathing
- Applies to all people in all circumstances
Social death
- Behaving as if the person is physically dead when the body has not died
- Can precede social death
- We also often keep the dead alive in our minds, memories, or rituals
Mortality Awareness
- Conscious acknowledgement of one’s own finiteness
Meaning in Life (MIL)
- Personal sense of purpose and significance
Attitudes towards death
- Fear vs Acceptance
- Death vs Dying (process vs outcome)
Meaning management theory (MMT)
- Mortality awareness can lead to both defensive response and growth-orientated processes
- Emphasizes meaning making and acceptance
Main difference between TMT and MMT
- TMT focuses on avoidance and defense
- MMT highlights acceptance and growth as paths to managing mortality awareness
Death education programs: didactic (informational)
- Provides theoretical knowledge on death and dying
- May increase awareness but risk raising anxiety
Death education programs: experiential (engagement-based)
- Activities such as reflective writing, group discussions, or visiting hospices
- Encourages personal reflection and emotional engagement
Limitations to death education programs
- Few programs explore meaning in life as an outcome
- Lack of longitudinal research on sustained impact
What were the findings of the mortality awareness on attitudes towards dying and death and meaning in life study
- Used two groups: One control and one participated in interventions
- Decrease in fear of dying
- Increase in their acceptance of dying
- No effects on attitudes toward death
- MIL was affected by religion