PSY 304 Ashford University Week 5 Applying Lifespan Development to Life Journal In this journal,Reflect on the knowledge, based on theories of development, you have learned during this courseDiscuss what skills can be developed from having this knowledge.Analyze how knowledge about lifespan development theory can be applied to your goals and career.Evaluate what ethical considerations should be taken when applying these skills. 12/8/2019
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Death, Dying, and Grieving
13
A close-up of a person’s hands holding a candle at a vigil, while another candle is lit by another person in the
background.
Steven Weinberg/The Image Bank/Getty Images
Learning Objectives
By the end of this chapter, you will be able to:
De ine death and describe the developmental perspectives on death as they relate to early childhood
through late adulthood.
Understand the various options regarding end-of-life decisions.
Identify the cognitive process involved in facing one’s own death.
Comprehend the grieving and bereavement process.
Introduction
This chapter provides a discussion of the developmental perspectives on death as they relate to young childhood,
middle childhood, adolescence, young adulthood, and late adulthood. In addition, there is a focus on options
regarding end-of-life decisions. Facing one’s own death is presented, in addition to an overview of the grieving and
bereavement process.
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13.1 De ining Death
Death is commonly de ined as the cessation of life. It is not considered to be part of the lifespan; in fact, it is the
termination of life. However, dying is part of life; it is the process in which the body declines, leading to eventual
death. As individuals are dying, their lives continue to hold signi icant meaning.
How do we know when dying has concluded and death has
taken place? Does death occur when the heart stops beating?
Or perhaps it occurs when an individual stops breathing?
From both a medical and legal standpoint, death occurs when
a person experiences brain death, meaning the activity in the
cerebral cortex has ceased (Burke, Schipper, & Wijdicks,
2011). This is most commonly con irmed by a lat EEG
recording. When there is no activity in the cortex,
consciousness, which is the sense of self and all psychological
functioning, has ceased. However, there is a broader term that
can be used as well, whole brain death, which refers to the
death of the brain stem, which is responsible for automatic
re lexes such as breathing (Miller, 2011). While these
wavebreakmedia/iStock/Thinkstock
de initions seem clear-cut, the end of life presents us with no
Death is often a medical and a legal matter.
shortage of ambiguities, especially with the advent of life
support technologies that can take over the breathing process for people who have suffered whole brain death.
Death is not just a medical matter; it is also a legal one. Most states rely on some combination of these criteria in
establishing the legal standard of death. In most states, a person is considered legally dead if there is an irreversible
cessation of breathing and blood circulation, or there is an irreversible cessation of brain activity, including activity in
the brain stem, which controls and regulates breathing (Burke et al., 2011).
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13.2 Developmental Perspectives on Death
Despite the establishment of legal and medical de initions of death, psychologists still strive to understand death and
people’s reactions to it. While the concept of death is elusive to many, it is evident that the human understanding of
death varies from person to person and evolves throughout the lifespan. Infants and young children have little to no
understanding of death; teens and young adults often act in ways that seem to ly in the face of death despite their
cognitive understanding of it. Others approach the concept of death from a religious perspective, choosing to believe
in a form of spiritual reversibility (Lattanzi-Licht, 2007). This section is devoted to exploring the many perspectives on
death from early childhood to late adulthood.
Children
Young children lack the cognitive ability to understand the
permanence of death (Nader & Salloum, 2011). According to
Piaget’s stages of cognitive development, preschoolers may
think that death is either reversible or temporary (Piaget,
1954). One of the main reasons for this involves the television
shows that they watch (Corr, 2010). For example, most
children watch cartoons in which a character dies but, in the
next scene, is resurrected and walking around. Another
reason young children may have a limited understanding of
death is that in many cultures, adults withhold the full truth
about death and instead use euphemisms to refer to it. This is
often done in an effort to protect them from the pain of losing
a loved one and to alleviate or prevent fear of their own death
Stephanie Frey/iStock/Thinkstock
and the death of their loved ones (Cicirelli, 2006). Most A child’s ability to comprehend death increases
commonly, we hear adults say things like “Grandpa has passed over time.
on,” or the family dog has “gone to sleep,” rather than blunt
statements about death.
Between ages 4 and 6, most children begin processing the world around them in a more realistic way (Corr & Balk,
2010). By irst or second grade, most children understand that death is irreversible (Poltorak & Glazer, 2006).
Research suggests that a child’s understanding of death increases as he or she learns about the biology of the human
body and how various organs support the process of life (Slaughter & Grif iths, 2007).
Web Field Trip: Discussing Death With Children
Explaining death to children can be particularly challenging, given their limited understanding of the inality
of such an event. Read the following article and consider the questions that follow.
http://www.parents.com/toddlers-preschoolers/development/social/talking-to-kids-about-death/
(http://www.parents.com/toddlers-preschoolers/development/social/talking-to-kids-about-death/)
1. Do you agree or disagree with the author when she says we should not tell children that the person
who died is sleeping? Why or why not?
2. How would you handle the situation if you had to tell a small child that someone who was not old had
died?
3. Do you agree or disagree with the author when she explains that telling a child that someone will
always be with them and watching over them could be scary for a child? Why or why not? Be sure to
use at least one scholarly or academic reference to back up your opinion.
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Adolescence
While it may seem that adolescents would view
death very differently from younger children, there
are ways in which their perspective is still
somewhat child-like. They know full well that once
life functions come to an end, they cannot be
restored. However, some may still rely on
constructing magical, spiritual, or pseudo-scienti ic
theories as to how some forms of life or thought
may be able to survive (Corr & Balk, 2010; Nader &
Salloum, 2011).
Children Coping with Loss
Children talk about the loss of a loved one, and what has helped
them feel better.
What Has Helped
From Title: Children and Grief (https://fod.infobase.com/PortalPlaylists.aspx?
wID=100753&xtid=55964)
As compared with young children, adolescents are
much more aware of death and are more likely to
be exposed to death (for example, when a
grandparent dies). Some adolescents may even
experience the death of a parent, sibling, or peer,
which will affect them profoundly. Adolescents are
more likely than children to attend funerals with
open caskets. However, these experiences challenge
the adolescent’s sense of immortality, which is
connected to their personal fable (discussed in
0:00 / 4:07
1x
Chapter 5; Corr & Balk, 2010). Even though
© Infobase. All Rights Reserved.
Length: 04:07
adolescents come to realize that death is something
that is unavoidable, and that they themselves will
die one day, they continue to engage in high-risk
behaviors much more than adults do. On the other
hand, after the death of a peer, especially if it is
accidental, they may perceive certain behaviors to be especially dangerous and may engage in them less often (Mills,
Reyna, & Estrada, 2008).
Adults
A common misperception is that the older we get and the closer we are to death, the more we begin to fear it;
however, research indicates that this is not usually the case. Death anxiety is the highest in young adulthood, and then
declines with age, reaching its lowest point in late adulthood (Russac, Gatliff, Reece, & Spottswood, 2007). Fear of
death during young adulthood may be a result of anxiety about not being able to ful ill one’s plans and achieve one’s
goals in life. Take, for instance, a 24-year-old mother who was just diagnosed with stage 3 breast cancer. She may have
a great fear of death because she has not accomplished the goal of seeing her children grow up into adults. An 84year-old grandfather may not have such a fear of dying because he has already had the opportunity to watch his
children grow into adults.
By late adulthood, especially after 80 years, many people feel as if they are reaching the end of their life, and there is
no reason to stay alive because their goals have either been met or they do not matter to them anymore (Cicirelli,
2006). These individuals are now entering a time Robert Butler (2002) refers to as life review, the process in which
people re lect on their lives and come to accept both the positive and negative aspects. As you may recall from
Chapter 9, Erikson (1950a) believed that the main crisis of late adulthood is Ego Integrity vs. Despair, and research
has indicated that most people end up in a stage of ego integrity, accepting their life. While most individuals do not
fear death itself during late adulthood, they may have fears that are associated with death, such as the amount of pain
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or suffering they may experience prior to death, the loss of self-control, and the effects of their death on their family
members (Kwak, Haley, & Chiraboga, 2008).
Thoughts about death change in a variety of ways over the course of adulthood (Cicirelli, 2006). Young parents may
experience the fear of a child dying or the fear of what would happen to their children if they themselves were to die.
In middle adulthood, people may become very aware that they have hit the halfway point in their lives and have fewer
years in front of them than behind them. For some, this sharpens their awareness of death and causes them to
reexamine their lives to determine whether they should make changes that would allow them to take full advantage of
the years that they have left. However, in late adulthood, people become more comfortable with death; this is when
they encounter death most frequently. The longer people live, the more likely they are to witness the deaths of
parents, friends, siblings, and even spouses or partners. This experience, along with their own proximity to death,
leads them to think more about death than younger people do (Hayslip & Hannson, 2003). Talking about death with
others offers consolation and humor can help them cope effectively with it (Lamburg, 2002). All of these
considerations may lead adults of all ages to address some of the practical issues surrounding death, such as making
a last will and testament or appointing a power of attorney (Kastenbaum, 2007).
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13.3 Options Regarding End of Life
There are a variety of options regarding end-of-life decisions. However, at times, individuals may not be able to
respond or participate in these types of decisions. For example, catastrophic illnesses or accidents can often limit the
ability of individuals to inform this process. As such, some individuals make choices prior to the time when death is
imminent and they may or may not be able to verbalize their wishes. In the next few sections, we will discuss end-oflife decisions involving hospice, euthanasia, and living wills.
Hospice
Hospice is a program of care geared toward making the end of life as
devoid of pain, anxiety, and depression as possible (Berry, 2010).
Contrary to a hospital’s goals of prolonging health and curing illness,
hospice emphasizes palliative care, care aimed at reducing pain and
suffering in an effort to assist individuals in dying with dignity (Bruera,
Billings, Lupu, Ritchie, & Academic Palliative Medicine Task Force, 2010).
Through a network of hospice professionals and workers, the focus of
hospice care is to treat a dying person’s symptoms by making the patient
as comfortable as possible, involving the individual and the individual’s
family in the patient’s care, and assisting all persons involved in their
efforts to cope with the eventual death of the patient (Ireland, 2010;
Kahana, Kahana, & Wykle, 2010). Subsequently, the emphasis in hospice
care is on making the patient’s life as full as possible (York, Churchman,
Woodard, Wainright, & Rau-Foster, 2012).
Currently, many health-care professionals have not received adequate
training to meet the demands of end-of-life-care (Unroe et al., 2013).
However, many care providers are interested in helping their patients
Stockbyte/Thinkstock
experience a “good death” (Lee, Woo, & Goh, 2013). As a result, a
Training for end-of-life care may not
particular emphasis of hospice care is centered on the emotional
be able to keep up with the need for it.
experience (i.e., sadness, anger, fear, etc. . . . ), where an effort is made to
directly provide or enable a process of dying that is founded upon respect for the patient and their underlying
emotional reactions (Sampson, Finlay, Byrne, Snow, & Nelson, 2014).
Euthanasia
Euthanasia is de ined as the active and painless termination of life at the request of a patient (Berghmans,
Widdershhoven, & Widdershoven-Heerding, 2013). It is often used to reduce the suffering of individuals with an
incurable disease or severe disability (Miller & Gonzalez, 2013). Euthanasia has sometimes been called “mercy killing”
(Jackson, 2013). There are two types. Passive euthanasia is de ined as the purposeful withdrawal or withholding of
life sustaining treatment, and is often used for patients who have brain death or are in a permanently vegetative state
(Poreddi, Nagarajaiah, & Math, 2013). This often involves taking a patient off of a respirator. Active euthanasia is
de ined as the deliberate death caused by an active life-ending procedure (such as the administration of a lethal drug)
(Romain & Sprung, 2014). In a study of approximately 7,000 dying patients, only 7% requested either passive or
active euthanasia and, of those who requested it, less than one third received it (Onwuteaka-Philipsen, Rurup, Pasman,
& van der Heide, 2010).
Because of technological advances in life-support devices, the debate regarding “quality of life” has dramatically risen
(Peterson, 2011). Arguably the most widely publicized case regarding quality of life in the United States involved Terri
Schiavo. In fact, “few cases in modern history have incited as much national debate and emotion as has the Theresa
(Terri) Marie Schiavo case” (Davis, 2013, p. 1). Terri Schiavo spent 15 years in a vegetative state after suffering severe
brain damage related to oxygen deprivation (Givens & Mitchell, 2009). On March 15, 2005, her feeding tube was
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removed, and she died 13 days later. Because she underwent the purposeful withdrawal of life sustaining treatment,
Terri Schiavo was able to die as a result of passive euthanasia. Subsequently, passive euthanasia in the case of
terminally ill patients has progressively been gaining acceptance (Seay, 2011). However, even individuals who would
decline chronic ventilation or resuscitation for themselves are likely to request that a family member be continuously
ventilated or undergo more aggressive treatment if that family member were in a similar circumstance (Sviri et al.,
2009).
Probably one of the most prominent proponents of active euthanasia in the United States was Dr. Jack Kevorkian
(Murphy, 2011), a Michigan pathologist who assisted terminally ill patients in their quest to end their lives. Dr.
Kevorkian was convicted of second-degree murder in the state of Michigan, where he served eight years in prison. Dr.
Kevorkian noted that he used carbon monoxide that was attached to a face mask in the majority of the more than 130
people he assisted (Mureşan, Ciocan, & Enache, 2013). He died (of natural causes) on June 3, 2011. Currently, active
euthanasia is legal in three U.S. states—Oregon, Washington, and Montana—and a few countries throughout the
world, such as Belgium, Luxembourg, the Netherlands, and Switzerland (Steck, Egger, Maessen, Reisch, & Zwahlen,
2013).
Living Wills
Sometimes, an individual is not able to express his or her wishes regarding the continuation of medical treatment. For
example, individuals in a coma are unable to verbally communicate their desires. As such, many individuals choose to
develop a living will in an attempt to proactively express their desires before any catastrophic illness or injury occurs.
A living will is de ined as a legal document intended for the sole purpose of expressing the desires of an individual
with regard to their medical treatment in the event of a medically hopeless situation (Henrikson, 2010). Similarly, “a
living will is a document that is meant to convey our intentions for medical care if we become incompetent. In reality, it
is simply a tool and as such is morally neutral; its contents and context determine the morality of its use” (Bustos,
2013, p. 1). In addition, an advance directive is de ined as a document, but not necessarily a legal document, which
details what medical procedures should not be used to prolong the individual’s life if death is imminent because of a
terminal illness (Hirschman, Abbott, Hanlon, Bettger, & Naylor, 2012).
There is considerable concern regarding living wills and advance directives, which often are misinterpreted and, at
times, may result in patient safety being compromised (Mirarchi et al., 2013). For example, Mirarchi et al. (2013)
found that advance directives are often misunderstood throughout the nation by physicians during their residency. In
addition, third- and fourth-year medical students are often unfamiliar with many of the key elements found in a living
will and demonstrate a lack of training with regard to this particular aspect of medical practice (Mirarchi, Ray, &
Cooney, 2014). Finally, nurses are often unfamiliar and lack speci ic knowledge regarding living wills, which affects
their clinical practice (Iglesias & de Bengoa Vallejo, 2013).
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13.4 Facing One’s Own Death
The late Elisabeth Kü bler-Ross (1926–2004) was a Swiss-American psychiatrist who studied the experiences of the
dying and their loved ones. Kü bler-Ross proposed that everyone who was going through a terminal illness would go
through the same ive steps or stages. She based this model on interviews she conducted with over 200 adults who
were dying of cancer. While many people still use Kü bler-Ross’s model today, there are many critics who believe that
individual differences can have an effect on the way a person processes the stages of de…
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