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Death and Dying Dr Michael Harper

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Death is a doorway: a compulsory journey through the eye of a needle. To what? ... Eternity. The thing we have to explore, or we are incomplete. Michael Harper. 18 ... – PowerPoint PPT presentation

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Title: Death and Dying Dr Michael Harper


1
Death and Dying Dr Michael Harper
2
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5
Introduction
  • Death is a doorway a compulsory journey through
    the eye of a needle
  • To what?
  • Who wants to go through the doorway?
  • Who wants to die?

6
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7
  • I am not afraid of death, I just don't want to be
    there when it happens.
  • Woody Allen

8
Introduction Death is…
  • Inevitable, inescapable
  • Usually untimely
  • Uncomfortable at best
  • Undignified

9
Introduction Dying is…
  • Separating
  • Letting go
  • Closing down
  • Departure
  • or
  • Embarkation

10
Reading the Signs A time to heal, and a time to
die
  • Healing
  • Or the ultimate healing?
  • Healing in dying
  • When Im 97…a story

11
Prognosticating
  • Patients perspective How long do you think
    youve got?
  • Discerning deaths approach in terminal illness
    Twycross

12
Age Concerns Good Death Principles To have
  • Control of what happens
  • Control over pain/symptom relief
  • Choice and control over place of death, including
  • Access to hospice-care
  • Control over who shares the end
  • Control through advance directives
  • Knowledge of deaths approach and what to expect
  • Control Dignity and Privacy
  • Access to any required information and expertise
  • Access to any required spiritual or emotional
    support
  • Time to say goodbye, and control over other
    timings
  • Control of DNAR/AND decisions

13
Reactions to terminal illness 5 Stages of
Elisabeth Kubler-Ross
  • Denial and Isolation No, its not me, it cannot
    be me.
  • Anger Why me?
  • Bargaining Ill serve You if You give me more
    time
  • Depression Reactive and Preparatory reality
    and consequence
  • Acceptance A summons has come and I am ready for
    my journey

14
3 Key Areas for the Dying Dying thoughts
  • Failure or fulfilment?
  • Fracture or forgiveness?
  • Flying or falling?

15
Dying needs
  • Love and friendship
  • Acceptance and Respect
  • Control
  • Information the right amount
  • A certain Hope

16
Ministering to the Dying 3 Categories
  • Atheists
  • Believers
  • Agnostics
  • ALL have spiritual issues not all have
    religious.

17
Ministering to the Dying Defining the terms we
use (1)
  • Spiritual
  • To do with transcendence
  • Something beyond ourselves
  • Related to a reaching out, a hunger…
  • Necessarily, mystery involved
  • Purpose, meaning, of my living and my dying
  • Fulfilment the filling full
  • Eternity
  • The thing we have to explore, or we are incomplete

18
Ministering to the Dying Defining the terms we
use (2)
  • Religious
  • Relating to the form of spirituality
  • The practice as opposed to the concept
  • The framework for the spiritual the rooting
  • The corporate as well as the individual
  • The liturgies or forms of worship
  • The rites and rituals
  • Religiousness emanates from spirituality (or
    sometimes upbringing or expectation)

19
Ministering to the Dying Preach the Gospel how?
  • It is as absurd to argue men, as to torture them,
    into believing. John Henry Newman
  • Preach the Gospel at all times and when
    necessary use words. Francis of Assissi
  • 2Ti 42 Preach the word be instant in season
    and out of season reprove, rebuke, exhort with
    all longsuffering and doctrine. St Paul

20
Ministering to the dying
  • Earn ones spurs
  • care
  • love
  • Listen
  • Meet the needs expertise
  • See the openings
  • No force feeding

21
Ministering to the Dying Spiritual needs of the
dying
  • Do patients with life-threatening illness
    consider they experience significant spiritual
    needs?
  • How might those needs vary over the course of the
    illness?
  • How do patients and carers think they might best
    be supported in addressing spiritual issues?
  • Murray, Kendall, Boyd, Worth and Benton Palliat
    Med. 2004 Jan18(1)39-45

22
Ministering to the Dying Spiritual needs
significant
  • 20 patients with inoperable lung cancer
  • 20 patients with end-stage heart failure
  • And their informal carers
  • Conclusions
  • Spiritual issues were significant for many
    patients and carers in last year of life
  • Many health professionals lack time and skill to
    uncover such issues
  • Creating opportunity to discuss spiritual issues
    requires highly developed communication skills
    and adequate time

23
Ministering to the Dying Benefits of Faith
  • McIllmurray, Francis, Harman et al Palliat. Med.
    2003 Jan 17(1)49-54
  • Quaire 354 respondents with Cancer in
    Lancaster
  • Included comprehensive psychosocial needs
    inventory
  • 83 said they had a religious faith
  • These patients were
  • Less reliant on health professionals
  • Had less need for information
  • Attached less importance to maintaining
    independence
  • Needed less help with feelings of guilt
  • Had fewer unmet needs overall

24
Ministering to the Dying Spirituality and
wellbeing in terminally ill hospitalized adults
  • Reed. Res Nurs Health.1987 Oct10(5) 335-44
  • 3 groups of 100 matched (on age, gender,
    education and religious background) adults
  • Terminally ill hospitalized patients have greater
    spiritual perspective than non-terminally ill
    hospitalized or healthy
  • Spiritual perspective in t-i-h-p is significantly
    correlated with well being

25
Ministering to the Dying Effect of spiritual
well-being on end-of-life despair in terminally
ill cancer patients
  • McClain Rosenfeld and Breitbart, Lancet.2003
    May10361(9369)1603-7
  • 160 patients with life expectancy of lt3/12 Bronx
  • Interviewed with a series of standardised
    instruments
  • Significant inverse correlations between
    spiritual well being and desire for hastened
    death, hopelessness and suicidal ideation
  • Spiritual wellbeing was the strongest predictor
    of each outcome variable (more than depression)
  • Depression was highly correlated with desire for
    hastened death in those with low spiritual
    wellbeing, but not in those with high spiritual
    wellbeing

26
Ministering to the Dying Assessing the
influence of spiritual beliefs on wellbeing in
hospitalised orthopaedic patients
  • Clark, Anniemarie (2000) unpublished BSc. Soton.
  • 50 orthopaedic patients recruited interviewed
    pre-op.
  • 35 returned questionnaires at 6 weeks post
    discharge.
  • Curvilinear relationship between spiritual belief
    and well-being.
  • Moderate strength of belief correlated with lower
    well-being than in those with no or high belief
  • At 6 wks quaires showed more anxiety, pain or
    personal growth in the moderate belief group.

27
Ministering to the Dying The role of religion in
recovery of adult burn patients
  • Sherrill and Larson South Med J. 1988 Jul
    81(7)821-5 N Carolina
  • Some such patients have remarkable emotional
    resilience others not. Why?
  • Research shows that when burn patients are given
    opportunity to talk about what helps them cope,
    they frequently credit their religious faith or
    God
  • We emphasize the importance of understanding the
    relationship between patients religious beliefs
    and their ability to deal with the stress of a
    traumatic injury

28
Ministering to the Dying Assessing the influence
of spiritual beliefs on wellbeing in hospitalised
orthopaedic patients
  • Clark, Anniemarie (2000) unpublished BSc. Soton.
  • 50 orthopaedic patients recruited interviewed
    pre-op.
  • 35 returned questionnaires at 6 weeks post
    discharge.
  • Curvilinear relationship between spiritual belief
    and well-being.
  • Moderate strength of belief correlated with lower
    well-being than in those with no or high belief
  • At 6 wks quaires showed more anxiety, pain or
    personal growth in the moderate belief group.

29
Ministering to the Dying Spiritual beliefs may
affect outcome of bereavement
  • Walsh King et al BMJ. 2002 Jun29 324(7353)1551
  • 135 soon to be bereaved in Marie Curie centre
    near London prospective study
  • Standardised assessment at 1,9 and 14 months post
    bereavement
  • NO belief poor resolution of grief
  • LOW belief slow for 9/12 then progressed well
  • HIGH belief progressive healthy resolution of
    grief
  • Conclusion People who profess stronger
    spiritual beliefs seem to resolve their grief
    more rapidly and completely than do those with no
    spiritual belief

30
  • Coleman,Speck Mills Belief and bereavement. A
    prospective study of older bereaved spouses post
    1st anniversary
  • This looked at
  • How well subjects with or without belief
    processed their grief
  • Particularly with regard to development of
    anxiety and depression
  • Utilizing RFH Strengths of Belief scale


31
Results in 2nd year of bereavement
(A) Strong believers and church attenders (32)
with high meaning scores were not depressed
(B) Moderate believers and non-attenders (39)
with low meaning scores showed much more evidence
of depression anxiety
Coleman, McKiernan, Mills Speck. 2002. Quality
in Ageing 3(1)
32
Application of findings
  • Important to assess spiritual need as part of
    bereavement assessment at time of death, pay
    special attention to moderate-weak believers.
  • c/f Walsh, King et al BMJ 2002 absence of
    belief is a risk factor for delayed or
    complicated grief.
  • Important challenge to those involved in funerals
    and follow-up of families post funeral.
  • (32 of sample had physical role limitations)
    Issues re. Faith Communities role towards those
    unable to attend place of worship in later years
    of life. Interviews of elderly revealed feelings
    of abandonment by churches.
  • Especially important for those dying at home with
    less easy access to spiritual care
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