OMEGA - Journal of Death and Dying

This report concerns the important empirical question of measuring distress experienced by a child while coming to terms with his or her own life-threatening illness. Nineteen fatally and chronically ill outpatient children were assessed in seven areas of personality functioning with seven different measurement methods. Inspection of the multitrait-multimethod correlation matrix indicates: that there are important differences in measures of distress that are thought to be roughly the same; and that, in general, the most common empirical methods are poorly fitted to the task of understanding the distress of fatally or chronically ill children.

Life changes, demographic characteristics, attitudes toward death, and plans for the future are examined in relation to quantification of time remaining and perceived distance from death among 568 nonhospitalized, older men and women. A substantial proportion (49%) did not quantify the remaining portion of life and age did not prompt specification of time remaining. Life changes were poor predictors of both quantification time remaining and perceived distance from death. Demographic characteristics provided the best model to explain perceived distance from death although there were some differences by sex.

During the past decade, behavioral and medical scientists have compiled an increasing amount of scientific work on the aspect of death known as the near-death experience. Investigators have found over 100 cases of near-death experience where persons have encountered another realm or mode of existence. This paper describes the perceived other world based on a limited number of insightful cases of Mormon near-death experiences. The social system of the other world is very organized and based on a moral order. The basic societal unit is the family. The other world has a system of social stratification and its most important desirable is morality. Social control processes are also evident in the other world. The Mormon findings suggest that a tremendous process of socialization is being undertaken there. The Mormon descriptions suggest the other world is vast and located near the earth. It contains buildings that are better constructed than the buildings on earth and landscape and vegetation “indescribably beautiful.” New powers and capabilities are experienced in the body form of the other world, and there are various styles of dress. The influence of the Mormon frame of reference on the findings is discussed.

Irreversible coma caused by the destruction of the whole brain has gained wide acceptance as an alternative to the traditional heart/lung approach to defining death. Robert Veatch has proposed an “updating” of the whole brain criteria to allow destruction of the neo-cortex alone to indicate the death of the person. This paper examines Veatch's definition of death, and its application to persons. Veatch's argument that a person is dead when he has irreversibly lost the capacities for conscious experience and social interaction confuses the criteria by which we determine that something is a person with the meaning of being a person. In so doing, it begs an important question: the relationship between the person and his body. Until that issue is resolved, the safer (and therefore morally preferable) course is to use the more stringent whole brain criteria for deciding when death has occurred.

Robert Veatch argues that the death of a person should be equated with the irreversible destruction of the cerebral cortex. This position is here questioned on grounds of tutiorism as well as on the basis of its philosophical assumptions. It is agrued that whole-brain death as an account of personal death is not open to these objections, and is a conception that can satisfy tutiorist standards of safety. The role of the EEG as an indicator of death is discussed.

This was a study of how staff organized behavior around dying children in two pediatric hospitals in a midwestern city. Both hospitals were observed for a period of a month, and eleven cases were compared in terms of staff organization of care and efforts of staff to adjust at death. Staff were seen to negotiate various demands upon care on the basis of whether or not they defined the death of a particular patient to be certain or uncertain. These definitions then served as guides to negotiations. Patients whose death was seen as uncertain had a higher claim of staff time than those whose death was considered certain. The result was that staff had less interaction with, and required less efforts to adjust after, the death of a child whose death was considered certain, and more involvement and more effort to adjust with the death of a child which was not considered certain. These strategies were not seen as preconceived plans of actions that were applied to situations but rather strategies that emerged as staff members attempted to negotiate varying demands upon time.

Very little has been written on the stress of the people working in a palliative care unit for terminally-ill cancer patients. Here are the results of a prospective research conducted at the Notre-Dame Hospital Palliative Care Unit in Montreal, using a self-rated measure of psychological impairment (Langner's scale). This test was applied as soon as the Unit received its first patients. After one year, we found no increase of reported symptoms and we believe these results are attributable to a good preliminary selection and an effective staff support system.

The Death Threat Index and four scales focussed on death concern, anxiety, fear and acceptance were applied to three groups: a death-involved group comprised of funeral directors, mortuary attendants and nurses; an ‘at-risk’ group comprised of parachutists and hang-gliders; and a control group whose contact with death was no more than a past and not recent bereavement. Consideration of the data focussed on the performance of the Index and the four scales in the Australian context, and on the effects of ‘proximity’ to death and dying on scores of the five measures. The Index was found to be problematic, though three of the four scales proved to have satisfactory reliability and validity. There were no significant differences on any measure across the three groups (though trends were in three cases as predicted), and only minor variations on the measures for ad hoc groups defined in terms of choices of options for questions concerning religious belief and belief in an afterlife; while self-report of death orientation was appropriately related to each measure.

This study investigated the death concerns of three groups, 258 participants, in different temporal phases of life. These groups, 86 participants each, were high school students, X̄ 16.3 years, persons in the work force, X̄ 42.5 years, and a retired group, X̄ 68.9 years. The fifteen question survey developed by Epstein was administered individually to each participant [1]. Non parametric analysis indicated a difference existed between the groups on eight of the fifteen items. In the retired group, concern centered around being helpless and dependent. The working group's concern was greater than the student and retired groups for both pain in dying and dying before ready. The students had greater concern over losing persons cared for, death as finality and punishment after death than did the other groups. Combined responses indicate concern over losing persons cared for, making loved ones unhappy, taking a long time to die, and being helpless and dependent are central themes to all groups. Discussions of differences and problems encountered in surveying attitudes toward death provides the basis for future research.