Thanatology

Study of the experiences of

dying and bereavement
Definitions
 Death
 absolute cessation of vital functions

 Dying
 process of losing these functions

 Good death
 Free from avoidable distress and suffering

 Bad death
 Needless suffering, dishonoring of patient/family wishes or values
Uniform Determination of Death Act
(1981)
 Irretrievable cessation of circulatory and
respiratory functions

 Irretrievable cessation of all brain

functions, including the brain stem
Interval between 2 evaluations
according to age
 Term to 2 months – 48 hours

 > 2 months to 1 year – 24 hours

 > 1 year to < 18 year – 12 hours

Legal Aspects of Death
 physicians must sign death certificate

 Attest cause of death

 Attribute death to natural, accidental, suicidal, homicidal or unknown

 Unattended cases – medical examiner, coroner or pathologist must

examine and perform an autopsy

 Psychological autopsy in some cases

Stages of Death and Dying
(Elisabeth Kubler Ross, MD –1969)
 Stage 1 – Shock and Denial

 Stage 2 – Anger – Why me?

 Stage 3 – Bargaining

 Stage 4 – Depression

 Stage 5 – Acceptance
Near Death Experience
 Strikingly similar
 Descriptions
 Out of body experience Viewing one’s body
 Overhearing conversations
 Feeling of peace and quiet
 Hearing a distant noise
 Entering a dark tunnel
 Leaving the body behind
 Returning to life to complete unfinished business
 Described as peaceful/loving
 Feels real
 Provoke sweeping lifestyle changes
 Experience of “visions” ( unio mystica )
Life Cycle Considerations about
Death/Dying
 Children
 Pre- school
 Death seen as temporary absence, incomplete and
reversible (departure/sleep)
 Maybe unable to relate treatment to illness

 School – age
 Recognize death as a final reality
 Active fantasies of violence/aggression (6-12 yrs)
II.
 Adolescents
 Understand death is inevitable/final but may not
accept that their own death is possible
 Concerns about body image or loss of body functions
– great resistance to treatment
 Alternating emotions of despair, rage, grief, terror, are
common
 Potential for withdrawal/isolation
 great
III.
 Adults
 Common fears
 Separation from loved ones
 Becoming a burden
 Losing control
 What will happen to dependents
 Pain
 Being unable to complete life tasks
 Dying
 Being dead
 Fears of others
 Fate of body
 The afterlife
 Sense of integrity vs. despair (Erik Erikson)
Management
 Highly individual
 caretakers need to need to deal with death
honestly; tolerate wide range or affects,
connect with patients and resolve issues
as they arise
 Major themes confront all health providers
caring for dying patient
Grief, Mourning and Bereavement
 Grief
 Subjective feeling precipitated by the death of a
loved one
 Mourning
 process by which grief is resolved
 Bereavement
 State of being deprived of someone by death ….
Being in a state of mourning
Normal Bereavement Reactions
 Protest
 Searching behavior
 Despair and detachment
 Reorganize self
Duration of Grief
 Few weeks to months to years
 Lasting manifestation is loneliness
 Protracted grief occurs intermittently
 Bittersweet memories may last a lifetime
Complicated Bereavement

 Chronic grief
 Hypertrophic grief
 Delayed grief
 Traumatic bereavement
Grief Depression
 Fluid, changing and  Pervasive
evolving state  Recognizable cluster of
 Fluctuating state and debilitating symptoms
cognitive and behavioral accompanied by a
adjustments are protracted, enduring low
progressively made mood
 Time limited fleeting with  Persistent and associated
full resumption o function with mark
social/occupational
dysfunction
Grief Therahy
 Normal grief – seldom need psychiatric help
 Seriously suicidal – psychiatric intervention ex.
Sleeping medications, antidepressants,
anxiolytics
 Counseling sessions – depressive disorder,
pathological mourning
 Grief theraphy – one on one or group