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DEATH AND BEREAVEMENT This essay examines death, bereavement, and the disposal of the dead through its social-psychological, historical, cross cultural, medical-ethical, and public policy aspects from the perspective of both the dying person and survivors. In its examination this course divided death and bereavement into the following five concepts and theories: 1) The stages of death and bereavement as outlined by Kubler-Ross. 2) Social implications, norms, and institutions that relate to death and dying in our society, i. e. , Western attitudes toward death, historically and in contemporary times. 3) Cross-cultural, subcultural, ethnicity, and religious differences in dealing with death, bereavement, and disposal. 4) Medical-ethical issues such as the right to die, euthanasia, medical intervention, life support, organ donation, hospice, living wills, and disposal of the dead. 5) Financial and legal aspects of death and dying. My first close encounter with death was when I was seven years old.
I traveled with my mother to visit with my maternal grandfather. He was my only living grandparent and it was the first time I had met him. I can remember that he looked old and pale and had a shock of white hair. While he knew who I was, he was somewhat confused as he kept referring to me by my mothers name.
Although, he did not appear to be in pain, he had recently suffered a massive heart attack and was not expected to last much longer. My mothers childhood home was filled with relatives and family friends, but for me it was a strange atmosphere. I had not previously met many of my relatives and it had been several years since my mother had been home. People were constantly stopping by with food dishes and there was always a pot of tea brewing. The local priest was also a constant visitor and seemed to be pleased that so many of the family had made it back for my grandfathers last days. There wasnt an air of expectancy, but rather a quite acknowledgment that his time had come.
My grandfather had been released from the hospital, because they could do nothing more for him. He knew he was going to die and it was his wish that he die at home, amongst family and friends. I often wonder if he would have had that choice today. My relatives took turns sitting with him and spent hours just holding his hand and talking to him softly. While I can see now that it must have been comforting for him to die surrounded by his family, it gave me the creeps to know that I was in the same house with someone who was going to die. I can remember praying that I would not be in the room when he passed on.
I wasnt, he died in his sleep and I heard the news from my mother the next morning. It really didnt affect me too much as I hadnt really known him and I guess I didnt really appreciate what death was. I do remember wondering what they were going to do with my grandfather, I didnt much care for the idea that I was in the same house as a dead body. As was the custom, my grandfather was laid out in the living room for viewing.
It was a small town and it seemed that most everyone stopped by to pay their respects. The funeral was held at the local Catholic Church and my grandfather was buried in the family plot, purchased long before, next to his wife. I remember walking around the cemetery and feeling very uneasy that so many gravestones had the names of my relatives on them. After the funeral everyone returned to the house for the wake. I was surprised how festive the occasion was and remember thinking it morbid somehow to throw a big party after burying someone you loved, but now I can see it was a good way for people to deal with their grief.
Food and drink flowed and everyone related their favorite tale, good and bad, about the deceased. I learned a lot about my grandfather and my family history and it made me feel part of the things. I felt somehow connected and part of this large and previously unknown crowd. The general consensus was that my grandfather had lived to be a good age, had lived a good life and would now be joining his wife in heaven. He was, they all agreed, lucky to be able to able to die surrounded by family and friends and in familiar surroundings. It is obvious to me now that my grandfathers death was accepted as a normal part of family life.
He had lived amongst family and friends all his life and those same people were there with him at the end. Although I did not appreciate it at the time, it was a good way to die. The stages of death and bereavement as outlined by Kubler-Ross My Aunt Caroline, my mothers older sister, was not so lucky when she died last year. In the months preceding her death my Aunt had suffered a series of debilitating strokes that had left her paralyzed on one side.
A widow and unable to look after herself, she had for the last few months been resident in a local nursing home. Looking back it is easy now to see that upon hearing the news of my Aunts initial stroke, my mother had struggled with the first stage of Kubler-Ross death and bereavement process: Denial and isolation. I can remember when she told me that my Aunt had a stroke, she focused on the fact that it was not serious. The first stroke had been minor and the paralysis only temporary. My mother did not want to think the seriousness of her sisters condition, she wanted to believe that her sister would recover fully.
However, over the next several months my Aunts condition worsened and she suffered a series of strokes and was eventually bed-ridden, paralyzed on one side and unable to speak. The doctors prognosis was there was no chance of recovery and the best they could do was to make her comfortable. On talking with my mother, it was obvious that she had moved on from denial to Kubler-Ross second stage: Anger. My mother is a Roman Catholic and has always believed that God had a purpose for everything. While her faith never really wavered, I could see that she was finding it difficult to resolve her anger at God for making her sister suffer needlessly and her guilt at hoping that her sisters suffering would soon end (Kubler-Ross, 1991). My mother briefly entertained the third stage of Kubler-Ross process: Bargaining.
We went to mass and lit candles for my Aunt and prayed. My mother prayed not only for her sisters recovery, but was also willing to accept that maybe the best she could bargain or trade for would be an end to my Aunts suffering. Just after Christmas my mother and I visited my Aunt and it was devastating to see the effect of the strokes. My aunt was able to recognize us and seemed to glad to know that someone was there. My mother spend hours with her sister just holding her hand and although it was obviously difficult for them to communicate, both seemed comforted.
However, we were only able to stay for ten days and then had to return home. The one comforting thing was knowing that my cousins worked at the nursing home and were able to look in on my Aunt daily. After we got home, my mother was depressed, Kubler-Ross fourth stage. She knew that it was unlikely that she would be able to see her sister again before she died and my mother wavered back and forth between depression and Kubler-Ross fifth stage: Acceptance. She knew that my Aunt was going to die soon, she didnt want her to suffer anymore and there was absolutely nothing else that she personally could do. I got the news of my Aunts passing in a telephone call from my mother.
While she was sad at the loss of her sister, she was also relieved that her suffering had ended. My Aunt had long ago purchased a funeral plan that paid for all the services and her will designated exactly the type of service she wanted. According to her wishes my mother and my cousin made all the arrangements and there were only a few miscellaneous items that had to be purchased. My mother stated that it was a relief that there was no family squabbling about the cost or choice of services.
My mother took care of the funeral arrangements and my Aunt was buried next to her husband in a double plot they had purchased soon after they got married. It was in the same cemetery where my grandfather had been buried. Looking back at my grandfathers death I can see now that both my grandfather and the family had somehow worked their way through to Kubler-Ross fifth stage: Acceptance. Attitudes toward death in the United States compared to other cultures One explanation for the difference between how Western (especially American) and non-Western cultures cope with death can be traced to the value that the elderly command in society. In Japan and other nations the elderly are revered for accumulating experience and perfecting spiritual development.
This is not generally so in America (Hoefler &# 038; Kamoie, 1995). In cultures where the elderly are held in high regard, death is most often confronted head on as an important rite of passage. By staying in contact with death in this way its members become more comfortable with death and see it as a normal and natural part of the progression of life. Americans on the other hand, have in many respects removed the specter of death from their everyday lives. The demise of the extended family often means that the elderly are no longer cared for in the home, but are condemned to live out their last days in nursing homes far removed for family and friends.
When death does come, the funeral arrangement can be handled from start to finish by professionals. All that is required it that the bill be paid. Denial of aging and inevitably death in America is an outgrowth of the liberal pursuit of happiness axiom that is central to the American political cultural and economic creed (Hoefler, Kamoie, 1995). American culture tends to value youth and would rather deny their mortality.
Basic to our failure to confront death is the fact that American society in its preoccupation with perpetual youth, beauty and strength, has typically disguised, avoided denied and embellished death. Acknowledgment of death implies a sense of limits that flies in the face of American consciousness. (Hoefler &# 038; Kamoie, 1995: p. 172). Americans treat death as a great surprise when it overcomes a friend or family member, even if the departed was relatively old and ill, as if such a thing were not entirely natural. They go to great lengths to disguise their own aging and infirmity by utilizing the services of plastic surgeons and bottomless jars of anti wrinkle cream. In contrast to the avoidance of death in American culture, Mexican culture sees life and death as different phases of an underlying process of regeneration...
The national fiesta El Dia de los Muertos, the Day of the Dead is a two day celebration of the communion between the living and the dead (Despelder &# 038; Strickland, 1992). During the Day of the Dead celebration families clean and decorate the graves of deceased family members, placing food offerings and lighted candles before the souls of ancestors. The night is devoted to meditative communion and mourning for dead loved ones who in return offer aid and comfort to the living. Failure to pay respect to the dead can bring scorn to a family that neglects its responsibilities (Despelder &# 038; Strickland, 1992). Dying individuals and their loved ones go through the human grieving process. Although the experience of grieving varies in some respects among societies and individuals, its basic aspects seem to universal and biological.
Those who are facing death or the loss of a loved one often find that because they share the same problem, they can offer the best support to one another. Medical and Ethical Issues such as the right to die and euthanasia. Advances in biomedical technology have greatly enhanced our ability to stave of impending death The statistically average person can look forward to living to 75 and will typically die in an institutional setting: a hospital or nursing home (Despelder &# 038; Strickland, 1992). This is far different than when my grandfather died. Today the hospital staff would probably be able to keep him alive for months by using drugs and other invasive treatments. However, I doubt if they would have been able to offer a quality of life that he would have found acceptable.
I believe that given the choice he would still chose to live out his last days, peacefully with family and friends surrounding him, than being hooked into all kinds of strange and wonderful machines. Death with dignity was seen as an important right for people of his generation and at the time of his death he believed that his time had come and was accepting and at peace with his fate. These technological advances have made the legal definition and criteria for death much more difficult. It used to be accepted that death had occurred when the vital functions ceased, i. e. , breathing and circulation as evidenced by the heart beating.
However, medical advances have made it possible for machines to sustain our breathing and heart beat. Because of these advances a majority of states switched to brain death as an essential sign of death by the late 1980 s. While the medical debate continues, society is faced with increasingly complex questions about death. Medical technology advances mean that more and more patients and their families are faced with the dilemma of determining when enough is enough. If a patient is terminally ill can they demand that extraordinary measures be stopped so that they may die in peace. What about those in comas, should the next of kin or legal guardian act for them.
Who shall decide the criteria for death; physicians, legislatures, or each person for him or herself (Hoefler &# 038; Kamoie, 1995). In conjunction with the rights and needs of the dying patient is the ongoing need for organs for transplants. Many hospitals garner huge fees for doing such operations and many people die every day because of a lack of donor organs. Knowing another patient needs those organs, will it become permissible to advance the moment of death for a terminally ill patient by cutting off artificial support. One way for patients to regain some control is Living Wills. These documents convey the right to withdraw life sustaining treatment upon family members or other representatives.
Recognized in most states, the living will is one attempt to regain the right to death with dignity on your own terms. The issue of intervening in the death process is one that will only get more complicated as our ability to forestall death increases in stride with advances in medicine and technology. In the United States, most of the discussion in recent years has concerned the issue of withholding or withdrawing treatment, while in the Netherlands physicians report taking active steps to end the lives of patients who request a dignified death (Strickland &# 038; Despelder, 1992). Kubler-Ross and Dame Cicely Saunders summarize the arguments against a legally sanctioned right to euthanasia as 1) There is an inherent risk that a legally sanctioned right to euthanasia might come to be experienced by the patient as an obligation coupled with a subtle pressure to end it all, so as to lessen the burden of loved ones. 2) Where would we draw the line once the slippery slope of euthanasia has been embarked on. 3). When the pain and depression are treated and the sources of anxiety are addressed the infrequent request for euthanasia may disappear. (Strickland &# 038; Despelder, 1992: p. 358). The answer to our challenge should not be to legalize euthanasia, but rather to transform our care of the suffering and dying. (p: 361).
Another attempt to treat the dying with dignity can be seen in the care of terminally ill patients in hospices. These specialized institutions offer patients the opportunity to spend their last days with staff who have been specially trained to deal with their own fear of death. Having come to terms with their own feelings the staff is often able to help patients to deal with the physical and emotional aspects of dying with dignity and serenity. Financial and legal aspects of death and dying Funerals are a focus of familial and community support for the bereaved, the funeral ceremony performs a unique function among the social rituals devised to mark significant events in the lives of a member of a community. Unless arrangements have previously been made those faced with the responsibility for arranging funerals can be faced with a dizzying array of choices, when they are least able to comparison shop. In modern America funeral practices are overlaid with such ostentation that the fundamental meaning and dignity of the funeral rite had all but disappeared (Despelder &# 038; Strickland, 1992).
There is a widespread feeling that funeral directors are in a position to take advantage of their customers since the activities and costs of funeral services are unfamiliar to people. While it may seem morbid, put simply people need to plan ahead. It is easier for families to discuss issues such as funeral arrangements and financial matters when death is not imminent (Kubler-Ross, 1991). There are four categories of charges that make up the cost of a conventional American funeral. 1) Services provided by the funeral director and mortuary staff, use of mortuary facilities and equipment and coffin and related merchandise. 2) Disposal of the body including: purchase of graveside, opening and closing grave, cost of a mausoleum crypt, cost of cremation. 3) Cost of gravestone, monument or marker. 4) Expenses paid directly by the family or reimbursed to the undertaker such as clergy members honorarium, use of limousines and other vehicles, flowers and death notices. To ease the burden on the bereaved and in recognition of the potential for abuse by unscrupulous funeral directors the 1984 Federal Trade Commissions Funeral Rule mandated that prices be itemized for seventeen specified goods and services.
These must be specified on the providers General Price List, which has been called the keystone of the Funereal rule, so that customers can compare prices or choose only those elements they want. However, as with most other commodities in America, package deals can and are offered (Despelder, Strickland 1992). Another source of our discomfort about the commercialization of funeral services is our aversion to touching or being in the presence of a corpse (Despelder &# 038; Strickland, 1992). My mother has helped lay out bodies of close friends who have died. I could not imagine ever doing such a thing. Yet when the corpse is of some we loved our aversion to look at or touch may be mixed with guilt.
Everyone deals with death and bereavement differently, but I believe that my increased knowledge and awareness of the process involved have left me in a better position to face the inevitable death of those close to me. Kubler-Ross stressed the importance of making peace between the person who is dying and his or her survivors. I agree with her when she says it is inevitable that things left unsaid or undone will come back to haunt you (Kubler-Ross, 1991). People should understand that during that During the process of working through grief many different emotions will be felt and many different thoughts will arise.
By allowing them all and withholding judgment as to the rightness and wrongness of particular emotions or thoughts, the survivors much more likely to experience grief as healing. (Hoefler &# 038; Kamoie, 1995: p. 102). Funerals are an important part of the grieving and recovery process and it is far better to discuss preferences and arrangements for covering these costs long before they will be needed. Funerals arrangements made in haste will often result in the bereaved spending far more that is necessary or they can really afford. It is difficult to think about economics and comparing cost in times of grief. Like many other aspects of life the more pre need planning a family can do, the less they will have to worry about when the fateful event happens. My final thoughts on the five step grieving and bereavement process are that they can also be applied to many other difficult situations such as job loss.
I noticed when I was laid off from work that I passed through those same stages. This realization has made it much easier to cope with changes, I know that eventually, I will work through my emotions and accept what has happened. In our stress filled modern work world this awareness is bound to come in handy again. Life is a journey and like any other journey there are any number of roads you can travel in order to reach your destination.
However, we must all face the fact that no matter which path we choose our final destination will be the same. Death is the great equalizer, it is the one thing that black or white, rich or poor we must all eventually face. Throughout recent history man has made giant strides in science and technology, we have solved numerous problems and cured many ills, but still the specter of death hovers over all of us. Death is the final frontier, and by its very nature, one that we will never be able to explain or fully explore.
REFERENCES Bartholomew, K. (1994). Doctor, Please Close the Door: Florida: Distinctive Publishing. Despelder, L. &# 038; Strickland, A. (1992). The Last Dance.
Mountain View, CA: Mayfield. Hoefler, J. &# 038; Kamoie, B. (1995). Death right, Culture, Medicine, Politics and the Right to Die. Boulder, Co. : Westview Press. Kubler-Ross, E. (1991).
On Death and Dying. New York: Macmillan.
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