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Chapter 12

PSYC 328 Chapter Notes - Chapter 12: Terminal Illness, Sue Rodriguez, Cardiovascular Disease

Course Code
PSYC 328
Barbel Knauper

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Chapter 12 Psychological Issues in Advancing and Terminal Illness
Adolescents + children die in car crashes often related to risky driving, drugs, alcohol, or a
combination of factors
Death in middle and old age is most commonly due to the cumulative effects of bad health habits,
such as smoking, poor eating, lack of exercise, and accompanying obesity
LO1 How Does Death Differ Across Lifespan?
100 years ago, people died primarily from infectious diseases (e.g. tuberculosis, influenza, pneumonia)
o Now much less widespread substantial advances in public health and preventive medical
On average, people in Canada: 81 years, longer than the average for most developed
Now, death is often caused by chronic illness or non-communicable disease (e.g. heart disease or
cancer) rather than from an acute disorder
o Instead of facing a rapid, unanticipated death, most may know he or she will probably die from
Death in Infancy or Childhood
o Infant mortality rate: number of infant deaths per thousand infants.
Still high in Canada relative to some Western European nations
Significant disparity in the rates of infant deaths across different socio-economic status
groups and locations
Higher among First Nations infants, but the gap has been shrinking dramatically
May be unrelated to socio-economic status
o Main causes of death during the first year:
Congenital abnormalities
Sudden infant death syndrome (SIDS): common cause of death among infants, in
which an infant simply stops breathing.
Higher among Aboriginal children
Causes unknown
More likely to occur
o Lower-class urban environments
o Mother smoked during her pregnancy
o When the baby is put to sleep on the stomach or side
Appears to be a gentle death for the child
Hard for parents: confusion, self-blame, and suspicion of others enormous
psychological toll on the parents
Adjustment seems to be better if they do not blame themselves
The fact that sleeping position has now been reliably related to SIDS is a great
breakthrough in its reduction many campaigns
o After the first year, main cause of death among children under age 15
External causes: motor vehicle accidents, accidental drowning, poisoning, injuries, or
falls in the home.
o In later years, chief external cause of accident: cars
The good news both accidental deaths in the home and automobile deaths have
Increasing attention
Preventive technologies
o Second leading cause of death among 1-15 year-olds: Cancer, especially leukemia
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Incidence is rising
Leukemia is a form of cancer that strikes the bone marrow, producing an excessive
number of white blood cells and leading to severe anemia and other complications
More than 80 percent of its victims survive the disease now
BUT the procedures, esp. bone marrow transplants, can be very painful and produce a
variety of unpleasant side effects
Mortality rates for most causes of death in infants and children have declined.
o Children’s Understanding of Death
Develop quite slowly
Up to age 5/6: great sleep
Curious rather than frightened or saddened
May not understand that death is final and irreversible
Between ages 5-9: the idea that death is final may develop, BUT no biological
understanding of death
Death is personified into a shadowy figure, e.g. supernatural ghost or the devil.
Ages 9-10: death is universal and inevitable
Some understanding of the processes involved in death (such as burial and
cremation), knows that the body decomposes, and realizes that the person who
has died will not return
Death in Young Adulthood
o Most young adults envision a trauma or fiery accident somewhat realistic.
o Death rate in adolescence is low
o Major cause of death: unintentional injury, mainly involving automobiles
o Second leading cause: suicide
o Third: cancer
o Fourth: homicide
o Heart disease, respiratory diseases, and congenital abnormalities account for most of the
remaining mortality
o Reactions to Young Adult Death
Most tragic, seeming waste of life and because they are robbed of the chance to
develop and mature
When young adults do receive a diagnosis of a terminal illness, they may feel shock,
outrage, and an acute sense of injustice.
Medical staff often find it difficult to work with these patients
Angry much of the time
May face a long and drawn-out period of dying
Fewer biological competitors for death do not quickly succumb to
Particular concern terminally ill parent of young children
Parents feel cheated of the chance to see their children grow up and develop,
and are concerned over what will happen to their children without them
Death in Middle Age
o In middle age, death begins to assume more realistic, fearful proportions more common,
people develop the chronic health problems that may ultimately kill them.
o Fear of death is more prominent during middle age more so than in later adulthood
Popularized midlife crisis that may occur in the 40s or early 50s stem partly from the
gradual realization of impending death
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May be touched off by the death of a parent, an acquaintance, or a friend or by
clear bodily signs that one is aging
The fear of death may be acted out as a fear of loss of physical appearance,
sexual prowess, or athletic ability
Or focused on ones work: the realization that one’s work may be meaningless
and that many youthful ambitions will never be realized
A Confrontation with Mortality
Personal contact with death can prompt a person to re-evaluate the course of
his or her life and to make radical life changes
Passages, writer Gail Sheehy
To be confronted for the first time with the arithmetic of life was, quite
simply, terrifying
o Premature Death
Premature death: death that occurs before the projected age of 81
The main cause in adulthood: heart attack or stroke
Compared with a slow and painful death, sudden death is quick and relatively
Most people reply that they would prefer a sudden, painless, and non-
mutilating death
BUT sudden death has the disadvantage of not allowing people to prepare
their exit
It facilitates a more graceful departure does not have to cope with physical
deterioration, pain, and loss of mental faculties
Kinder to family members as well does not have to go through the
emotional torment of watching the patient’s worsening condition, and finances
and other resources are not as severely taxed
Risk: families may be poorly prepared financially to cope with the loss,
estranged, with reconciliation now impossible.
Causes of premature death
Family history of heart attack or stroke
Environmental factors
o Before the age of 65, different adverse childhood events including
neglect, abuse, domestic violence in the home, and criminal acts by a
family member
Behavioural factors (major contributor)
Overall, death rates in the middle-aged group have declined with gender differences
E.g. decline in death rates due to lung cancer has been more dramatic for men
Death in Old Age
o May be easier in old age
o Generally more prepared to face death than are the young some initial preparations
o They have seen friends and relatives die and often express readiness
o They may have come to terms with issues associated with death (e.g. loss of appearance,
failure to meet all the goals) may have withdrawn from activities because of their now
limited energy
o Typically die of degenerative diseases
E.g. cancer, stroke, heart failure, or just general physical decline that predisposes
them to infectious disease or organ failure
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