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Chapter 18 - Death and Dying 1. According to terror management theory, thinking about one’s own death leads to which of the following? a. denial b. despair c. confusion d. a stronger self-concept Answer: d Rationale: Terror management theory posits that contemplation of one's mortality can lead individuals to reinforce their sense of self-worth and significance in order to manage existential anxiety. This can result in a stronger self-concept as individuals strive to find meaning and purpose in the face of mortality. 2. According to research cited in the text, when caregivers were asked to comment about the relief they felt following their loved one’s death, about ____ reported that death was a relief to them and about ____ reported that they felt it provided a welcome relief to the person who died. a. 5%; 50% b. 35%; 55% c. 50%; 50% d. 72%; 90% Answer: d Rationale: The research cited in the text indicates that a significant percentage of caregivers, approximately 72%, reported feeling relief following their loved one's death. Additionally, approximately 90% reported feeling that death provided a welcome relief to the person who died, suggesting that the end of suffering or distress was perceived positively. 3. In 1900, the death rate of U.S. children under the age of 5 was ____; in 2009 it was ____. a. 8%; 4% b.18%; 8% c. 50%; 5% d. 30%; 1.5% Answer: d Rationale: The death rate of U.S. children under the age of 5 significantly decreased from 30% in 1900 to 1.5% in 2009. This dramatic decline reflects advancements in healthcare, sanitation, and public health initiatives over the past century. 4. The text notes that today in the United States, we live in an era of “invisible death.” By this, the text means that: a. the rituals surrounding death are very clear and well understood by members of our culture b. we often cope with death by denying its existence in our lives c. most people die while they are unconscious, thus the last moments of life are peaceful d. the terror surrounding death is paralyzing and therefore we seldom see death approaching us Answer: b Rationale: The term "invisible death" refers to the cultural tendency to deny or avoid confronting the reality of death. In modern society, death is often shielded from public view and discussions about mortality may be avoided, leading to a sense of denial or invisibility surrounding death. 5. According to the work of Elisabeth Kübler-Ross, which of the following statements best reflects the anger stage of dying? a. "I'm a goner." b. "The doctor has given me the wrong diagnosis." c. "Why me?" d. "How can I get out of this?" Answer: c Rationale: In Kübler-Ross's model, the anger stage of dying is characterized by expressions of frustration, resentment, and protest against one's fate. The statement "Why me?" reflects the typical response of anger as individuals grapple with the injustice or perceived unfairness of their situation. 6. Between 2003 and 2010, the number of hospice patients served in the United States: a. decreased very slightly b. remained about the same c. increased very slightly d. increased by about 65% Answer: d Rationale: Between 2003 and 2010, the number of hospice patients served in the United States increased significantly by about 65%. This growth reflects a broader acceptance and utilization of hospice care as an approach to end-of-life care. 7. The text points out an inconsistency between hospice care and hospital care. Which of the following best captures the sense of that inconsistency? a. Hospitals focus on keeping patients alive, whereas hospice is focused on helping a person die. b. In a hospital, decisions about extending life are made by the patient but in hospice care trained professionals make these decisions for the patient. c. Most real care in hospitals is done by nurses but in hospice care the real care is done by physicians. d. Most hospital care is covered by insurance but hospice care is hardly ever covered by insurance. Answer: a Rationale: The inconsistency highlighted between hospice care and hospital care is that hospitals typically focus on aggressive medical interventions aimed at prolonging life, whereas hospice care emphasizes comfort, quality of life, and acceptance of death as a natural process. 8. Jodi is dying from a rare blood disorder, but insists that her doctor has made a mistake in the diagnosis. Jodi’s reaction is best considered to be an example of which of Kübler-Ross's five stages of dying? a. anger b. denial c. bargaining d. depression Answer: b Rationale: Jodi's insistence that her doctor has made a mistake in the diagnosis is a characteristic response of denial, which is one of the five stages of dying according to Kübler-Ross's model. Denial involves rejecting or refusing to accept the reality of one's terminal condition. 9. A small town has experienced an unusually high suicide rate in recent years. Local officials try to prevent future suicides by concentrating their efforts on those most likely to commit suicide. These people would be: a. women under age 21 b. women between ages 21 and 35 c. men under age 21 d. men over age 75 Answer: d Rationale: Men over age 75 are identified as the demographic group most likely to commit suicide in the given scenario. Suicide prevention efforts target this population to address underlying factors such as social isolation, declining health, and loss of autonomy often associated with aging. 10. George is diagnosed with Alzheimer’s disease, so he and his wife consult an attorney to draw up and sign documents giving George’s wife the legal authority to make decisions about George’s care. Such a document is called: a. living will b. a probated will c. a medical power of attorney d. a right to die document Answer: c Rationale: The document that grants George's wife legal authority to make decisions about his care is called a medical power of attorney. This legal document allows designated individuals to make healthcare decisions on behalf of someone who becomes incapacitated or unable to communicate their wishes, such as in the case of Alzheimer's disease. 1. According to the theory set forth by Kübler-Ross, the stage of adjustment in which the terminal patient has recognized that death will come is called: a. acceptance b. depression c. anticipatory grief d. bereavement overload Answer: a Rationale: Kübler-Ross's theory of the five stages of grief outlines the psychological processes individuals often go through when facing death or loss. The stage characterized by recognizing and coming to terms with the inevitability of death is indeed "acceptance." 2. The goal of hospice is to: a. keep down the cost of health care b. prevent contamination from contagious diseases c. help terminally ill patients live their final days as fully and independently as possible d. allow the terminally ill person a spiritual retreat before death Answer: c Rationale: Hospice care focuses on providing comfort, dignity, and support to terminally ill patients during their final days. The primary goal is to enhance the quality of life by managing symptoms and addressing the physical, emotional, and spiritual needs of patients, allowing them to live their remaining time as fully and independently as possible. 3. A legal document that informs both family and health-care workers of the signer's wish to avoid the use of "heroic measures" to maintain life in the event of irreversible illness is called a(n): a. donor's will b. medical power of attorney c. intestate will d. living will Answer: d Rationale: A living will is a legal document that allows individuals to specify their preferences regarding medical treatment and end-of-life care in case they become unable to communicate their wishes. It typically includes instructions about the use of life-sustaining measures in the event of terminal illness or irreversible condition. 4. When Elisabeth Kübler-Ross began her research on death and dying in the 1960s, she commonly observed all of the following EXCEPT: a. patients were sometimes not told they had a terminal diagnosis b. doctors and nurses seemed to avoid patients who were dying c. doctors and nurses provided better and more attentive care, but only after a terminal diagnosis was certain d. patients were discouraged from talking about their own deaths Answer: c Rationale: When Kübler-Ross began her research, one common observation was that doctors and nurses often provided inadequate emotional support and avoided discussions about death and dying with patients. Patients were sometimes not informed of their terminal diagnosis, and there was often a reluctance to engage in conversations about death and end-of-life preferences. 5. Generalizing from the text, terror management theory seems to provide the best predictions for which of the following groups of people? a. older people from collectivist cultures b. older people from individualist cultures c. younger people from collectivist cultures d. younger people from individualist cultures Answer: d Rationale: Terror management theory posits that individuals cope with the fear of mortality by developing cultural worldviews and self-esteem to buffer against existential anxiety. Research suggests that individuals from individualist cultures, which prioritize personal achievement and independence, may be more likely to engage in behaviors aimed at managing existential fears compared to those from collectivist cultures, which emphasize group harmony and interconnectedness. 6. Statistically speaking, which of the following people would be at the highest risk of suicide? a. a married woman b. a married man c. a man who has just become a widower d. a woman who has just become a widow Answer: c Rationale: Research indicates that widowers, especially men who have recently lost their spouses, are at higher risk of suicide compared to other demographic groups. The loss of a spouse can lead to profound feelings of loneliness, depression, and hopelessness, contributing to an increased risk of suicidal behavior. 7. Of the children who die before they reach age 18, the largest percentage falls into which of the following age group? a. age 0 to age 1 b. age 1 to age 4 c. age 5 to age 9 d. age 15 to age 19 Answer: a Rationale: The largest percentage of children who die before reaching age 18 falls into the age group of 0 to 1 year old. This age group is particularly vulnerable to infant mortality due to various factors such as congenital anomalies, prematurity, and complications during childbirth. 8. Brittany, age 23, has just been told by her doctor that she has only a few months to live due to a heart ailment. Her reaction is to say that the diagnosis must be wrong and to seek out opinions from other doctors. Brittany’s reaction is best considered to be an example of which of Kübler-Ross's five stages of dying? a. depression b. anger c. denial d. acceptance Answer: c Rationale: Brittany's initial refusal to accept her terminal diagnosis and her attempt to seek alternative opinions are indicative of the stage of denial in Kübler-Ross's model. Denial is characterized by a refusal to acknowledge the reality of impending death or loss. 9. Terry, a 73-year-old widower, was in the hospital for six months with cancer. Finally, the painful treatments got to be too much for him and he just gave up and let himself die. This passive form of suicide is best considered to be an example of: a. suicide-by-proxy b. anticipatory suicide c. submissive death d. unilateral death Answer: c Rationale: Terry's decision to cease medical treatments and passively allow himself to die due to the burden of pain and suffering is best characterized as a form of submissive death. This type of death involves a resignation to one's fate and a lack of active intervention to prolong life. 10. MacDonald’s has established a network of “Ronald McDonald” houses near major hospitals so that families of very ill children will have a place to stay while visiting their ill child. This charity is best considered to be an example of: a. hospice care b. palliative care c. bereavement assistance d. grief work Answer: b Rationale: The Ronald McDonald House program provides accommodations and support services to families of seriously ill children receiving medical treatment. This initiative aligns with the principles of palliative care, which focus on enhancing the quality of life for patients and their families by addressing physical, emotional, and practical needs during times of serious illness or medical treatment. Multiple Choice questions: Thoughts and Fears of Death 1. In comparison to how developmental psychologists engaged with the study of death a few decades ago, today there is _____ interest in studying death and psychologists know _____ about how people approach and experience their own death, as well as the deaths of others. a. more; more b. more; less c. less; more d. less; less Answer: a Rationale: In recent decades, death has been studied thoroughly. As compared to the past, we now have a better understanding of how people typically confront the prospect of death—their own as well as others’—and how we cope with the psychological loss that death implies. 2. Up until the middle of the 20th century, in the United States death usually occurred in: a. hospitals b. hospices c. the home d. nursing homes Answer: c Rationale: Historically, up until the middle of the 20th century, death in the United States typically occurred at home. Families often cared for their dying loved ones in the familiar and comforting environment of their own homes, with the assistance of family members, friends, or community support. 3. According to the text, in the United States today, death usually occurs in: a. hospices b. the home c. the workplace d. hospitals Answer: d Rationale: In contemporary United States, death predominantly occurs in hospitals. Advances in medical technology and healthcare delivery have led to a shift towards hospital deaths, where terminally ill patients often receive end-of-life care from medical professionals. 4. The text notes that today in the United States, we live in an era of “invisible death.” By this, the text means that: a. the rituals surrounding death are very clear and well understood by members of our culture b. we often cope with death by denying its existence in our lives c. most people die while they are unconscious, thus the last moments of life are peaceful d. the terror surrounding death is paralyzing and therefore we seldom see death approaching us Answer: b Rationale: Some theorists have suggested that we currently live in an era of “invisible death,” where we cope with death through psychological denial. Although we know that everyone dies, we distance ourselves emotionally from the realization that death will eventually come to us. 5. Generalizing from the text’s discussion of how death is considered today in Western societies, which of the following terms best characterizes how people in these societies deal with death? a. acceptance b. anger c. worry d. denial Answer: d Rationale: Some theorists have suggested that in Western nations, we currently live in an era of “invisible death,” where we cope with death through psychological denial. Although we know that everyone dies, we distance ourselves emotionally from the realization that death will eventually come to us. 6. When Elisabeth Kübler-Ross began her research on death and dying in the 1960s, she commonly observed all of the following EXCEPT: a. patients were sometimes not told they had a terminal diagnosis b. doctors and nurses seemed to avoid patients who were dying c. doctors and nurses provided better and more attentive care, but only after a terminal diagnosis was certain d. patients were discouraged from talking about their own deaths Answer: c Rationale: Kübler-Ross noted a diagnosis of a terminal illness was made, nurses and doctors paid less attention to the patient, and they seemingly avoided all but the most necessary contact. They talked to the patient less, they provided less routine care, and they usually did not tell the patient that he or she was in a terminal state—even when the patient asked. Patients who were dying also were discouraged from discussing their feelings about dying. 7. In comparison to how dying patients were cared for four or five decades ago, today medical staff members are _____ likely to encourage dying patients to talk about their impending deaths and are _____ likely to be trained in caring for terminally patients. a. less; less b. less; more c. more; less d. more; more Answer: d Rationale: Compared to previous decades, modern medical staff members are more likely to encourage dying patients to discuss their impending deaths openly. Additionally, they are also more likely to undergo specialized training in providing care for terminally ill patients, reflecting advancements in palliative and hospice care. 8. According to research described in the text, _______ individuals and those with _______ religious beliefs are typically found to have the least anxiety about their own death. a. younger; strong b. younger; no c. older; strong d. older; no Answer: c Rationale: Studies have found that older adults generally are somewhat less anxious about death than younger people are. Religious beliefs are also important in coping with death. Research has repeatedly shown that people with strong religious convictions and a deep belief in an afterlife experience less depression and anxiety about death. 9. Dr. Christiansen believes that thinking about death is very frightening to most people, and they cope by becoming more attentive to others around them, thereby enhancing their own self-esteem. Dr. Christiansen’s beliefs are most similar to those advanced by: a. Freud’s theory of psychosexual development b. Erikson’s conceptualization of the stage of generativity versus stagnation c. Erikson’s conceptualization the stage of integrity versus despair d. terror management theory Answer: d Rationale: According to terror management theory—our biologically motivated desire for life is in direct contradiction with our knowledge that we will die at some point. This conflict gives rise to terror. If this terror is not addressed, it can be psychologically paralyzing and lead to despair and depression over the hopelessness of our situation. According to terror management theory, we cope with this terror by developing our self-esteem. We work on becoming competent, attached, and important to other people and on attending to the needs of others, as well as ourselves. 10. According to terror management theory, death is a cause for: a. anger b. despair c. inspiration d. denial Answer: c Rationale: According to terror management theory, contemplating one's mortality can evoke feelings of existential anxiety or terror. However, individuals may also find inspiration or motivation to pursue meaningful goals and values as a means of managing or transcending the fear of death. 11. According to terror management theory, thinking about one’s own death leads to which of the following? a. denial b. despair c. confusion d. a stronger self-concept Answer: d Rationale: According to terror management theory, contemplating one's own mortality can lead to a stronger self-concept or sense of identity as individuals seek to affirm their worth and significance in the face of existential threats. 12. Suppose you conduct a research study in China, which has a collectivist culture, and the Unites Stated. In your study, you encourage adults in both cultures to think about and write about their own deaths. Generalizing from similar research described in the text, you should expect that the U.S. participants in your study will experience a greater tendency to focus on _________ and that their self-esteem will ___________, relative to the Chinese participants. a. collectivism; increase b. collectivism; decrease c. individualism; increase d. individualism; decrease Answer: c Rationale: The text reports a study of Australians and Japanese participants, in which the Australians experienced an enhanced individualism and a greater focus on their own self-esteem when they were asked to consider their own mortality (Kashima, Halloran, & Yuki, 2004). 13. According to the text, people with high levels of self-esteem generally experience ____ death-related anxiety, and this result is _________ with predictions from terror management theory. a. more; consistent b. more; inconsistent c. less; consistent d. less; inconsistent Answer: c Rationale: The text cites research that demonstrates that people with high levels of self-esteem generally experience less death-related anxiety. This is consistent with terror management theory, which suggests that we cope with the terror created by our awareness of our own mortality by developing our self-esteem. 14. Generalizing from the text, terror management theory seems to provide the best predictions for which of the following groups of people? a. older people from collectivist cultures b. older people from individualist cultures c. younger people from collectivist cultures d. younger people from individualist cultures Answer: d Rationale: Anxiety over death is particularly acute in individualist cultures where the focus is on personal accomplishments. When the cultural context is more collectivist and group welfare is emphasized over that of an individual, there is less anxiety about death. Additionally, because of their greater anxiety about death, terror management theories may better explain the relationship between self-esteem and anxiety for younger, compared to older, adults. Confronting One’s Own Death 15. If you asked a high school student, “If you knew you had 2 months to live, what would you most want to do?” the most typical response would be: a. spend more time with my family b. spend more time with my friends c. travel and do the things that I want to do but have not yet had the chance d. kill myself Answer: c Rationale: The text describes a study in which young people and older adults were asked how they would spend the remaining 6 months of their life if they know that was all they had. The typical response was to describe activities such as traveling and trying to do the things they had not yet had the chance to do. 16. If you asked an older adult, “If you knew you had 2 months to live, what would you most want to do?” the most typical response would be: a. spend more time with my family and friends b. take time to do the things I’ve always wanted to do but have never had time for c. travel and read d. kill myself Answer: a Rationale: The text describes a study in which young people and older adults were asked how they would spend the remaining 6 months of their life if they know that was all they had. Older adults typically talked about contemplation, meditation, and other inner-focused pursuits and about spending time with their families and those closest to them. 17. If you asked a young person and an older adult, “If you knew you had 2 months to live, what would you most want to do,” you would expect that the young person would say _____________ and the older adult would say _______________: a. spend time with family and friends; travel and experience the world b. travel and experience the world; spend time with family and friends c. spend time with family and friends; spend time with family and friends d. travel and experience the world; travel and experience the world Answer: b Rationale: The text describes a study in which young people and older adults were asked how they would spend the remaining 6 months of their life if they know that was all they had. The typical response from younger people was to describe activities, such as traveling and trying to do the things they had not yet had the chance to do. Older adults typically talked about contemplation, meditation, and other inner-focused pursuits and about spending time with their families and those closest to them. 18. Which of the following lists the five stages of death and dying described by Kübler-Ross in the correct order? a. denial, anger, bargaining, depression, acceptance b. depression, denial, anger, bargaining, acceptance c. anger, depression, denial, bargaining, acceptance d. anger, denial, bargaining, depression, acceptance Answer: a Rationale: Elisabeth Kübler-Ross proposed the five stages of death and dying in the following order: denial, anger, bargaining, depression, and acceptance. This model suggests that individuals facing death may pass through these stages in their adjustment process. 19. Which of the following people was the researcher who studied the way people typically adjust to their own death and who identified five stages that many people go through as they prepare for their own death? a. Mary Ainsworth b. Elisabeth Kübler-Ross c. Anna Erikson d. Robert Havighurst Answer: b Rationale: Elisabeth Kübler-Ross was the researcher who extensively studied the psychological processes involved in facing death and proposed the five stages of death and dying, which have become influential in understanding end-of-life experiences. 20. According to the work of Elisabeth Kübler-Ross, which of the following statements best reflects the anger stage of dying? a. "I'm a goner." b. "The doctor has given me the wrong diagnosis." c. "Why me?" d. "How can I get out of this?" Answer: c Rationale: Table 18-1 outlines Kübler-Ross’ 5 stages of death and dying. According to this table, people in the anger stage realize their death is imminent and experience anger, resentment, and envy; they feel frustrated because plans and dreams will not be fulfilled. 21. According to the view of Elisabeth Kübler-Ross, the stage of adjustment to dying in which the person searches for a more promising diagnosis is called: a. depression b. bargaining c. denial d. anger Answer: c Rationale: Table 18-1 outlines Kübler-Ross’ 5 stages of death and dying. According to this table, people in the denial stage reject the possibility of their death and search for more promising opinions and diagnoses. 22. Brittany, age 23, has just been told by her doctor that she has only a few months to live due to a heart ailment. Her reaction is to say that the diagnosis must be wrong and to seek out opinions from other doctors. Brittany’s reaction is best considered to be an example of which of Kübler-Ross's five stages of dying? a. depression b. anger c. denial d. acceptance Answer: c Rationale: Table 18-1 outlines Kübler-Ross’ 5 stages of death and dying. According to this table, people in the denial stage reject the possibility of their death and search for more promising opinions and diagnoses. 23. Edie, age 33, is full of resentment and envy because a terminal illness is going to cut short her career as a writer. Edie’s reaction is best considered to be an example of which of Kübler-Ross's five stages of dying? a. denial b. anger c. depression d. acceptance Answer: b Rationale: Table 18-1 outlines Kübler-Ross’ 5 stages of death and dying. According to this table, people in the anger stage realize their death is imminent and experience anger, resentment, and envy; they feel frustrated because plans and dreams will not be fulfilled. 24. Gordie promises that if God will just give him six months more to live, he will give up smoking and be a better husband. Gordie’s reaction is best considered to be an example of which of Kübler-Ross's five stages of dying: a. denial b. anger c. bargaining d. acceptance Answer: c Rationale: Table 18-1 outlines Kübler-Ross’ 5 stages of death and dying. According to this table, people in the bargaining stage look for ways to buy time, making promises and negotiating with their God, doctors, nurses, or others for more time and for relief from pain and suffering. 25. Andrea, age 45, has developed a sense of hopelessness over her terminal illness, and she especially mourns the approaching separation from her friends and family. Andrea’s reaction is best considered to be an example of which of Kübler-Ross's five stages of dying? a. denial b. anger c. bargaining d. depression Answer: d Rationale: Table 18-1 outlines Kübler-Ross’ 5 stages of death and dying. According to this table, the depression stage occurs when helplessness and hopelessness take hold as bargaining fails or time runs out; people mourn both for the losses that have already occurred and for the death and separation from family and friends that will soon occur. 26. Lyle, who is about to die of cancer, has stopped fighting the illness and now awaits his fate quietly. Lyle’s reaction is best considered to be an example of which of Kübler-Ross's five stages of dying? a. denial b. acceptance c. bargaining d. depression Answer: b Rationale: Table 18-1 outlines Kübler-Ross’ 5 stages of death and dying. According to this table, in the acceptance stage, people accept the fact of imminent death and await death calmly. 27. When Rod was diagnosed with terminal cancer, he sought out another doctor to get a different diagnosis. Rod’s reaction is best considered to be an example of which of Kübler-Ross's five stages of dying? a. anger b. denial c. bargaining d. depression Answer: b Rationale: Table 18-1 outlines Kübler-Ross’ 5 stages of death and dying. According to this table, people in the denial stage reject the possibility of their death and search for more promising opinions and diagnoses. 28. Yolanda is dying from cancer. She promises God that she will remarry her ex-husband if she is freed from the disease. Yolanda’s reaction is best considered to be an example of which of Kübler-Ross's five stages of dying? a. anger b. denial c. bargaining d. depression Answer: c Rationale: Table 18-1 outlines Kübler-Ross’ 5 stages of death and dying. According to this table, people in the bargaining stage look for ways to buy time, making promises and negotiating with their God, doctors, nurses, or others for more time and for relief from pain and suffering. 29. A terminally ill patient keeps saying, "This can't be happening to me." This patient’s reaction is best considered to be an example of which of Kübler-Ross's five stages of dying? a. anger b. denial c. bargaining d. depression Answer: b Rationale: Table 18-1 outlines Kübler-Ross’ 5 stages of death and dying. According to this table, people in the denial stage reject the possibility of their death and search for more promising opinions and diagnoses. 30. Jodi is dying from a rare blood disorder, but insists that her doctor has made a mistake in the diagnosis. Jodi’s reaction is best considered to be an example of which of Kübler-Ross's five stages of dying? a. anger b. denial c. bargaining d. depression Answer: b Rationale: Table 18-1 outlines Kübler-Ross’ 5 stages of death and dying. According to this table, people in the denial stage reject the possibility of their death and search for more promising opinions and diagnoses. 31. According to the theory proposed by Kübler-Ross, the stage of adjustment in which the terminal patient feels frustrated by the fact that plans and dreams will not be fulfilled is called: a. resentment b. bargaining c. anger d. depression Answer: c Rationale: In Kübler-Ross's model, the stage characterized by frustration and resentment over unfulfilled plans and dreams is termed as anger. This stage reflects the emotional turmoil experienced by individuals facing the reality of their impending death. 32. A man dying of lung cancer asks his doctor to confirm that he will be cured from his cancer if he quits smoking. According to the theory set forth by Kübler-Ross, this man is most likely in the stage of: a. bargaining b. acceptance c. denial d. depression Answer: a Rationale: Table 18-1 outlines Kübler-Ross’ 5 stages of death and dying. According to this table, people in the bargaining stage look for ways to buy time, making promises and negotiating with their God, doctors, nurses, or others for more time and for relief from pain and suffering. 33. According to the theory set forth by Kübler-Ross, the stage of adjustment in which the terminal patient grieves for the people and things that will be left behind after death is called: a. acceptance b. denial c. anger d. depression Answer: d Rationale: In Kübler-Ross's model, the stage marked by grieving for losses and impending separation is termed as depression. During this stage, individuals may experience profound sadness and despair as they come to terms with the impact of their impending death on their relationships and life experiences. 34. According to the theory set forth by Kübler-Ross, the stage of adjustment in which the terminal patient has recognized that death will come is called: a. acceptance b. depression c. anticipatory grief d. bereavement overload Answer: a Rationale: In Kübler-Ross's model, the final stage of adjustment characterized by a sense of peace and readiness for death is termed as acceptance. During this stage, individuals may find a degree of resolution and come to terms with the inevitability of their impending death. 35. Research studies of how people actually progress through Kübler-Ross’s stages of dying suggests that ______ people experience the 5 stages she identified and these 5 stages are _______ experienced in the order she specified. a. all; always b. all; sometimes c. most; always d. most; sometimes Answer: d Rationale: The text notes that not all people experience all the stages, and only a few people experience the stages in the specified order. 36. According to the text, what should health-care providers do if a terminally ill patient is not progressing through the 5 stages of death in the proper sequence or is stuck in one stage for too long a period of time? a. encourage the person to spend more time thinking about death b. suggest the person reconsider his or her religious beliefs c. allow the person to follow whatever path he or she chooses toward death d. refer the person for a psychological evaluation and possible counseling Answer: c Rationale: The text notes that it is important to remember that people cope with death in individual ways and therefore no one should be forced or expected to adjust according to a set pattern of stages. Instead, each person should be allowed to follow his or her unique path to dying. 37. According to research cited in the text, when caregivers were asked to comment about the relief they felt following their loved one’s death, about ____ reported that death was a relief to them and about ____ reported that they felt it provided a welcome relief to the person who died. a. 5%; 50% b. 35%; 55% c. 50%; 50% d. 72%; 90% Answer: d Rationale: The provided answer reflects the statistics cited in the text. It indicates that a significant proportion of caregivers (72%) reported feeling relief following their loved one's death, while an even larger percentage (90%) reported feeling that death provided a welcome relief to the person who died. 38. In the U. S. today, the ideal death trajectory is: a. to die in battle, fighting for one’s country b. to die suddenly, without warning c. to have about 6 months after the diagnosis of a terminal illness to adjust d. to have 2-3 years after the diagnosis of a terminal illness to adjust Answer: b Rationale: In the United States today, the commonly accepted ideal trajectory is to be healthy to age 85 or more, put your affairs in order, and die suddenly and without pain, perhaps while asleep. 39. According to the text, the term “submissive death” refers to which of the following circumstances? a. when palliative care is unavailable b. when the family withdraws life support c. when the ill person neglects his or her own needs d. when death occurs suddenly Answer: c Rationale: The provided answer reflects the statistics cited in the text. It indicates that a significant proportion of caregivers (72%) reported feeling relief following their loved one's death, while an even larger percentage (90%) reported feeling that death provided a welcome relief to the person who died. 40. According to the text, the term that is used to describe the situation where people fail to take care of themselves and essentially contribute to their own premature death is which of the following? a. suicidal erosion b. anticipatory death c. anticipatory suicide d. submissive death Answer: d Rationale: The term "submissive death" precisely describes the situation where people fail to take care of themselves and essentially contribute to their own premature death, as stated in the text. 41. Terry, a 73-year-old widower, was in the hospital for six months with cancer. Finally, the painful treatments got to be too much for him and he just gave up and let himself die. This passive form of suicide is best considered to be an example of: a. suicide-by-proxy b. anticipatory suicide c. submissive death d. unilateral death Answer: c Rationale: Submissive death occurs when people simply let themselves die by not caring for themselves. 42. Lance's doctor told him 15 years ago that if he did not change his lifestyle, the drinking, smoking, and drug abuse were going to kill him. Lance didn't heed the warning, claiming that if he died no one would miss him anyway, and now he has died. Lance’s situation is best considered to be an example of: a. suicidal erosion b. passive death c. assisted suicide d. unilateral death Answer: a Rationale: Suicidal erosion is an indirect form of suicide by engaging in high-risk activities, such as excessive drinking, smoking, or other drug abuse. 43. Suicide that occurs when one simply gives up and allows oneself die is called: a. submissive death b. suicidal erosion c. vital loss d. palliative suicide Answer: a Rationale: The term "submissive death" as described in the text fits the scenario where one simply gives up and allows oneself to die, rather than actively taking action to end their life. 44. If all of the following people are the same age, who is statistically most likely to commit suicide? a. Alan, a White man b. Jeffrey, a Black man c. Lacey, a Black women d. Juan, a Hispanic man Answer: a Rationale: Statistically, white men have the highest suicide rate over all other groups, as shown in Figure 18-2. 45. If all of the following people are the same age, who is statistically LEAST likely to commit suicide? a. Tasha, a Black woman b. Ryan, a Black man c. Lindsey, a White woman d. Robert, a White man Answer: a Rationale: Statistically, white men have the highest suicide rate over all other groups, as shown in Figure 18-2. 46. The greatest number of suicides occurs among: a. female adolescents b. male adolescents c. older women d. older men Answer: d Rationale: The text notes that although the most highly publicized suicides are those of young adults, adolescents, and even schoolchildren, the greatest number of suicides occur among older men. This can also be seen in Figure 18-1, which shows the suicide rates for men and women. 47. A small town has experienced an unusually high suicide rate in recent years. Local officials try to prevent future suicides by concentrating their efforts on those most likely to commit suicide. These people would be: a. women under age 21 b. women between ages 21 and 35 c. men under age 21 d. men over age 75 Answer: d Rationale: The text notes that although the most highly publicized suicides are those of young adults, adolescents, and even schoolchildren, the greatest number of suicides occur among older men. This can also be seen in Figure 18-1, which shows the suicide rates for men and women. 48. For White adults over the age 85, which of the following is true? a. Men are 10 times more likely to commit suicide than women. b. Women are 10 times more likely to commit suicide than men. c. Men are 4 times more likely to commit suicide than women. d. Women are 4 times more likely to commit suicide than men. Answer: a Rationale: According to the text, after age 85 the rate of suicide among older women is only about one-tenth the rate for men. 49. If you examined a stack of death certificates of White people age 85 and older who died of suicide and find that 100 of these belong to women, you would guess that the number of men’s records in this stack would number about: a. 100 b. 200 c. 400 d. 1,000 Answer: d Rationale: The text reports that about 10 times as many White men over age 85 as White women in this age group commit suicide. Thus, if records show that there were 100 women’s suicides, there likely would be 1,000 men’s suicides. 50. Statistics indicate that, among those age 85 and older, for every 100 women who commit suicide, about ____ men commit suicide. a. 100 b. 200 c. 400 d. 1,000 Answer: d Rationale: The text reports that about 10 times as many older men as women commit suicide. Thus, for every 100 older women’s suicides, there likely would be 1,000 older men’s suicides. 51. Compared to the suicide rate at age 50, the suicide rate at age 85 is _____ for men and _____ for women. a. much higher; much higher b. slightly lower; slightly higher c. about the same; slightly higher d. considerably higher, slightly lower Answer: d Rationale: Figure 18-1 shows suicide rates across adulthood for men and women. At age 50, the suicide rate for women is about 6 deaths per 100,000, compared to men’s rate of about 25 deaths per 100,000. At age 85, the women’s rate is about 3-4 deaths per 100,000 and the men’s rate is about 35-40 deaths per 100,000. Thus, the women’s rate declines slightly between age 50 and age 85, while the men’s rate increases significantly. 52. Statistically speaking, which of the following people would be at the highest risk of suicide? a. a younger man who has just become a widower b. a younger women who has just become a widow c. an older man who has just become a widower d. an older woman who has just become a widow Answer: c Rationale: The greatest number of suicides occurs among older men. Additionally, widowers particularly are at a higher risk for suicide than the general population, especially during the first year of bereavement. 53. Statistically speaking, which of the following people would be at the highest risk of suicide? a. a married woman b. a married man c. a man who has just become a widower d. a woman who has just become a widow Answer: c Rationale: The text notes that overall, 10 times as many older men as older women commit suicide. Additionally, widowers particularly are at a higher risk for suicide than the general population, especially during the first year of bereavement. The Search for a Humane Death 54. According to research cited in the text, people who attempt to control their own environment and make their own choices regarding their impending death: a. are more likely to become depressed b. have weaker coping skills c. survive longer d. help their friends and relatives grieve more successfully after they die Answer: c Rationale: The text indicates that individuals who attempt to control their own environment and make their own choices regarding their impending death tend to survive longer, as noted in the provided answer. 55. Which of the following is NOT true regarding hospice care? a. Hospice care is usually covered by insurance. b. Hospice care is designed to help the ill person live as independently as possible. c. Hospice care is designed to help the family of the ill person understand the process of dying. d. Hospice care originated in the late 1800s in New England. Answer: d Rationale: Hospice care was started in England, but in 1967. Thus, it is a modern institution, rather than older one. 56. Between 2003 and 2010, the number of hospice patients served in the United States: a. decreased very slightly b. remained about the same c. increased very slightly d. increased by about 65% Answer: d Rationale: Figure 18-3 shows the number of hospice patients in the U. S. as being 950,000 in 2003 and 1,580,000 in 2010, which is about a 65% increase. 57. About how many hospice programs are currently certified in the United States? a. 50, which is 1 per state b. 101, which is 2 per state, plus 1 in the District of Columbia c. about 2,000 d. more than 5,000 Answer: d Rationale: According to the text, there are more than 5,000 hospice programs currently certified in the United States, reflecting the extensive availability of hospice care across the country. 58. Karen has a terminal illness. She is considering living out her days as independently and painlessly as possible in a residential facility designed to provide assistance and comfort to dying patients. The care she is seeking is often referred to as: a. respite care b. hospice care c. a halfway house program d. a bereavement setting Answer: b Rationale: Hospice is designed to help people with a terminal illness live out their days as fully and independently as possible by giving needed care, counseling, support, and other assistance both to patients and to their families and loved ones. 59. Sally is in the final stage of full-blown AIDS. She lives at her home, is visited daily by her physician and staff, and receives spiritual guidance from the pastor of her church. The staff of a local organization that coordinates Sally’s care also provides bereavement care to her family. The goal of Sally’s caregivers is to help her live out her days as fully and independently as possible. The type of care that Sally is receiving is best thought of as an example of: a. hospice care b. outpatient care c. natural care d. adult day care Answer: a Rationale: Hospice is designed to help people with a terminal illness live out their days as fully and independently as possible by giving needed care, counseling, support, and other assistance both to patients and to their families and loved ones. It is based on the philosophy that death is a natural process and that individuals should be allowed to maintain some control over how they die. 60. The goal of hospice is to: a. keep down the cost of health care b. prevent contamination from contagious diseases c. help terminally ill patients live their final days as fully and independently as possible d. allow the terminally ill person a spiritual retreat before death Answer: c Rationale: The primary goal of hospice care, as outlined in the text, is to help terminally ill patients live their final days as fully and independently as possible, providing comfort and support. 61. When was the first hospice established? a. 1909 b. 1945 c. 1967 d. 2001 Answer: c Rationale: The text states that the first hospice was established in 1967, aligning with the provided answer. 62. At what point in a person’s illness and death do hospice care programs typically end for family members? a. at the time of the patient's death b. 3 days following the patient's death. c. 1 week after the patient's funeral, whenever that occurs d. after the bereavement process is complete Answer: d Rationale: Hospice care programs typically end for family members after the bereavement process is complete, allowing them the necessary support and resources to cope with their loss. 63. According to the text, about what percent of hospice care is provided while the patient is in a hospital or a hospice inpatient facility? a. less than 1% b. about 33% c. about 80% d. nearly 100% Answer: b Rationale: The text indicates that about 33% of hospice care is provided while the patient is in a hospital or a hospice inpatient facility, reflecting the varying settings in which hospice care is administered. 64. The text points out an inconsistency between hospice care and hospital care. Which of the following best captures the sense of that inconsistency? a. Hospitals focus on keeping patients alive, whereas hospice is focused on helping a person die. b. In a hospital, decisions about extending life are made by the patient but in hospice care trained professionals make these decisions for the patient. c. Most real care in hospitals is done by nurses but in hospice care the real care is done by physicians. d. Most hospital care is covered by insurance but hospice care is hardly ever covered by insurance. Answer: a Rationale: Hospitals are devoted to life and life support; hospital personnel tend to see death as the enemy, and they often work to prolong life, sometimes irrespective of the wishes of the patient. The hospice concept emphasizes that death is a normal and natural stage of life to be approached with dignity. Both hospital care and hospice care are usually covered by insurance. 65. The core concept in the “right to die” approach is: a. suicide should not be considered murder b. that death is a right to be exercised at the individual’s discretion c. physicians who perform assisted suicide should be prosecuted for murder d. premature infants who could not survive without life support should be allowed to die, regardless of their parents’ wishes Answer: b Rationale: The "right to die" approach asserts that individuals have the autonomy to make decisions about their own death, including the timing and manner of it. Option b best reflects this core concept by emphasizing that death is a right that individuals should be able to exercise based on their own discretion. 66. A more formal term for the practice sometimes referred to as mercy killing is: a. euthanasia b. palliative aid c. rational suicide d. suicidal erosion Answer: a Rationale: The more formal term for mercy killing is euthanasia. This term specifically refers to the intentional ending of a person's life to relieve suffering, typically at the person's request. 67. According to the text, which of the following famous people died as the result of active euthanasia: a. Jean Piaget b. Lawrence Kohlberg c. Mary Ainsworth d. Sigmund Freud Answer: d Rationale: Freud asked his physician to inject him with a fatal dose of morphine when his cancer pain became too great. This is an example of assisted suicide, which is a form of active euthanasia. 68. In the United States, active euthanasia is considered to be: a. an option only for patients who have flat brain waves b. one option that hospice patients can request c. murder d. on option only for people who need a ventilator to breathe on their own Answer: c Rationale: Active euthanasia involves intentionally causing the death of a patient, typically through administration of a lethal substance, and is considered illegal in the United States. Therefore, it is classified as murder under U.S. law. 69. Erik has a terminal illness which is causing him great pain. He and his family are discussing their options with Erik's physician, including having Erik himself self-administer a lethal drug. If this is the option Erik chooses, the process would be an example of: a. passive euthanasia b. active euthanasia c. negative euthanasia d. positive euthanasia Answer: b Rationale: Active euthanasia is defined as taking steps to bring about another person’s death. Assisted suicide is the term given to cases in which the ill person is provided with a means of ending his or her own life, which is the case that is described in this question. Assisted suicide is considered to be a special case of active euthanasia. The terms “positive euthanasia” and “negative euthanasia” have no particular meaning, and thus are not the best answer choice for this question. 70. Roger begs his doctor to give Roger a fatal injection so Roger can “end my pain and suffering.” Roger’s request is for: a. passive euthanasia b. active euthanasia c. negative euthanasia d. positive euthanasia Answer: b Rationale: Active euthanasia is defined as taking steps to bring about another person’s death. Passive euthanasia involves withholding or disconnecting life-sustaining equipment so that death can occur naturally. The terms “positive euthanasia” and “negative euthanasia” have no particular meaning, and thus are not the best answer choice for this question. 71. Polls usually indicate that the majority of the U. S. public ______ active euthanasia and the American Medical Association’s official position is _______ using active euthanasia as a means of ending a person’s life. a. opposes; strongly opposed to b. opposes; actively in favor of c. is in favor of; strongly opposed to d. is in favor of; actively in favor of Answer: c Rationale: The text notes that most polls indicate that the majority of U.S. people now support the right of a person with a terminal illness to receive a lethal drug from their physician if they wish. Some health-care organizations also endorse this view, but the AMA strongly opposes suicide with the assistance of a physician. 72. Suppose Paul believes that every dying person should be able to receive a medicine from a physician that will bring death quickly and painlessly. Paul’s position would ______ the opinion help by the majority of U.S. adults and would ______ the official position of the American Medical Association. a. be consistent with; be consistent with b. be consistent with; differ from c. differ from; be consistent with d. differ from; differ from Answer: b Rationale: The text notes that most polls indicate that the majority of U. S. people now support the right of a person with a terminal illness to receive a lethal drug from their physician if they wish. Some health care organizations also endorse this view, but the AMA strongly opposes suicide with the assistance of a physician. Thus, Paul’s position is consistent with the majority of U. S. adults, but different from the official position of the AMA. 73. The use of "death machines" that administer a lethal drug automatically when a patient pushes a button is an example of the practice of: a. assisted suicide b. passive euthanasia c. palliative end-of-life care d. suicidal erosion Answer: a Rationale: Assisted suicide is the term given to cases in which the ill person is provided with a means of ending his or her own life and it is considered to be a special case of active euthanasia. 74. Rosanne has a terminal condition, and she has decided to request that her doctors withhold all life-sustaining procedures, so that her death will come about naturally. Rosanne’s request is best considered an example of: a. passive euthanasia b. active euthanasia c. natural euthanasia d. assisted suicide Answer: a Rationale: Passive euthanasia involves withholding or disconnecting life-sustaining equipment so that death can occur naturally. Active euthanasia is defined as taking steps to bring about another person’s death. Assisted suicide is the term given to cases in which the ill person is provided with a means of ending his or her own life and it is considered to be a special case of active euthanasia. The term “natural euthanasia” has no particular meaning, and thus is not the best answer choice for this question. 75. A legal document that informs both family and health-care workers of the signer's wish to avoid the use of "heroic measures" to maintain life in the event of irreversible illness is called a(n): a. donor's will b. medical power of attorney c. intestate will d. living will Answer: d Rationale: A living will is a legal document that outlines an individual's preferences regarding medical treatment and end-of-life care in the event that they become incapacitated and unable to communicate their wishes. This includes decisions about the use of life-sustaining treatments such as mechanical ventilation or CPR. 76. Kayla has drafted a legal document that informs both her family and health-care workers of her wish to avoid the use of heroic measures to maintain her life in the event of irreversible illness. This document is called a: a. medical power of attorney b. last will and testament c. living will d. dying declaration Answer: c Rationale: A living will informs a person’s family, or others who may be concerned, of the person’s wish to avoid the use of heroic or extraordinary measures to maintain life in the event of irreversible illness. It is not legally binding; however, a living will does clarify a person’s wishes and provides both comfort and some legal protection to a loved one who makes the decision to discontinue the use of artificial means to sustain life. 77. In her elderly years, Barb signed a legal document that informed her family and doctor of her wish to avoid the use of heroic measures to keep her alive if she gets an irreversible illness. This document would be called: a. a medical power of attorney b. a living will c. an intestate will d. a donor's will Answer: b Rationale: A living will informs a person’s family, or others who may be concerned, of the person’s wish to avoid the use of heroic or extraordinary measures to maintain life in the event of irreversible illness. It is not legally binding; however, a living will does clarify a person’s wishes and provides both comfort and some legal protection to a loved one who makes the decision to discontinue the use of artificial means to sustain life. 78. A legal document that sets forth a person’s request for passive euthanasia is called a: a. last will and testament b. hospice request c. living will d. death trajectory Answer: c Rationale: A living will informs a person’s family, or others who may be concerned, of the person’s wish to avoid the use of heroic or extraordinary measures to maintain life in the event of irreversible illness. It is not legally binding; however, a living will does clarify a person’s wishes and provides both comfort and some legal protection to a loved one who makes the decision to discontinue the use of artificial means to sustain life. 79. A person who would like to make his or her wishes known regarding the extent to which “heroic measures” should be taken to maintain his or her life in the event of irreversible illness or injury should: a. make arrangements for hospice care b. contact a medical doctor to enter a “assisted suicide pact” c. hire an attorney to draw up a living will d. make arrangements for palliative care Answer: c Rationale: A living will informs a person’s family, or others who may be concerned, of the person’s wish to avoid the use of heroic or extraordinary measures to maintain life in the event of irreversible illness. It is not legally binding; however, a living will does clarify a person’s wishes and provides both comfort and some legal protection to a loved one who makes the decision to discontinue the use of artificial means to sustain life. 80. George is diagnosed with Alzheimer’s disease, so he and his wife consult an attorney to draw up and sign documents giving George’s wife the legal authority to make decisions about George’s care. Such a document is called: a. living will b. a probated will c. a medical power of attorney d. a right to die document Answer: c Rationale: Medical power of attorney refers to a legal document by which a person authorizes another to make life-or-death medical decisions. 81. Suppose Sarah is worried that she will become too ill to make sound decisions about her own care, and she wants to have a family member have the legal authority to make these decisions for her. If she decides to put her wishes in writing, she should have a _______ create a ________ for her. a. physician; living will b. physician; medical power of attorney c. lawyer; living will d. lawyer; medical power of attorney Answer: d Rationale: A living will informs a person’s family, or others who may be concerned, of the person’s wish to avoid the use of heroic or extraordinary measures to maintain life in the event of irreversible illness. It is not legally binding; however, a living will does clarify a person’s wishes and provides both comfort and some legal protection to a loved one who makes the decision to discontinue the use of artificial means to sustain life. A medical power of attorney is a legally binding document by which a person authorizes another to make life-or-death medical decisions. A medical power of attorney document typically is created by lawyers. 82. A medical power of attorney serves to: a. give the physician the legal authority to end the person’s life if the person is in extreme pain and no recovery is possible b. assign the decisions about how a person will be cared for to a friend or family member, should the person become too ill to make these decisions c. legally bind a physician to provide “all due care” for the person up to the moment of natural death d. advise the next of kin that the person does not wish to use heroic measures to sustain life Answer: b Rationale: A medical power of attorney, also known as a healthcare proxy, designates a trusted individual to make healthcare decisions on behalf of the person if they become unable to do so themselves. This ensures that their preferences regarding medical treatment and end-of-life care are upheld. 83. If a person completes a “Five Wishes” document, this would imply that the person has also completed: a. a living will and a medical power of attorney b. a living will but NOT a medial power of attorney c. a medical power of attorney but NOT a living will d. neither a living will nor a medical power of attorney Answer: a Rationale: The "Five Wishes" document typically covers a wide range of end-of-life care preferences, including those addressed in both a living will and a medical power of attorney. Therefore, completing a "Five Wishes" document implies that the person has also addressed these specific legal documents. 84. According to the text, the “Five Wishes” document is now considered legally binding in: a. 5 states b. 12 states c. 42 states d. all 50 states and the District of Columbia Answer: c Rationale: The "Five Wishes" document is recognized as a legally binding advance directive in 42 states in the United States. This document allows individuals to express their preferences for medical treatment and end-of-life care in a legally enforceable manner. 85. Which of the following best captures the central aim of palliative care? a. to extend the person’s life b. to limit the person’s physical pain c. to bring death more quickly than a terminal illness would cause d. to allow terminally ill patients and their families to live as normal a life as possible Answer: d Rationale: Palliative care focuses on improving the quality of life for patients facing serious illnesses, such as cancer or heart failure, and their families. The central aim is to provide relief from symptoms, pain, and stress, while addressing the emotional, social, and spiritual needs of patients and their loved ones. Option d best captures this holistic approach to care. 86. MacDonald’s has established a network of “Ronald McDonald” houses near major hospitals so that families of very ill children will have a place to stay while visiting their ill child. This charity is best considered to be an example of: a. hospice care b. palliative care c. bereavement assistance d. grief work Answer: b Rationale: Palliative care can be defined as care that attempts to prevent or relieve the emotional distress and physical difficulties associated with a life-threatening illness. The aim is for the terminally ill and their families to continue to live as normal a life as possible. 87. Which of the following best captures the central aim of end-of-life care? a. to extend the person’s life b. to provide counseling for the dying patient’s family and friends c. to bring death more quickly than a terminal illness would cause d. to allow terminally ill patients to settle affairs and make decisions about how life will end Answer: d Rationale: The central aim of end-of-life care is to honor the wishes and dignity of terminally ill patients by providing them with the opportunity to settle affairs, make decisions regarding their care, and ensure their preferences for end-of-life arrangements are respected. 88. Which of the following is NOT one of the guidelines provided by the American Medical Association’s position on end-of-life care? a. Physicians have the right to withhold information about any discomfort associated with death from the patient, based on their judgment of the patient’s mental state. b. Patients should be assured that their wishes will be followed regarding the end of life arrangements. c. Patients will be treated with dignity and respect throughout all stages of their illness. d. Provisions should be made so pain is reduced and comfort is increased, to the degree possible. Answer: a Rationale: The American Medical Association's position on end-of-life care emphasizes transparency and patient autonomy. Withholding information about discomfort associated with death from the patient contradicts these principles and is not aligned with the guidelines provided by the AMA. Grief and Bereavement 89. According to the dual-process model of stress and coping, bereavement requires coping with two things: a. stress and fatigue associated with caregiving b. grief and life adjustments following the death of a loved one c. anticipating death and experiencing death d. denial and exhaustion Answer: b Rationale: The dual-process model of stress and coping posits that bereavement involves coping with two types of stressors: loss-oriented stressors, which involve dealing with the emotional aspects of grief, and restoration-oriented stressors, which involve adapting to the practical changes and life adjustments resulting from the loss. 90. Now that Cindy has died, her family members and close friends must make short-term adjustments, including planning Cindy’s funeral and dealing with their initial emotional reactions to Cindy's death. According to the text, these short-term adjustments are called: a. grief work b. grief erosion c. chronic grief d. end-of-life care Answer: a Rationale: The text defines grief work as dealing with the emotional reactions to the loss of a loved one. 91. Gina’s husband of 47 years died, and Gina’s current focus is on learning how to care for herself, make decisions for herself, and forgive her husband for leaving her all alone. Gina’s focus is best considered to be an example of the tasks usually associated with which of the following stages of grieving? a. the shock phase b. the overload phase c. the renewal phase d. the healing phase Answer: d Rationale: The first phase of grieving typically involves healing, where the person adjusts to the sense of loss and the new roles and responsibilities forced by the death of his or her loved one. 92. Matt’s wife of 38 years died of cancer. He is now at the point that he has established a new group of friends and he can remember his years with his wife with pleasure, rather than only with a sense of loss and grief. Matt’s focus is best considered to be an example of the tasks usually associated with which of the following stages of grieving? a. the overload phase b. the renewal phase c. the healing phase d. the bereavement phase Answer: b Rationale: In the renewal phase of grieving, a person establishes new life patterns and a future-oriented focus. 93. Accepting new roles and learning to enjoy life again are tasks usually associated with which of the following stages of grieving? a. the shock phase b. the stress phase c. the renewal phase d. the healing phase Answer: c Rationale: Accepting new roles and learning to enjoy life again are tasks typically associated with the renewal phase of grieving, where individuals begin to integrate the loss into their lives and find meaning and purpose in moving forward. 94. Before Leo died, his close friends were able to share their feelings of loss, guilt, and missed opportunities with him. This situation is best thought of as an example of: a. bereavement overload b. chronic grief c. end-of-life care d. anticipatory grief Answer: d Rationale: Anticipatory grief refers to grief that is experienced as people emotionally prepare themselves for the death of a loved one, as in cases of prolonged terminal illness. 95. When Bonnie's husband was diagnosed with terminal cancer, she prepared herself for the loss. She and her husband had many conversations about their feelings of loss, their time spent together, and what they would miss when he was gone. What is Bonnie experiencing? a. anticipatory grief c. chronic grief b. bereavement overload d. submissive death Answer: a Rationale: Anticipatory grief refers to grief that is experienced as people emotionally prepare themselves for the death of a loved one, as in cases of prolonged terminal illness. 96. According to the text, anticipatory grief can be beneficial, unless: a. the grief is too intense b. the dying person is a child c. the dying person is an older adult d. the dying person lives much longer than anticipated Answer: d Rationale: Anticipatory grief, experienced before a death occurs, can be beneficial in helping individuals prepare emotionally for the loss. However, if the dying person lives much longer than anticipated, prolonging the anticipatory grief phase excessively, it can lead to emotional exhaustion and strain on coping resources. 97. Renaldo, who has had several gay friends die of AIDS in the past few months, is now overwhelmed with grief, to the point where he doesn’t eat or want to go outside his house. Renaldo’s condition is best considered to be an example of: a. bereavement overload b. palliative trauma c. chronic grief d. anticipatory grief Answer: a Rationale: Bereavement overload is a stress reaction experienced by people who lose several friends or loved ones during a short period of time, often characterized by depression. 98. In the same year that she retired, Julie's father and sister-in-law both died. If Julie became depressed as the result of this significant loss, her depression would be attributed to: a. bereavement overload b. anticipatory grief c. end-of-life trauma d. passive euthanasia Answer: a Rationale: Bereavement overload is a stress reaction experienced by people who lose several friends or loved ones during a short period of time, often characterized by depression. 99. The loss of several loved ones in the span of a year or two may cause an increase in depression referred to as: a. bereavement overload b. anticipatory grief c. learned helplessness d. passive euthanasia Answer: a Rationale: Bereavement overload is a stress reaction experienced by people who lose several friends or loved ones during a short period of time, often characterized by depression. 100. According to the text, depression is especially likely in cases that involve: a. submissive death b. passive euthanasia c. anticipatory grief d. bereavement overload Answer: d Rationale: Depression is particularly likely in cases of bereavement overload, where individuals experience multiple losses or overwhelming grief from a single loss, leading to prolonged and severe symptoms of depression. 101. Louis has never recovered from the death of his wife 15 years ago. This sort of pathological mourning process is labeled as: a. posttraumatic stress disorder b. chronic grief c. bereavement overload d. palliative grief Answer: b Rationale: Chronic grief refers to an ingrained, pathological mourning process in which the person never overcomes the grief. 102. The failure to ever recover from a loss is called: a. social grief b. anticipatory grief c. chronic grief d. bereavement overload Answer: c Rationale: Chronic grief refers to the failure to ever fully recover from a loss, resulting in persistent and debilitating symptoms of grief over an extended period, significantly impacting daily functioning and quality of life. 103. According to the text, which of the following conditions is most likely to be added as a diagnostic category in the next edition of the Diagnostic and Statistical Manual? a. chronic grief b. anticipatory grief c. passive grief d. active grief Answer: a Rationale: Chronic grief, characterized by persistent and prolonged symptoms of grief, is likely to be considered for inclusion as a diagnostic category in future editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM). 104. In comparison to grieving rituals common in the United States a century ago, today the grief rituals are _________ and are _________ effective in helping survivors deal with their loss. a. longer; more b. longer; no more c. shorter; more d. shorter; no more Answer: d Rationale: Grieving rituals in the United States have become shorter and less elaborate compared to a century ago. However, they remain effective in helping survivors deal with their loss, providing structure, support, and a sense of closure during the grieving process. 105. In 1900, the death rate of U.S. children under the age of 5 was ____; in 2009 it was ____. a. 8%; 4% b.18%; 8% c. 50%; 5% d. 30%; 1.5% Answer: d Rationale: The correct answer is d. In 1900, the death rate of U.S. children under the age of 5 was approximately 30%, while in 2009, it had significantly decreased to around 1.5%. This substantial reduction in child mortality rates over the years is attributed to improvements in healthcare, sanitation, nutrition, and vaccination programs. 106. In 1915, the infant mortality rate in the Unites States was ____; today it is ____. a. 10%; less than1% b. 20%; 5% c. 30%; 13% d. 50%; 20% Answer: a Rationale: The correct answer is a. In 1915, the infant mortality rate in the United States was approximately 10%, while today it is less than 1%. This dramatic decline in infant mortality rates over the years is mainly due to advancements in medical technology, public health initiatives, and improved access to healthcare services. 107. Of the children who die before they reach age 18, the largest percentages fall into which of the following age groups? a. age 0 to age 1 b. age 1 to age 4 c. age 5 to age 9 d. age 15 to age 19 Answer: a Rationale: Figure 18-5 on page 512 of the textbook shows the percentage of children’s deaths to be concentrated in the “under 1 year” category and this is also stated in the text. 108. If a couple in the United States were to have a child born this year, they should understand that the odds that the child would survive to age 5 years is about: a. 99.99% b. 99.5% c. 98.5% d. 95% Answer: c Rationale: The death rate for children under the age of 5 in the U.S. today is about 1.5%. Thus, the survival rate is 98.5%. 109. Compared to 50 years ago, the average life expectancy for individuals who have intellectual or developmental disabilities is: a. much longer, approaching a near-normal lifespan for most such people b. slightly longer, but still considerably less than a normal lifespan c. about the same as it was 50 years ago d. slightly shorter, owing to more infants who today are born alive but die in infancy Answer: a Rationale: The correct answer is a. Compared to 50 years ago, the average life expectancy for individuals with intellectual or developmental disabilities has significantly increased, approaching a near-normal lifespan for many. This improvement is primarily attributed to advances in medical care, social support systems, and advocacy efforts aimed at enhancing the quality of life for individuals with disabilities. 110. The text reports the results of a study of grief patterns among parents of children who were killed in the Arab-Israeli conflict. This study found that _______ were more likely to see the forces that led to death as being external, and _______ expressed greater feelings of hopelessness about their loss. a. mothers; mothers b. mothers; fathers c. fathers; mothers d. fathers; fathers Answer: a Rationale: The correct answer is a. According to the study mentioned in the text, mothers who lost children in the Arab-Israeli conflict were more likely to perceive the forces leading to death as external factors, such as political circumstances, and both mothers and fathers expressed feelings of hopelessness about their loss. However, the study specifically highlights that mothers were more inclined towards external attributions of death. Completing the Life Cycle 111. According to the text, it is customary in Jewish families to emphasize the connection between birth and death by: a. taking even very young children to funerals of friends and neighbors b. keeping pictures of grandparents in every child’s room c. naming children after a family member who has died d. remembering the names of dead relatives in meal-time prayers Answer: c Rationale: The correct answer is c. In Jewish families, it is customary to emphasize the connection between birth and death by naming children after a family member who has died. This practice symbolizes the continuity of life and honors the memory of deceased relatives. 112. According to the text, it is customary in Chinese cultures to emphasize the connection between birth and death by: a. keeping pictures of grandparents in every child’s room b. urging young couples to marry or have a child when an older relative dies c. naming children after recently deceased relatives d. taking even very young children to funerals of friends and relatives Answer: b Rationale: The correct answer is b. In Chinese cultures, there is a tradition of urging young couples to marry or have a child when an older relative dies. This practice is rooted in the belief that it helps maintain the continuity of family lineage and balances the cycle of life and death. Current Issues: Searching for Meaning in Natural Disasters, Accidents, Terrorism, and Personal Tragedies 113. According to terror management theory, we deal with uncertainly and tragedy in our lives by: a. becoming depressed b. establishing a positive self-concept c. going into a state of self-denial d. focusing on the quality of our interpersonal relationships with friends and family Answer: b Rationale: The correct answer is b. According to terror management theory, individuals cope with uncertainty and tragedy in their lives by establishing a positive self-concept. This involves reinforcing beliefs, values, and identities that provide a sense of meaning and security, thereby mitigating existential anxiety. 114. According to research on terror management, if terrorists from a foreign country bombed the subways in New York City, killing innocent people, New Yorkers would be expected to cope by becoming _____ prejudiced against foreigners and spending ______ money on luxury goods: a. more; more b. more; less c. less; more d. less; less Answer: a Rationale: The correct answer is a. According to research on terror management, when faced with existential threats or reminders of mortality, individuals tend to respond by becoming more prejudiced against out-groups and seeking comfort in familiar symbols of security, such as spending more money on luxury goods. 115. According to research presented in the text, after the 9/11 terrorist attacks in 2001, the most typical responses by U. S. citizens were to ________ their support for President Bush and to spend ______ money on luxury goods. a. decrease; less b. decrease; more c. increase; less d. increase; more Answer: d Rationale: In a study that examined how thoughts about the 9/11 terrorist attack affected Americans’ attitudes about President George W. Bush, researchers found that reminding people about their own mortality or refreshing their memories about the 9/11 disaster increased their support for the president and his antiterrorist policies. Additionally, research suggests that we tend to become more materialistic following disasters. Conspicuous consumption—buying wanted things that enhance our status—may help us cope with the uncertainty about when our lives might end. Changing Perspectives: Humane End-of-Life Care for Children Who Are Dying and for Their Families 116. Which of the following is NOT a reason cited in the text for why terminally ill children pose a special challenge to those providing end-of-life care? a. Children do not have the same cognitive abilities as adults and they sometimes understand their illness in different ways. b. Parents usually have adequate time to thoroughly research all treatment options and they sometimes interfere with physician’s orders. c. Children’s terminal diseases are often rare and little is known about the best course of treatment to use. d. Terminal illness of children seems especially unfair and family members often have a very hard time coming to terms with the fact their child is dying. Answer: b Rationale: The correct answer is b. While parents may indeed experience challenges in dealing with their child's terminal illness, the text does not cite interference with physician's orders as one of the reasons for why terminally ill children pose a special challenge to those providing end-of-life care. 117. Which of the following is NOT a working principle for caring for terminally ill children advocated by the Institute of Medicine? a. to attend to and limit the pain the child experiences b. to expand funding for more home-based care options c. to expand funding for more hospital-based care options d. to provide effective, ongoing education for health-care professionals about the special circumstances and needs of children who are dying Answer: c Rationale: The correct answer is c. The Institute of Medicine advocates for expanding funding for more home-based care options and providing effective, ongoing education for healthcare professionals about the special circumstances and needs of children who are dying. However, it does not advocate for expanding funding for more hospital-based care options as a working principle for caring for terminally ill children. True-False questions: Thoughts and Fears of Death 118. The text draws the conclusion that many people living in the United States today cope with death primarily through denial. Answer: True Rationale: Denial is a common defense mechanism observed in individuals facing the prospect of death. While it may not be the only coping mechanism utilized, it is prevalent, as individuals may find it difficult to confront the reality of mortality, leading them to deny or avoid thoughts and discussions about death. 119. Compared to today, in the 1960s in the United States, physicians were usually more direct with dying patients, giving them more information about their conditions and spending more time with them as they adjusted to the idea of their own death. Answer: False Rationale: According to the research by Elisabeth Kübler-Ross, in the 1960s, physicians shied away from talking with patients about their terminal condition. 120. Studies typically show that older adults express much greater levels of anxiety about their own death than do younger adults and children. Answer: False Rationale: Older adults typically express less anxiety about their own deaths than younger people do. 121. Research shows that people who have strong religious convictions and a deep belief in an afterlife experience less depression and anxiety about death. Answer: True Rationale: Numerous studies have indeed demonstrated that individuals with strong religious beliefs and convictions regarding an afterlife tend to experience less fear, anxiety, and depression surrounding death. Such beliefs often provide comfort and a sense of meaning, helping individuals cope with existential concerns. 122. According to terror management theory, we cope with our own mortality by enhancing our self-esteem. Answer: True Rationale: Terror management theory posits that humans cope with the existential anxiety of mortality by bolstering self-esteem and cultural worldviews. By maintaining a positive self-image and affirming beliefs that provide a sense of meaning and significance, individuals can mitigate the fear of death. 123. According to terror management theory, death is a negative force that we cope with primarily by denying that it will ever come to us. Answer: False Rationale: Terror management theory suggests that people cope with thoughts of their own death not by denial but rather by improving their own self-esteem and becoming more attached and important to other people. 124. According to the text, terror management theory provides a better explanation for how older adults cope with their own death than for how younger adults cope. Answer: False Rationale: Terror management may provide a better explanation for how younger people cope because older people are better able to cope with and accept the fact that they will die. Confronting One’s Own Death 125. Contemplating one’s own death prompts a kind of life review, and therefore can be considered as a final developmental task. Answer: True Rationale: Many psychological theories, including Erik Erikson's stages of psychosocial development, suggest that contemplating one's own mortality prompts a reflection on life experiences and accomplishments, leading to a form of life review. This process is often considered a final developmental task, allowing individuals to find closure and meaning in their lives. 126. Kübler-Ross’s research on death and dying identified five stages of coping that are universal and experienced in much the same way by all terminally ill adults. Answer: False Rationale: Although Kübler-Ross’s five stages are commonly experienced by many people, there are individual differences, with some people going through these stages is a different order and with some people not experiencing all five stages. 127. According to Kübler-Ross’s view of death and dying, one of the stages that occurs in most people facing a terminal illness is elation. Answer: False Rationale: Kübler-Ross’s five stages of coping with death are: denial, anger, bargaining, depression, and acceptance. 128. In studies of caregivers of people who are terminally ill, when death finally comes, the caregivers’ typical response is one of despair and denial. Answer: False Rationale: The typical response in this situation is for caregivers to experience relief, both for themselves and for the person who died. 129. In the United States, the ideal death trajectory is to be healthy to age 85 or older, and then to die quickly and without pain. Answer: True Rationale: Cultural norms and preferences regarding death in the United States often emphasize the ideal of a "good death," characterized by maintaining health and independence into old age, followed by a quick and painless death. This trajectory is often perceived as ideal, although individual preferences may vary. 130. Surveys show that most people would prefer a sudden death, rather than an extended death. Answer: True Rationale: Numerous surveys and studies have consistently found that a majority of people express a preference for a sudden death over an extended one. Sudden death is often perceived as less burdensome, sparing individuals from prolonged suffering or dependency on medical interventions. 131. By far, the largest proportion of suicides occurs among older men. Answer: True Rationale: Suicide rates indeed tend to be highest among older men, particularly those over the age of 85. Factors contributing to this trend include social isolation, physical health decline, and untreated mental health issues. 132. Submissive death is defined as an indirect form of suicide where the person engages in high-risk activities that could lead to death. Answer: False Rationale: High-risk behavior defines suicidal erosion. Submissive death occurs when people limply let themselves die by not caring for themselves. 133. Suicide rates are higher for married men than for single men, but higher for single women than for married women. Answer: False Rationale: The suicide rate for married and single women is nearly identical, but the rate for married men is about 5 times lower than for single men. The Search for a Humane Death 134. In a study of adults with congestive heart failure, the key finding was that those who become more discouraged were more likely to die from their illness. Answer: True Rationale: Research on patients with congestive heart failure has indicated that psychological factors such as discouragement and depression can impact disease progression and mortality. Individuals who experience greater psychological distress may be less likely to adhere to treatment regimens and engage in self-care behaviors, contributing to poorer outcomes. 135. The use of hospice services by terminally ill people in the United States has increased by about two-thirds in the past decade. Answer: True Rationale: Hospice services have indeed seen a significant increase in utilization over the past decade, reflecting a growing recognition of the benefits of palliative care for terminally ill individuals. Factors contributing to this trend include improved access to hospice care, shifting attitudes towards end-of-life care, and efforts to enhance the quality of life for dying patients. 136. Hospice workers not only provide direct care to dying patients, but also help the family members of patients to understand patients’ needs and experiences. Answer: True Rationale: Hospice workers play a crucial role in providing comprehensive care for terminally ill patients, which extends beyond medical assistance to encompass emotional, spiritual, and practical support. Additionally, they offer guidance and counseling to family members, helping them navigate the challenges of caring for a dying loved one and understanding their needs and experiences. 137. In the United States, active euthanasia, from a legal perspective, is murder. Answer: True Rationale: Active euthanasia, which involves intentionally causing the death of a patient, is considered illegal and classified as murder in most jurisdictions in the United States. Laws typically prohibit healthcare professionals from directly ending a patient's life, even if the patient requests it. 138. Today, the American Medical Association endorses the practice of assisted suicide, even though the majority of Americans believe that physicians should not be involved in this practice. Answer: False Rationale: The AMA is opposed to the practice of assisted suicide, although a majority of Americans support the right of a dying person to receive a lethal drug from their physician, which they can use to end their life. 139. Assisted suicide is one form of passive euthanasia. Answer: False Rationale: Assisted suicide occurs when a physician, or other person, provides a person with a means of ending his or her own life. Assisted suicide is a form of active euthanasia, which is defined as taking steps to bring about another person’s death. Passive euthanasia involves withholding or disconnecting life-sustaining equipment so that death can occur naturally. 140. Even today, it can be difficult to determine whether a person is technically alive or dead. Answer: True Rationale: Despite advances in medical technology, determining the precise moment of death can still be challenging, especially in cases where there is uncertainty about brain function or when artificial life support systems are involved. This ambiguity can lead to ethical and legal dilemmas. 141. A medical power of attorney is another term for a living will. Answer: False Rationale: These are two quite different documents. A medical power of attorney is a legally binding document that gives a trusted person the authority to make decisions on a patient’s behalf if the patient becomes mentally incapacitated. A living will is a nonbinding document that expresses a patient’s wishes about withholding treatment if the person has an irreversible illness. 142. Palliative care attempts to prolong life as long as is possible in cases of life-threatening illness. Answer: False Rationale: Palliative care is care that attempts to prevent or relieve the emotional distress and physical difficulties associated with a life-threatening illness. It is not linked to either prolonging or abbreviating life. 143. The American Medical Association has approved a set of guidelines for end-of-life care, and these guidelines emphasize that patients and their families should have access to full information about their condition and should be assured their wishes will be followed to the extent possible. Answer: True Rationale: The American Medical Association (AMA) indeed provides guidelines for end-of-life care, emphasizing the importance of informed decision-making and respecting patients' autonomy. These guidelines advocate for open communication between healthcare providers, patients, and their families, ensuring that patients' wishes regarding their care are respected. Grief and Bereavement 144. According to the text, the term “grief work” emphasizes the short-term adjustments that must be made following the death of a loved one. Answer: True Rationale: The term "grief work" refers to the psychological and emotional processes individuals go through to cope with the loss of a loved one. This includes various short-term adjustments such as accepting the reality of the loss, experiencing and expressing emotions, adjusting to life without the deceased, and finding ways to remember and honor the person who has passed away. 145. The ways in which people experience grief varies widely among individuals and across cultures. Answer: True Rationale: Grief is a deeply personal experience, and its expression can vary significantly from person to person and across different cultural contexts. Factors such as cultural beliefs, religious practices, personality traits, and the nature of the relationship with the deceased all influence how individuals experience and cope with grief. 146. One can experience grief before the death of a loved one actually occurs. Answer: True Rationale: Anticipatory grief is a phenomenon where individuals begin to grieve the impending loss of a loved one before death actually occurs. This can happen when a person is terminally ill or facing a life-threatening condition, allowing both the individual and their loved ones to gradually adjust to the impending loss and begin the grieving process before the actual event. 147. Bereavement overload is a stress reaction that often is characterized by extreme agitation, anxiety, and hyperactivity. Answer: False Rationale: Bereavement overload is a stress reaction, but it is more often characterized by depression, rather than excessive anxiety. 148. According to the text, the next edition of the Diagnostic and Statistical Manual that is used to classify mental disorders may well include a diagnostic category for chronic grief reactions. Answer: True Rationale: There has been ongoing discussion within the field of psychology about the inclusion of a diagnostic category for chronic or prolonged grief reactions in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Some researchers argue that persistent and debilitating grief reactions may warrant clinical attention and intervention similar to other mental health disorders. 149. Most cultures have some sort of ritual that marks a person’s death. Answer: True Rationale: Across cultures and societies, rituals surrounding death and mourning are common. These rituals serve various purposes, including providing structure and support for grieving individuals, honoring the deceased, and helping the community cope with loss. Funeral ceremonies, memorial services, and mourning customs are examples of such rituals. 150. The highest rate of death among children for any single-year period occurs between the ages of 15 and 16. Answer: False Rationale: The highest single-year death rate in childhood is between ages 0 and 1, which is mentioned in the text and also displayed in Figure 18-5. 151. People with disabilities typically experience little grief when a family member dies and they usually do not experience bereavement at all. Answer: False Rationale: People with disabilities experience grief and go through bereavement, much like other family members. 152. Compared to previous decades, today individuals with disabilities are more likely to experience grief and bereavement because they are more likely to live at home, rather than in an institutional setting. Answer: True Rationale: Advances in healthcare and social policies have led to a shift towards community-based care for individuals with disabilities, allowing them to live at home rather than in institutional settings. As a result, these individuals are more likely to experience grief and bereavement directly within their familial and social support networks, leading to different experiences and challenges compared to those living in institutions. Completing the Life Cycle 153. In some cultures, there are practices or rituals that link the beginning and ending of life. Answer: True Rationale: Certain cultural practices or rituals may symbolically link the beginning and ending of life, highlighting the cyclical nature of existence or the continuity of familial and social ties. Examples include rites of passage ceremonies, religious rituals, or cultural traditions that acknowledge the interconnectedness of birth, life, and death. 154. According to the text, a central theme that cuts across development at every stage is that hereditary and environmental forces interact in intricate ways. Answer: True Rationale: Developmental psychology emphasizes the complex interplay between genetic or hereditary factors and environmental influences in shaping human development across the lifespan. This interaction between nature (genetics) and nurture (environment) is a central theme in understanding how individuals grow, learn, and adapt at various stages of life. Short Answer questions: Thoughts and Fears of Death 155. Identify 3 specific ways in which people in the United States today treat death differently than people living in the United States would have 100 years ago. Answer: 1. Increased medicalization of death: Today, death is often viewed through a medical lens, with a focus on medical interventions and prolonging life. In contrast, 100 years ago, death typically occurred at home with minimal medical involvement. 2. Shift in funeral practices: Modern funeral practices, such as embalming, elaborate ceremonies, and commercialized funeral industry, are more prevalent today compared to a century ago when funerals were simpler, family-centered affairs often held in the home. 3. Attitudes towards discussing death: Today, there is greater openness and willingness to discuss death and dying, including topics such as end-of-life care preferences, advance directives, and grief support. In contrast, discussions about death were often considered taboo or reserved for private settings in the past. 156. Are people in the United States today more willing or less willing to discuss the topic of death, compared to the 1960s? Cite evidence for your conclusion. Answer: People in the United States today are generally more willing to discuss the topic of death compared to the 1960s. Evidence for this includes the proliferation of initiatives aimed at promoting open conversations about death and end-of-life issues, such as death cafes, advance care planning workshops, and death education programs in schools and communities. Additionally, surveys and studies have found an increase in individuals' willingness to engage in discussions about end-of-life care preferences, advance directives, and funeral planning. This shift towards greater openness reflects changing societal attitudes towards death and dying, driven in part by efforts to destigmatize death and promote informed decision-making about end-of-life issues. 157. How does having a strong religious conviction and a secure belief in an afterlife typically affect how people react to their own impending death? Answer: Having a strong religious conviction and a secure belief in an afterlife often provides individuals with a sense of comfort and reassurance regarding their own impending death. It can lead to greater acceptance of mortality, reduced fear or anxiety about death, and a belief in the continuity of existence beyond physical life. This can result in individuals facing death with greater peace and equanimity. 158. According to terror management theory, how do individuals cope with the anxiety they feel about their own death? Answer: According to terror management theory, individuals cope with the anxiety they feel about their own death by engaging in various psychological defense mechanisms aimed at managing existential terror. These mechanisms include bolstering self-esteem through accomplishments and social connections, maintaining cultural worldviews and beliefs, and striving for symbolic immortality through leaving a legacy or contributing to future generations. 159. Would terror management theory predict that individuals from collectivist, or from individualist, cultures experience the most anxiety about their own deaths? Explain your answer. Answer: Terror management theory would predict that individuals from individualist cultures experience the most anxiety about their own deaths. This is because individualist cultures emphasize personal achievement, autonomy, and distinctiveness, leading individuals to place greater emphasis on their own mortality and existential concerns. In contrast, collectivist cultures prioritize group harmony, social cohesion, and interconnectedness, which may provide individuals with more buffers against existential anxiety through strong social support networks and shared cultural beliefs about death and the afterlife. Confronting One’s Own Death 160. List the 5 stages of death and dying identified by Elisabeth Kübler-Ross and indicate the usual order in which these stages occur. Answer: The 5 stages of death and dying identified by Elisabeth Kübler-Ross are: 1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance The usual order in which these stages occur, according to Kübler-Ross, is denial, followed by anger, bargaining, depression, and finally acceptance. 161. Describe the typical reaction of family members who have cared for a loved one through a long and difficult terminal illness at the time that the loved one finally dies. Cite research evidence to support your description. Answer: Family members who have cared for a loved one through a long and difficult terminal illness often experience a complex array of emotions at the time of the loved one's death. Research by Stajduhar et al. (2010) found that caregivers commonly report feelings of relief, sadness, grief, guilt, and exhaustion upon the death of their loved one. The relief may stem from the end of the caregiving burden and witnessing the loved one's suffering come to an end, while sadness and grief are natural responses to the loss. Guilt may arise from perceived shortcomings in caregiving, and exhaustion may result from the physical, emotional, and psychological toll of long-term caregiving. 162. Describe the ideal death trajectory held by most people in the United States today. Answer: The ideal death trajectory held by most people in the United States today is one characterized by a sudden and painless death occurring at an advanced age after a brief period of illness or decline. This trajectory reflects a desire for minimal suffering, a quick transition from life to death, and the ability to maintain autonomy and dignity until the end. 163. Describe the statistics associated with suicide in the United States, indicating how suicide rates are influenced by age and by marital status. Answer: In the United States, suicide rates vary significantly by age and marital status. According to data from the Centers for Disease Control and Prevention (CDC), suicide rates tend to be highest among middle-aged and older adults, particularly men. However, suicide rates among adolescents and young adults have been increasing in recent years. Additionally, marital status is a significant factor influencing suicide rates, with individuals who are unmarried, divorced, or widowed being at higher risk compared to those who are married or in stable relationships. The Search for a Humane Death 164. What services are typically provided by hospice care, both for the person who is dying and for that person’s family members? Answer: Hospice care typically provides a range of services aimed at addressing the physical, emotional, and spiritual needs of both the person who is dying and their family members. These services may include: • Pain and symptom management to ensure comfort and quality of life • Nursing care provided by trained hospice nurses • Assistance with activities of daily living, such as bathing, dressing, and toileting • Emotional and psychosocial support for the patient and their family members, including counseling and bereavement services • Spiritual care and assistance with end-of-life decision-making • Volunteer services to provide companionship, respite care, and practical assistance to patients and families 165. State in your own words the core philosophy of the hospice movement. Answer: The core philosophy of the hospice movement is to provide compassionate and holistic care to individuals with terminal illnesses, focusing on enhancing quality of life, managing symptoms, and supporting patients and their families through the end-of-life journey. Hospice emphasizes dignity, autonomy, and comfort, allowing individuals to die with dignity in a supportive and home-like environment, surrounded by their loved ones. 166. Explain the difference between active euthanasia and passive euthanasia. Answer: Active euthanasia involves deliberately taking action to end a person's life, such as administering a lethal dose of medication. In contrast, passive euthanasia involves withholding or withdrawing life-sustaining treatment or medical interventions, allowing the person to die naturally without direct intervention to prolong life. 167. Explain the difference between a living will and a medical power of attorney and describe how legally binding each of these documents are. Answer: A living will is a legal document that allows individuals to specify their wishes regarding medical treatment and end-of-life care in advance, particularly in situations where they are unable to communicate their preferences. A medical power of attorney, on the other hand, designates a trusted individual (the "agent" or "proxy") to make healthcare decisions on behalf of the person if they become incapacitated. Both documents are legally binding if properly executed according to state laws and requirements. 168. Explain the difference between palliative care and end-of-life care. Answer: Palliative care is a holistic approach to care aimed at providing relief from the symptoms, pain, and stress of a serious illness, regardless of the stage of the disease. It focuses on improving the quality of life for patients and their families through comprehensive physical, emotional, social, and spiritual support. End-of-life care, on the other hand, specifically addresses the needs of individuals who are nearing the end of life, emphasizing comfort and dignity as they approach death. While palliative care may be part of end-of-life care, the latter encompasses a broader range of services and support tailored to the unique needs and preferences of individuals facing the end of life. Grief and Bereavement 169. In your own words, describe the basic premise of the dual-process model of stress and coping. Answer: The dual-process model of stress and coping proposes that individuals experiencing grief and bereavement engage in two main types of coping processes: loss-oriented coping and restoration-oriented coping. Loss-oriented coping involves confronting the emotional pain and feelings of loss associated with the death of a loved one, while restoration-oriented coping involves attending to practical tasks and adapting to the changes and challenges resulting from the loss. According to this model, individuals oscillate between these two coping processes, moving back and forth as they navigate the grieving process. 170. Identify two tasks that most people do immediately after the death of a loved one, and two tasks that are performed only later, over time. Answer: Immediately after the death of a loved one, most people may engage in tasks such as notifying family and friends of the death and making funeral arrangements. These immediate tasks often involve practical and logistical matters that require immediate attention. Over time, individuals may engage in tasks such as processing their emotions and grief, adjusting to life without the deceased, and finding new sources of meaning and purpose. Additionally, tasks related to estate settlement and legal matters may be addressed in the weeks or months following the death, as individuals navigate the practical implications of the loss. 171. Describe two tasks that typically occur in the healing phase of grieving and two that typically occur in the renewal phase of grieving. Answer: Healing Phase: 1. Acceptance and Integration: This involves coming to terms with the reality of the loss and integrating it into one's sense of self and life. Individuals in this phase often acknowledge the pain of loss while also starting to recognize the possibility of healing. 2. Rebuilding Relationships: During the healing phase, individuals often focus on rebuilding connections and relationships that may have been strained or neglected during the acute phase of grief. This can involve reaching out to friends and family for support, seeking professional help, or joining support groups. Renewal Phase: 1. Rediscovery of Meaning: In the renewal phase, individuals begin to find new sources of meaning and purpose in life. This might involve pursuing new interests, hobbies, or goals that align with their changed circumstances and identities post-loss. 2. Integration of Loss into Life Narrative: As individuals move forward, they often find ways to incorporate the experience of loss into their life story in a way that feels meaningful and authentic. This can involve finding lessons or insights gained from the grieving process and using them to shape their future growth and decisions. 172. What is anticipatory grief, and what positive purpose does it typically serve? Answer: Anticipatory Grief: Anticipatory grief refers to the mourning and emotional preparation that occurs before the actual death of a loved one, often when death is expected due to a terminal illness or a prolonged decline in health. It involves experiencing the stages of grief—such as denial, anger, bargaining, depression, and acceptance—prior to the loss itself. Positive Purpose: Anticipatory grief serves several positive purposes: • Emotional Preparation: It allows individuals to gradually come to terms with the impending loss, which can reduce the shock and intensity of grief after the death occurs. • Time for Closure: Anticipatory grief provides an opportunity for individuals to express their feelings, resolve conflicts, and say goodbye to their loved one, which can facilitate a sense of closure and peace. 173. Explain the difference between chronic grief and bereavement overload. Answer: Chronic Grief: Chronic grief refers to a prolonged and intense mourning process characterized by persistent feelings of sadness, emptiness, and longing for the deceased. It may involve difficulty accepting the loss and moving forward with life. Individuals experiencing chronic grief often struggle to find meaning or joy in life and may be at risk for complications such as depression or anxiety. Bereavement Overload: Bereavement overload occurs when an individual experiences multiple losses within a relatively short period, overwhelming their capacity to grieve each loss fully. This can lead to emotional exhaustion, numbness, and difficulty processing feelings of grief for each individual loss. Bereavement overload may make it challenging for individuals to mourn effectively and can increase the risk of unresolved grief or complicated mourning. 174. Is grief and bereavement experienced in the same ways by people belonging to different cultural traditions? Explain your answer and provide examples that support your conclusion. Answer: Grief and Bereavement Across Cultures: Grief and bereavement are experienced differently across cultural traditions due to variations in beliefs, rituals, and social norms surrounding death and mourning. While the core emotions of grief—such as sadness, anger, and longing—are universal, the expression and management of these emotions can vary widely. Example 1: In Western cultures, grief may be more individualistic, with emphasis placed on openly expressing emotions and seeking professional support. In contrast, in collectivist cultures, such as many Asian societies, grief may be more communal, with family members and community providing significant support and guidance. Example 2: Rituals and customs surrounding death and mourning also vary greatly across cultures. For instance, some cultures may have elaborate funeral ceremonies with specific rituals for honoring the deceased and supporting the bereaved, while others may prioritize simplicity and privacy in mourning practices. 175. Describe why the death of a child might be harder to deal with by people living in the United States today, in comparison to 100 years ago. Cite statistics to support your answer. Answer: The death of a child might be harder to deal with for people living in the United States today compared to 100 years ago due to several factors: 1. Decreased Infant Mortality: Over the past century, significant advancements in healthcare, sanitation, and nutrition have led to a substantial decrease in infant mortality rates. As a result, parents today have higher expectations of their children surviving into adulthood, making the loss of a child more unexpected and devastating. 2. Increased Emotional Investment: Modern parenting practices often involve a deeper emotional investment in children's lives, with parents placing greater emphasis on nurturing and bonding. Consequently, the loss of a child today may be perceived as a more profound personal tragedy, resulting in heightened grief and emotional distress. Statistics from the Centers for Disease Control and Prevention (CDC) show that infant mortality rates in the United States have declined dramatically over the past century. In 1920, the infant mortality rate was approximately 100 infant deaths per 1,000 live births, compared to less than 6 infant deaths per 1,000 live births in recent years. This decrease reflects significant improvements in healthcare and public health interventions, contributing to longer life expectancies for children and heightened expectations for their survival. 176. Why is it more important today to consider how best to cope with deaths involving individuals with disabilities compared to 50 years ago? Answer: It is more important today to consider how best to cope with deaths involving individuals with disabilities compared to 50 years ago due to several reasons: 1. Increased Life Expectancy: Advances in healthcare and medical technology have led to increased life expectancies for individuals with disabilities. As a result, more people with disabilities are living longer, and their deaths are becoming a more common experience for families and caregivers. Therefore, there is a greater need for supportive resources and coping strategies to navigate the grief and loss associated with the death of individuals with disabilities. 2. Evolving Attitudes and Inclusion: Society's attitudes toward disability have shifted over the past few decades, with greater emphasis placed on inclusion, equality, and person-centered care. As a result, individuals with disabilities are more likely to be integrated into their communities and have meaningful relationships and connections, making their deaths more impactful and complex for those involved. Additionally, families and caregivers may have invested significant time, effort, and emotional energy in advocating for the rights and well-being of individuals with disabilities, further intensifying the grief and sense of loss when they pass away. 177. Describe two factors that make coping with the death of a child especially difficult for family members. Answer: Coping with the death of a child is especially difficult for family members due to several factors: 1. Unfulfilled Potential: The death of a child often represents the loss of potential and unfulfilled dreams, leaving parents grappling with the imagined futures and milestones that will never be realized. This sense of unrealized potential can intensify grief and contribute to feelings of profound sadness and emptiness. 2. Disruption of Family Dynamics: The death of a child can disrupt family dynamics and relationships, causing profound changes in roles, routines, and interactions. Siblings may struggle with feelings of guilt, confusion, or jealousy, while parents may experience strain in their marital relationship as they navigate grief and cope with the loss in different ways. This disruption of family cohesion and stability can compound the challenges of grieving the death of a child. Completing the Life Cycle 178. Describe a cultural tradition that is performed as a way of linking the beginning and ending of the lifespan. Answer: One cultural tradition that is performed as a way of linking the beginning and ending of the lifespan is the Dia de los Muertos, or Day of the Dead, celebrated in Mexico and other Latin American countries. During this tradition, families gather to honor and remember deceased loved ones, creating altars adorned with photographs, candles, flowers, and offerings of food and drink. The celebration is a vibrant and joyous occasion that symbolizes the continuation of life beyond death, as families come together to share stories, memories, and prayers for the souls of the departed. Through this ritual, individuals acknowledge the cyclical nature of life and death, affirming the interconnectedness of past, present, and future generations. 179. Describe how the cultural taboo against discussing death has changed over the past several decades and describe the research that has brought about this change in attitudes about death. The cultural taboo against discussing death has evolved significantly over the past several decades. Historically, death was often considered a taboo subject in many societies, leading to avoidance or hushed conversations about it. However, in recent years, there has been a noticeable shift towards more open discussions about death and dying. This change can be attributed to various factors: a. Medical advancements have led to increased exposure to death due to longer life expectancies and encounters with terminal illnesses. This exposure has made discussions about death more prevalent. b. Movements like hospice and palliative care have worked to destigmatize death, promoting open conversations about end-of-life care and dying. These movements emphasize compassionate care and support for individuals facing terminal illnesses. c. Social and cultural shifts have led to a broader movement towards discussing taboo topics openly, including death. Initiatives such as death cafes, where people gather to discuss death over coffee, indicate a growing acceptance of discussing death in public settings. d. Psychological research and education have played a significant role in changing attitudes about death. Studies exploring death anxiety, grief, and end-of-life decision-making have highlighted the importance of addressing these topics openly and honestly. Educational programs aimed at healthcare professionals and the general public have increased awareness and understanding of death and dying. Overall, these factors have contributed to a gradual shift in societal attitudes towards death, leading to greater openness and willingness to discuss this once-taboo subject. Essay questions: Thoughts and Fears of Death 179. Describe how the cultural taboo against discussing death has changed over the past several decades and describe the research that has brought about this change in attitudes about death. Answer: The cultural taboo against discussing death has gradually lessened over the past several decades, marked by increasing openness and willingness to engage in conversations about mortality. This shift can be attributed to several factors, including: • Advancements in research: Research in fields such as psychology, sociology, and anthropology has shed light on the psychological and societal benefits of confronting mortality. Studies have shown that discussing death openly can lead to greater acceptance of death as a natural part of life, reduced fear and anxiety surrounding death, and improved end-of-life decision-making. • End-of-life care movements: The hospice and palliative care movements have played a significant role in challenging the taboo against discussing death. These movements emphasize the importance of open communication about end-of-life preferences and goals of care, encouraging individuals to have conversations with loved ones and healthcare providers about their wishes for their final days. • Cultural shifts: Changing societal attitudes towards death, influenced by factors such as globalization, multiculturalism, and the rise of social media, have contributed to greater openness in discussing mortality. Cultural traditions and practices surrounding death are being reexamined and redefined, leading to increased dialogue and exploration of diverse perspectives on death and dying. Research has played a crucial role in bringing about this change in attitudes about death by providing evidence-based insights into the benefits of discussing mortality openly and honestly. Studies have shown that confronting death can lead to greater psychological well-being, improved quality of life, and more meaningful end-of-life experiences for both individuals and their loved ones. 180. According to the text, are people who are healthy and psychologically well-adjusted more anxious, or less anxious, when they face their own impending death? Explain your conclusion. Answer: According to the text, people who are healthy and psychologically well-adjusted tend to be less anxious when they face their own impending death. This conclusion is supported by research in psychology and thanatology, which has found that individuals with a strong sense of purpose, meaningful connections with others, and a positive outlook on life are better equipped to cope with the existential anxiety associated with mortality. Healthy and psychologically well-adjusted individuals often have developed coping mechanisms and resources that enable them to confront their own mortality with greater resilience and acceptance. They may have a more realistic understanding of death as a natural part of the life cycle and may be more proactive in engaging in meaningful end-of-life planning and preparation. Additionally, research has shown that confronting one's mortality can serve as a catalyst for personal growth and self-reflection, leading to a greater appreciation for life and a deeper sense of meaning and purpose. Therefore, while the prospect of death may still evoke some degree of anxiety for healthy individuals, their overall psychological well-being and resilience tend to mitigate feelings of fear and distress associated with impending death. 181. What role does religion typically play in how adults face the prospect of their own deaths? Answer: Religion often plays a significant role in how adults face the prospect of their own deaths. Many religious traditions offer beliefs, rituals, and practices that provide comfort and guidance to individuals confronting mortality. For example: a. Belief in an afterlife provides reassurance and hope to believers facing death, as they anticipate an existence beyond the physical realm. b. Rituals and ceremonies surrounding death, such as funerals and prayers for the deceased, help mourners cope with loss and provide a sense of closure and community support. c. Moral and ethical guidance from religious teachings offers believers a sense of purpose and fulfillment, alleviating anxiety about death. Overall, religion can serve as a source of comfort, meaning, and support for individuals facing the prospect of their own deaths, helping them navigate existential questions and find solace in their beliefs. 182. What are the basic assumptions of terror management theory and how do they relate to how individuals deal with the issue of death? Answer: The basic assumptions of terror management theory (TMT) include: a. Mortality salience: TMT posits that individuals experience heightened anxiety when reminded of their mortality or confronted with the idea of death. This awareness, known as mortality salience, triggers defensive reactions and psychological coping mechanisms. b. Cultural worldview defense: Individuals seek to mitigate death anxiety by adhering to cultural worldviews, which provide meaning, values, and beliefs about life's purpose. By maintaining a connection to their cultural worldview, individuals feel more secure against the fear of death. c. Self-esteem maintenance: TMT suggests that individuals bolster their self-esteem to cope with death anxiety. Affirming personal worth and significance serves as a psychological buffer against existential threats. These assumptions relate to how individuals deal with the issue of death by highlighting the psychological mechanisms and strategies used to manage death anxiety. By understanding these processes, researchers gain insight into how individuals navigate existential concerns and cope with the inevitability of death. 183. How would terror management theory explain why consumers spend more money following a close brush with death? Answer: Terror management theory suggests that when individuals are reminded of their mortality, they are motivated to bolster their self-esteem and sense of significance. This can lead to increased spending as a way to affirm one's worth and distract from existential concerns. 184. Describe two sources of evidence that support the conclusions of terror management theory as being valid. Answer: One source of evidence supporting terror management theory is experimental studies demonstrating that reminders of mortality lead to increased adherence to cultural worldviews and bolstering of self-esteem. Another source comes from studies showing that when mortality salience is high, individuals exhibit more defensive reactions against worldview-threatening information. Confronting One’s Own Death 185. How can death be considered to be the final developmental task that most people face? What processes do individuals engage in if they confront death as their final developmental task? Answer: Death is considered the final developmental task because it forces individuals to confront the ultimate existential challenge. People engage in processes such as seeking meaning, reconciling with their life choices, and striving for a sense of closure as they approach death. This task often involves accepting mortality and finding ways to leave a legacy. 186. Describe the research conducted by Kübler-Ross. What did it show about how individuals cope with a terminal illness? Answer: Elisabeth Kübler-Ross conducted seminal research on the stages of grief experienced by individuals facing terminal illness. Her work outlined five stages: denial, anger, bargaining, depression, and acceptance. This research highlighted that individuals cope with terminal illness through a process of emotional adaptation, where they gradually come to terms with their impending mortality. 187. What changes in the medical field have occurred because of the research conducted by Kübler-Ross? Do you think these are good changes, or bad changes? Explain your answer. Answer: Elisabeth Kübler-Ross's research, particularly her groundbreaking work on the five stages of grief, has significantly influenced the medical field's approach to end-of-life care. Her insights have led to a greater emphasis on providing holistic care for terminally ill patients, including addressing their emotional and psychological needs alongside medical treatment. This has spurred the development of hospice and palliative care programs, as well as training initiatives for healthcare professionals to better support patients and their families through the dying process. These changes are generally considered positive. Kübler-Ross's research has helped to humanize end-of-life care, promoting greater compassion, understanding, and dignity for patients facing terminal illnesses. By acknowledging and addressing the psychological aspects of dying, healthcare providers can offer more comprehensive support, enhancing the quality of life for patients and their loved ones during this difficult time. 188. How do the coping patterns of caregivers change, depending on whether the terminal illness of a loved one has a very fast, very slow, or moderate trajectory? Answer: The coping patterns of caregivers can vary significantly depending on the trajectory of the terminal illness. • Fast trajectory: When a loved one's terminal illness progresses rapidly, caregivers often experience intense emotional turmoil and may feel overwhelmed by the suddenness of the situation. They may have limited time to prepare emotionally and practically for the impending loss, leading to high levels of stress and anxiety. Coping strategies may involve seeking support from friends, family, or professional counselors, as well as focusing on making the most of the time remaining with their loved one. • Slow trajectory: In cases of a slowly progressing terminal illness, caregivers may face a prolonged period of anticipatory grief. This can result in emotional strain and uncertainty as they navigate the challenges of providing care while also grieving the gradual decline of their loved one. Coping strategies may involve seeking out support groups or online forums where they can connect with others facing similar experiences, as well as finding ways to prioritize self-care to avoid burnout. • Moderate trajectory: When the terminal illness progresses at a moderate pace, caregivers may experience a mixture of emotions as they navigate the ups and downs of their loved one's condition. They may find themselves constantly adjusting their expectations and coping strategies as the illness evolves. Coping mechanisms may involve finding a balance between hope and acceptance, as well as seeking out practical resources to help manage the challenges of caregiving. 189. Describe 3 reasons why death from a progressive terminal disease like Alzheimer’s or ALS is often an especially difficult death with which to cope. Do you agree that dying from a disease like these poses special coping tasks that must be dealt with by the dying person and his or her loved ones? Answer: Death from progressive terminal diseases like Alzheimer’s or ALS presents unique challenges for both the dying person and their loved ones. 1. Prolonged grief and anticipatory mourning: With diseases like Alzheimer’s or ALS, the progression of the illness can be slow and unpredictable. This prolonged period of decline often leads to anticipatory grief, where loved ones mourn the loss of the person they once knew while they are still alive. Coping with this extended period of grieving can be emotionally exhausting and challenging. 2. Loss of autonomy and identity: Progressive terminal diseases often rob individuals of their independence and ability to engage in activities they once enjoyed. This loss of autonomy can be distressing for both the dying person and their loved ones, as they grapple with the gradual erosion of the person's identity and capabilities. Coping with these changes may involve finding ways to adapt and find meaning in new ways of connecting and relating to one another. 3. Emotional and physical toll on caregivers: Providing care for someone with a progressive terminal disease can be physically and emotionally demanding. Caregivers may experience high levels of stress, anxiety, and depression as they navigate the challenges of caregiving while also mourning the impending loss of their loved one. Coping with these demands often requires accessing support networks, practicing self-care, and seeking professional assistance when needed. Yes, I agree that dying from a disease like Alzheimer’s or ALS poses special coping tasks that must be dealt with by both the dying person and their loved ones. These tasks include navigating the complexities of anticipatory grief, finding ways to maintain dignity and autonomy in the face of decline, and accessing support to cope with the emotional and physical toll of the illness. 190. Describe how suicide rates change for men and women between the periods of early adulthood and older adulthood. Then describe 2 factors that most likely explain this pattern of changes. Answer: Suicide rates tend to vary between men and women across different stages of adulthood. • Early adulthood: During early adulthood, suicide rates are generally higher for men than for women. Men in this age group often face unique stressors such as financial pressures, relationship issues, and challenges related to establishing their identity and place in the world. Additionally, young men may be less likely to seek help for mental health issues due to societal expectations around masculinity and self-reliance. • Older adulthood: In contrast, suicide rates among older adults typically show a reversal of this trend, with rates higher among men than women. Factors contributing to this pattern may include social isolation, declining physical health, loss of social roles and identity (such as retirement), and limited access to mental health support services. Older men, in particular, may struggle with a lack of emotional support networks and may be less likely to seek help for mental health concerns. Two factors that likely explain these patterns of changes include: 1. Socialization and help-seeking behavior: Societal norms around masculinity often discourage men from seeking help for mental health issues or expressing vulnerability. This reluctance to seek support may contribute to higher suicide rates among men, especially in early adulthood when individuals may feel pressure to conform to traditional gender roles. 2. Access to resources and support: In older adulthood, men may face additional challenges related to social isolation and limited access to mental health resources. Factors such as retirement, loss of friends and family members, and physical health problems can further exacerbate feelings of loneliness and despair, increasing the risk of suicide. 191. Describe how suicide rates change for men versus women depending on whether they are married or widowed. Then describe 2 factors that most likely explain this pattern of changes. Answer: The relationship between marital status and suicide rates varies between men and women. • Married individuals: Generally, being married is associated with lower suicide rates for both men and women. Marriage often provides social support, companionship, and a sense of belonging, which can act as protective factors against suicide. However, the effect of marriage on suicide rates tends to be more pronounced for men than for women. • Widowed individuals: Widowed individuals, particularly men, have been found to have higher suicide rates compared to their married counterparts. The loss of a spouse can lead to profound feelings of loneliness, grief, and social isolation, which may increase the risk of suicide. Women who are widowed also experience increased suicide risk compared to their married counterparts, although the effect tends to be less pronounced than for men. Two factors that likely explain these patterns of changes include: 1. Social support: Marriage often provides a source of social support and companionship, which can buffer against the stressors and challenges of life. Widowed individuals, especially men, may experience a significant loss of social support following the death of a spouse, increasing their vulnerability to suicide. 2. Coping resources: Married individuals may have access to greater coping resources, such as emotional support from their spouse, shared responsibilities, and financial stability. The loss of these coping resources following spousal bereavement can leave widowed individuals feeling overwhelmed and struggling to cope with their grief and loneliness, potentially increasing the risk of suicide. The Search for a Humane Death 192. How does a person’s sense of control typically influence the course of their terminal illness? Describe the results of a research study noted in the text that support your answer. Answer: A person's sense of control significantly influences the course of their terminal illness. Research has shown that patients who feel a sense of control over their treatment and circumstances tend to experience better psychological well-being and sometimes even better physical outcomes. One study, noted in the text, conducted by Dr. Ellen Langer and her colleagues, demonstrated the impact of perceived control on health outcomes. In this study, nursing home residents were given more control over their environment, such as choosing their own plants, participating in decision-making processes, and being actively engaged in their care. The results showed that those who had more control over their environment had better overall health outcomes compared to those who had little control. This highlights the importance of empowering terminally ill patients with a sense of control, as it can positively influence their quality of life and possibly even their medical condition. 193. What is the “Five Wishes” method and how does it help individuals plan for their own death? Answer: The "Five Wishes" method is a comprehensive advance directive document designed to help individuals plan for their own death and communicate their end-of-life wishes to their loved ones and healthcare providers. It covers a wide range of topics including medical treatment preferences, comfort measures, spiritual and emotional wishes, and preferences for how one wants to be treated by others. By addressing these aspects, Five Wishes goes beyond the legal requirements of a traditional living will, providing a more holistic approach to end-of-life planning. It helps individuals articulate their values and preferences, ensuring that their wishes are respected and followed even if they are unable to communicate them directly. 194. What does it mean to say that “hospice is a philosophy, not a place”? Cite evidence to support the idea behind this statement. Answer: Saying "hospice is a philosophy, not a place" emphasizes that hospice care is more about a holistic approach to end-of-life care rather than a physical location. This philosophy focuses on providing comfort, dignity, and quality of life for terminally ill patients and their families. Evidence supporting this idea can be found in the diverse settings where hospice care can be delivered, including patients' homes, nursing homes, hospice facilities, or hospitals. Hospice care emphasizes symptom management, emotional and spiritual support, and enhancing the patient's quality of life during their remaining time. This philosophy underscores the importance of treating the person as a whole, addressing not just their physical needs but also their emotional, social, and spiritual well-being. 195. How does the philosophy of hospice differ from the philosophy that guides most physicians in their care of terminally ill patients? What advantages and disadvantages are associated with each of these philosophical positions? Answer: The philosophy of hospice differs from the philosophy that guides most physicians in their care of terminally ill patients in several key aspects. Hospice care focuses on maximizing comfort and quality of life, often foregoing aggressive medical interventions that aim to prolong life. Physicians, on the other hand, may tend to prioritize curative treatments and prolonging life, even if it means subjecting the patient to potentially burdensome medical interventions. Advantages of the hospice philosophy include promoting dignity, comfort, and emotional support for the patient and their family during the end-of-life process. It allows patients to spend their final days in familiar surroundings, surrounded by loved ones, and receiving personalized care tailored to their needs and preferences. However, a potential disadvantage is that some patients may feel they are giving up hope or feel abandoned by the medical system if they choose hospice care. The philosophy guiding most physicians may offer advantages such as providing hope for a cure or extended life, and the possibility of accessing potentially life-prolonging treatments. However, this approach may also lead to overtreatment, unnecessary suffering, and diminished quality of life for terminally ill patients. Additionally, it may prolong the dying process and delay important discussions about end-of-life preferences and goals of care. Ultimately, both philosophical positions have their merits and drawbacks, and the most appropriate approach depends on the individual patient's values, preferences, and medical circumstances. 196.The topic of assisted suicide is hotly debated, with strong opinions on both sides of this issue. Identify the most important arguments on both sides of this issue, and then state your own opinion about whether or not assisted suicide should be legalized in the United States. Answer: Arguments in Favor of Legalizing Assisted Suicide: 1. Autonomy and Dignity: Advocates argue that individuals should have the right to make decisions about their own bodies and end their lives with dignity if facing terminal illness or unbearable suffering. 2. Relief of Suffering: Assisted suicide can provide relief from prolonged and excruciating suffering for terminally ill patients who have exhausted all other options for pain management. 3. Empowerment: Legalizing assisted suicide empowers patients to have control over their own end-of-life care and allows them to die on their own terms. Arguments Against Legalizing Assisted Suicide: 1. Ethical Concerns: Critics argue that intentionally ending a life, even with consent, violates fundamental ethical principles and undermines the sanctity of life. 2. Potential for Abuse: There are concerns about the potential for abuse, coercion, and pressure on vulnerable individuals, particularly those who may feel like a burden on their families or society. 3. Slippery Slope: Legalizing assisted suicide could lead to broader societal implications, such as devaluing the lives of individuals with disabilities or creating a culture where euthanasia becomes routine rather than a last resort. Personal Opinion: I believe that assisted suicide should be legalized under carefully regulated conditions, with stringent safeguards in place to protect against abuse and ensure that it remains a choice made by individuals who are of sound mind and facing unbearable suffering with no hope of improvement. 197. Describe the view of the U. S. public with respect to assisted suicide. Do most adults in the U.S. support or oppose this practice? What is the view of the American Medical Association? In light of public opinion about assisted suicide, what factors most likely account for the AMA’s position on this topic? Answer: The views on assisted suicide vary among the U.S. public. However, there has been a gradual shift towards more acceptance of the practice. According to polls, a majority of adults in the U.S. now support assisted suicide, particularly when it's framed within the context of terminal illness and unbearable suffering. The American Medical Association (AMA) traditionally opposed assisted suicide, viewing it as contrary to the physician's role as a healer and protector of life. However, the AMA has undergone some shifts in its stance in recent years. While it still officially opposes physician-assisted suicide, it has adopted a neutral stance on the issue, allowing individual physicians to make their own decisions regarding participation. Public opinion likely plays a significant role in the AMA's position. As societal attitudes change and more people express support for assisted suicide, the AMA may feel pressure to reconsider its stance. Additionally, ethical considerations, concerns about patient autonomy, and the complexities of end-of-life care likely contribute to the AMA's nuanced approach. 198. Why would a terminally ill person want to draw up a living will? Why would he or she want to have a medical power of attorney? What do each of these documents do, and what do they not do, to make sure that a person’s wishes about their death carried out? Answer: A terminally ill person might want to draw up a living will to outline their preferences for medical treatment and end-of-life care in case they become incapacitated and unable to communicate their wishes. A living will allows individuals to specify whether they want life-sustaining treatments such as artificial nutrition or ventilation to be administered in certain circumstances. Having a medical power of attorney (or healthcare proxy) allows a person to appoint someone they trust to make medical decisions on their behalf if they become unable to do so themselves. This ensures that their preferences regarding treatment and end-of-life care are upheld, even if they are unable to express them. While these documents provide guidance for medical decision-making, they do not cover every possible scenario, and there may still be situations where interpretation is needed. Additionally, they do not guarantee that healthcare providers or family members will adhere to the individual's wishes, particularly if there is disagreement or ambiguity. 199. What philosophical viewpoint rests at the center of both palliative care and end-of-life care strategies? When is each more likely to apply in the case of a person who has just been diagnosed with a very serious disease, such as cancer? Answer: The philosophical viewpoint central to both palliative care and end-of-life care strategies is the focus on improving the quality of life for patients facing serious illness, especially when cure or remission is no longer possible. This approach prioritizes alleviating pain and suffering, addressing emotional and spiritual needs, and supporting patients and their families throughout the trajectory of illness. Palliative care is more likely to apply at any stage of a serious illness, including at the time of diagnosis. Its goal is to provide holistic support to patients and families, regardless of whether they are pursuing curative treatments or focusing on symptom management and comfort care. Palliative care can be integrated alongside other treatments to improve the overall well-being of the patient. End-of-life care strategies become more prominent as a disease progresses and it becomes clear that the focus is shifting from prolonging life to ensuring comfort and dignity in the dying process. These strategies specifically address the needs of individuals who are nearing the end of life, including advance care planning, hospice care, and support for both the patient and their loved ones as they navigate the final stages of illness. 200. Identify and describe 3 services that hospitals could provide that would be consistent with a philosophy of palliative care. Answer: 1. Pain Management: Hospitals can offer specialized pain management services to alleviate physical discomfort associated with serious illness. This may include medication management, physical therapy, acupuncture, or other complementary therapies aimed at reducing pain and improving quality of life. 2. Psychosocial Support: Hospitals can provide counseling, support groups, and other psychosocial services to address the emotional and psychological needs of patients and their families. This support helps individuals cope with the stress, anxiety, and grief that often accompany serious illness, fostering emotional resilience and enhancing overall well-being. 3. Advance Care Planning: Hospitals can facilitate advance care planning discussions and assist patients in documenting their preferences for end-of-life care through advance directives, living wills, and medical power of attorney documents. By encouraging proactive decision-making and honoring patient preferences, hospitals ensure that individuals receive care aligned with their values and wishes, even in the face of complex medical circumstances. 201. Explain two functions that the process of grieving serves for the loved ones left behind after a death. Answer: The process of grieving serves several functions for loved ones left behind after a death. Firstly, it provides an opportunity for individuals to express and process their emotions surrounding the loss, allowing them to come to terms with the reality of the situation. Secondly, grieving helps individuals to gradually adjust to the new reality of life without their loved one by integrating the loss into their sense of self and identity. 202. Describe the typical pattern of grief that most people experience following the death of a loved one. Identify a specific task that occurs in each of the stages you identify. Answer: The typical pattern of grief often follows the Kübler-Ross model, which includes stages such as denial, anger, bargaining, depression, and acceptance. In these stages, individuals may experience various emotions and reactions. For example, in the stage of bargaining, a specific task involves attempting to negotiate with a higher power to reverse or mitigate the loss, such as making promises or seeking alternative outcomes. 203. What is anticipatory grief, and what positive and negative reactions are associated with it? Answer: Anticipatory grief is the process of mourning and coping with the impending death of a loved one before it occurs. Positive reactions associated with anticipatory grief include the opportunity for individuals to prepare emotionally, say goodbye, and make the most of the time they have left with their loved one. Negative reactions may include feelings of anxiety, sadness, and anticipatory mourning as individuals confront the reality of the impending loss. 204. Describe 2 different types of situations that would put a person at risk for bereavement overload. If a person did experience bereavement overload, what kinds of symptoms would that person typically display? Answer: Two types of situations that can put a person at risk for bereavement overload include experiencing multiple losses within a short period, such as the death of multiple family members or friends, and being in a caregiving role for a terminally ill loved one for an extended duration. If a person experiences bereavement overload, they may display symptoms such as intense and prolonged grief, difficulty coping with daily tasks, social withdrawal, and physical health issues due to chronic stress. 205. What are the symptoms that make chronic grief a different type of reaction than bereavement overload? What symptoms do these two conditions have in common? Answer: Chronic grief is characterized by prolonged and intense grieving that persists over an extended period, often without resolution. Symptoms specific to chronic grief may include persistent feelings of sadness, guilt, or anger, difficulty accepting the loss, and ongoing preoccupation with the deceased. In contrast, bereavement overload is marked by the cumulative impact of multiple losses within a short time frame. Symptoms common to both conditions may include depression, anxiety, social withdrawal, and difficulty functioning in daily life. However, chronic grief typically involves a prolonged and unresolved grieving process, while bereavement overload results from the sheer volume of losses experienced. 206. Give an example of how grief and bereavement are experienced in a culture other than that typical in the United States. What conclusions does a cross-cultural comparison of grief rituals lead one to make? Answer: In many cultures, such as in Japan, the ritual of Obon is significant for honoring deceased ancestors. During Obon, families clean and decorate graves, make offerings to ancestors, and participate in Bon Odori dances. A cross-cultural comparison of grief rituals suggests that while the specific customs and practices may vary, the underlying themes of honoring the deceased, supporting the bereaved, and facilitating the grieving process are universal. It highlights the importance of cultural context in understanding and addressing grief. 207. Describe how a narrowly prescribed cultural ritual that surrounds death can be a helpful practice for grieving survivors. Under what circumstances could such a ritual also be a problem in helping survivors adjust to death? Answer: A narrowly prescribed cultural ritual surrounding death can be a helpful practice for grieving survivors by providing structure, support, and a sense of community during a difficult time. Such rituals offer a framework for expressing grief, sharing memories, and receiving social support from others who are also mourning. However, under certain circumstances, these rituals may also be problematic in helping survivors adjust to death. For instance, if the rituals are overly rigid or fail to accommodate individual differences in grieving styles and needs, they may contribute to feelings of alienation or disenfranchised grief among some mourners. Additionally, if the rituals are enforced in a way that disregards or suppresses the emotional needs of the bereaved, they can hinder the healing process rather than facilitating it. 208. What is the text’s position on how the grief associated with a child’s death is different in the United States in the 21st century, compared to how it was in the early 1900s? Do you agree with this point of view? Why or why not? Answer: The text suggests that in the United States in the 21st century, the grief associated with a child's death differs significantly from how it was experienced in the early 1900s. In the past, child mortality rates were higher, and death was often seen as a more natural and accepted part of life. As a result, expressions of grief may have been more subdued or normalized within communities. However, in contemporary American society, there is often a greater emphasis on individualism, and the death of a child is viewed as a profound and traumatic loss. Grieving parents may experience intense social support but also face societal expectations to "move on" or "recover" from their loss quickly. Whether one agrees with this point of view may depend on various factors, including cultural background, personal experiences, and perspectives on grief and mourning. Some individuals may resonate with the idea that contemporary society places greater emphasis on the unique and devastating impact of child loss, while others may argue that historical perspectives on grief were equally valid and influenced by different societal norms and values. 209. What special circumstances should be considered when death or bereavement involves an individual with intellectual or developmental disabilities? Answer: When death or bereavement involves an individual with intellectual or developmental disabilities, special circumstances should be considered to support both the individual and their caregivers. These circumstances may include communication barriers, unique support needs, caregiver support, and cultural considerations. Overall, supporting individuals with disabilities through the grieving process requires a compassionate and individualized approach that addresses their unique needs and circumstances. 210. Identify 3 ways in which the death of a child is more difficult to cope with than is the death of an older adult. Answer: 1. Unfulfilled Potential: The death of a child often involves the loss of unrealized potential and future dreams, which can be especially challenging for parents who had envisioned a lifetime with their child. In contrast, older adults have typically lived longer and may have achieved many of their goals, making their death somewhat more expected. 2. Developmental Timing: Losing a child disrupts the natural order of life and challenges one's understanding of the lifespan. Parents may struggle to reconcile the idea of a child dying before them, which can lead to profound feelings of confusion and injustice. In contrast, the death of an older adult, while still difficult, may be perceived as a more natural part of the life cycle. 3. Impact on Family Dynamics: The death of a child often creates significant emotional upheaval within a family, potentially straining relationships and leading to profound feelings of guilt and blame. Moreover, parents may find it challenging to support one another while grieving the loss of their child. Comparatively, the death of an older adult may still bring grief but may not disrupt family dynamics to the same extent. Completing the Life Cycle 211. What is implied in calling death the “completion of the life cycle”? How does such a statement reflect the emphasis of the study of lifespan development? Answer: The statement "death as the completion of the life cycle" suggests that death is a natural and inevitable part of the human experience, marking the end of the journey through the various stages of development. This reflects the emphasis of the study of lifespan development, which focuses on understanding the progression of individuals from birth to death and the changes, challenges, and milestones encountered along the way. Viewing death as the final stage underscores the interconnectedness of all developmental periods and emphasizes the importance of considering the entire lifespan in understanding human development. 212. Erik Erikson viewed the final developmental stage as one in which the individual confronts the challenge of integrity versus despair. In what ways does viewing death as the final developmental task reflect Erikson’s thinking about the period of older adulthood? Answer: 212. Erik Erikson viewed the final developmental stage as one in which the individual confronts the challenge of integrity versus despair. In what ways does viewing death as the final developmental task reflect Erikson’s thinking about the period of older adulthood? Erikson's concept of integrity versus despair suggests that in older adulthood, individuals reflect on their lives and evaluate whether they have lived with a sense of purpose and fulfillment or if they harbor regrets and unresolved conflicts. Viewing death as the final developmental task aligns with Erikson's thinking by emphasizing the importance of achieving a sense of integrity and acceptance as one approaches the end of life. It underscores the idea that confronting mortality prompts individuals to reconcile their past experiences, relationships, and accomplishments, leading to either a sense of contentment or despair regarding their life's journey. 213. Suppose a person makes the statement, “The study of human development is the study of how all people are alike and all people are different from each other.” Would the overarching perspective of the text be compatible or incompatible with such a statement? Explain your answer. Answer: The overarching perspective of the text would likely be compatible with the statement. Human development research often seeks to identify universal patterns and milestones that are common to all individuals across cultures and contexts, highlighting the ways in which people are alike. However, it also acknowledges the significance of individual differences in shaping development, including variations in temperament, personality, cultural background, and life experiences. Therefore, while recognizing the shared aspects of human development, the text would also emphasize the importance of understanding and appreciating the diversity and uniqueness of each individual's developmental journey. Conclusion: While the experience of grief and bereavement shares common elements across cultures, cultural differences profoundly shape how individuals understand, express, and cope with loss. Understanding and respecting these cultural variations is essential for providing effective support and care to those who are grieving. Test Bank for Understanding Human Development Wendy L. Dunn, Grace J. Craig 9780205989522, 9780135164204, 9780205233878, 9780205753079

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