1. Agonal Phase: Greek, "struggle." Gasps, muscle spasms during first moments in which regular heartbeat disintegrates (body can no longer support life).
2. Clinical Death: A short interval follows in which heartbeat, circulation, breathing, and brain functioning stop, but resuscitation is still possible.
3. Mortality: The individual passes into permanent death. Often looks shrunken, not like self.

Brain Dead

• All activity in brain/brain stem stopped
• Irreversible

Persistent Vegetative State

• Activity in cerebral cortex stopped
• Brain Stem still alive

Communication with/care of dying person

• assurance of support
• humane, compassionate, care
• esteem and respect
• candid about certainty of death
• information to make end of life choices

Development of Death Concept

1. Permanence: once a living thing dies, it cannot be brought back to life.
2. Inevitability: all living things eventually die.
3. Cessation: all living functions, including thought, feeling, movement, and bodily processes, cease at death.
4. Applicabiliy: death applies only to living things.
5. Causation: death is caused by a breakdown of bodily functioning.

**Direct communication with sensitivity to age appropriateness and cultural differences.**

Understanding Death

Adolescence 

• Gap between logic/reality.
• High-risk activities/low mortality rate suggest that they do not take death personally.
• Many events in this stage are in contradiction to death.
• Encourage discussions of death concerns.

Understanding Death

Adulthood

• Avoidance - death anxiety, lack of interest.
• Concept no longer vague--looming in the near future.
• More time spent pondering process/circumstances.

Understanding Death

Death Anxiety

• Fear of no longer existing, loss of control, painful death, decay of body, separation from loved ones, and unknown.
• Firmness of beliefs and consistency between beliefs and practices (rather than religion, itself) reduce fear of death.

Self Concept Descriptions/Expectations

Adolescence

• Unification of individual traits into more abstract descriptions--not interconnected, often contradictory.
• Ability to combine traits into organized system
• Emphasis on social values--desire to be liked.

• delay in transition to adulthood

• Possible Selves: future-oriented representations of what one hopes to become and what one is afraid of becoming.
• Possible Selves are the temporal dimension of self-concept--what the individual is striving for and attempting to avoid.
• Self Acceptance: good and bad qualities, positive feelings about self and life
• Autonomy: less concerned about others' expectations and evaluations, more with following self-chosen standards.
• Environmental Mastery: capable of managing complex array of tasks easily and effectively.

Secure/multifaceted self-concept

• Autobiographical selves emphasize coherence/consistency.
• Achievement/Improvement/Attainment--life satisfaction, longer life.

Physical Development: Changes in body size, proportions, appearance, functioning of body systems, perceptual and motor capacities, and physical health.

Cognitive Development: Changes in intellectual abilities, including attention, memory, academic, and everyday knowledge, problem solving, imagination, creativity, and language.

Emotional and Social Development: Changes in emotional communication, self-understanding, knowledge about other people, interpersonal skills, friendships, intimate relationships, and moral reasoning and behavior.