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Overview Lecture 12 Death and Dying

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Overview Lecture 12 Death and Dying 1. Defining Death (Technical and Medical Aspects) 2. Cultural Perspectives 3. Dying Process Trajectories Stages – PowerPoint PPT presentation

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Title: Overview Lecture 12 Death and Dying


1
Overview Lecture 12Death and Dying
  • 1. Defining Death (Technical and Medical Aspects)
  • 2. Cultural Perspectives
  • 3. Dying Process
  • Trajectories
  • Stages
  • End of Life Issues
  • 4. Bereavement

2
Death
  • Involves a person
  • Involves those close to the person
  • Involves a society

3

Definition of death (Technical)
  • Irreversible cessation of circulatory and
    respiratory functions
  • All structures of brain have ceased to function

Complicated by
  • Subcortical areas intact

Permanent vegetative state
  • Lack of conscious awareness

4
Medical Aspects of Death
Physical symptoms
  • Asleep most of time
  • Disoriented
  • Irregular breathing
  • Hallucinations
  • Reduced vision
  • Changes in autonomic bodily functions
  • Anorexia-cachexia syndrome- loss of appetite and
    muscle atrophy

Can also be period of emotional and spiritual
growth
5
Medical Aspects of Death
Medical Procedures After Death
  • Cause of death coded by classification system
  • Autopsy may be performed to determine cause
  • Medicolegal autopsy in forensic or doubtful cases

6
Cultural Perspectives
Death ethos
  • Prevailing philosophy of death
  • Can be inferred from cultural practices

7
Cultural Perspectives
History of Attitudes in Western Society (Aries)
Tame death
End of self
Remote death
Beautiful death
Medica- lization
Early middle ages
Later middle ages
1700s
1800s
1950s
8
Cultural Perspectives
Contemporary Attitudes
  • Disasters
  • Death of famous person
  • People with terminal illness
  • Sentimental deaths

Media images
Religious convictions
  • Belief in afterlife
  • Test of faith
  • Death as blessed relief

9
Cultural Perspectives
Contemporary Attitudes
Changes in health care
  • Death associated with later life
  • Has become invisible
  • People rely on media images
  • Fear of aging itself
  • Fear of loss of capacity
  • Fear of social death

Ageism
Terror management theory
Death with Dignity
  • Physician-assisted suicide
  • Euthanasia

10
The Dying Process
Dying process

Organism loses viability
Dying trajectory
  • Rate of decline of functioning
  • Characterized by duration and shape

11
The Dying Process
Dying Trajectories
Sudden Death from an Unexpected Cause
12
The Dying Process
Dying Trajectories
Steady Decline from a Progressive Terminal
Disease
13
The Dying Process
Dying Trajectories
Advanced Illness Marked by Slow Decline with
Periodic Crises
Sudden death
14
The Dying Process Stages of Dying
Kübler- Ross 5 Stages of Dying
Refusal to accept diagnosis
Denial
Anger
Feeling cheated or robbed
Bargaining
Attempt to strike a deal with God
Sense of loss when death seen as inevitable
Depression
Acceptance
Finality of disease is no longer fought
Acceptance requires ability to talk openly about
death
15
The Dying Process Stages of Dying
Criticisms of Kübler- Ross
  • Five stages have become interpreted as steps that
    MUST be followed
  • Theory written about relatively young patients
  • Ignores other emotions that might be experienced
  • Researchers unable to establish existence of the
    stages

16
The Dying Process Stages of Dying
Psychological Perspectives on the Dying Process
  • Attempt to understand past life patterns
  • Awareness of finitude
  • Legitimization of biography

Processes described by Marshall
  • Time of taking stock
  • May occur at any age

Life review (Butler)
17
The Dying Process Issues in End-of-Life Care
Advance Directives and Patient Self-Determination
Living Will or Advance Directive (AD)
  • States wishes should person require medical or
    surgical intervention to prolong life

Alberta The Personal Directives Act
18
The Dying Process Issues in End-of-Life Care
Research on the End of Life The SUPPORT Study
  • 1989-91 and 1992-94 enrolled 9105 patients in
    final stages of terminal illness
  • Impact of PSDA on treatment of the dying
  • 1. Where deaths occurred
  • 2. Characteristics of dying persons
  • 3. Whether care consistent with preferences
  • 4. Effectiveness of the PSDA and investigation of
    DNR (Do Not Resuscitate)

Results
19
The Dying Process Issues in End-of-Life Care
Findings from the SUPPORT Study
  • 1. Majority preferred to die at home but most
    died in hospital
  • 2. Dying patients suffered from pain, difficulty
    breathing, and confusion

20
The Dying Process Issues in End-of-Life Care
Findings from the SUPPORT Study
  • 3. Majority preferred palliative care but
    instead were given life-sustaining- known as
    overtreatment
  • 4. PSDA had no effect on health care workers
    talking to patients about their preferences

DNRs more likely to be given to older patients
regardless of their preferences
21
The Dying Process Issues in End-of-Life Care
Suggestions for End-of-Life Care
Palliative care focusing on needs of dying
patients
Hospice
Desires of dying patients
  • Obtaining adequate pain control
  • Avoiding extended period of dying
  • Achieving sense of personal control
  • Relieving burden on others

22
The Dying Process Issues in End-of-Life Care
Suggestions for End-of-Life Care
Guidelines to establish quality care
  • Provide patients with chance to discuss care
  • Attempt to provide comfort and respect patients
    wishes
  • Assure dignity
  • Attend to individuals goals
  • Minimize burden on family

23
The Dying Process Issues in End-of-Life Care
Suggestions for End-of-Life Care
Care at End of Life
  • Attend to practical needs of patients
  • Assist in obtaining home health care
  • Make changes in home to accommodate patient
  • Involve others in social network

Practical needs
  • Patient feels cared for emotionally

24
Bereavement Death of a Spouse
Problems of Widowhood
  • Loss of attachment figure
  • Changes in plans
  • Construction of new identity
  • Loneliness
  • Sensing or hallucinating the deceased

Symptoms may persist for as long as 2-3 years
25
Bereavement Death of a Spouse
Adjustment to widowhood
  • Expectedness of death
  • Age of widow
  • Length of caregiving time
  • Gender
  • Social support
  • Practical support

Adjustment
26
Bereavement Death of Other Family Members
Death of Adult Child
  • Increased risk of depression, guilt and health
    complaints
  • Feelings of helplessness, insecurity, and
    isolation
  • Loss of identity as parent
  • Loss of support from child

Death of Grandchild
  • Shared grief with childs parents
  • Guilt over being alive
  • Worse for grandparents involved in raising child
  • May be relieved somewhat by support

27
Bereavement Death of Other Family Members
Death of Parent
  • More normative experience
  • May cause psychological distress and
    deterioration of health status
  • Increased marital conflict
  • More upsetting for daughters than for sons

Death of Siblings and Friends
  • Additional sources of distress
  • Death of brother can cause financial problems
  • Loss of friends may lead to greater closeness
    with remaining ones

28
Bereavement Theories of Bereavement
Previous theories
  • Necessary to work through grief and move on

Current theories
  • Expressions of attachment are potentially adaptive

Sense of spouses presence Maintain possessions
for symbolic value Keep memories alive
Older adults seem able to integrate loss
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