Death & Dying

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Elisabeth Kubler-Ross

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her book On Death and Dying, 1969 helped create demand for a better way to care for dying patients. Developed 5 stages of coping--denial, anger, bargaining, depression and acceptance.

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Cicely Saunders

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Care of the Dying, 1959--hospice pioneer established St. Christopher's Hospice in London in 1967

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Thanatology

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study of death; integrate issues associated with study of life with death included.

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death anxiety

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a cluster of death attitudes characterized by fear, threat, unease, discomfort and similar negative emotional reactions.

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el Dia de los Muertos

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day of the dead in Mexican Culture

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autopsy

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detailed medical examination of a body after death to determine cause of death or to investigate the nature of changes caused by a disease.
Legal- missing person ID, homicide, malpractice.
Benefit-confirm diagnoses, train doctors, conduct research

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terror management theory (Becker)

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Ernest Becker-insights as to how do people cope with an awareness of death.Four strands of emphasis: 1)world is terrifying, 2) need to control our anxiety, to deny the terror of death, 3) terror of death is so overwhelming we keep it unconscious, 4)psychologically perceive every threat as a life and death struggle against evil

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life expectancy

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the average number of years a specified group of infants would live if they were to experience throughout their lives the age-specific death rates prevailing in their birth year.

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mortality rates

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the number of individuals dying per 1000 population in a given year.

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causes of death

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infectious disease, chronic illness, accident, war, homicide, suicide

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Where do you get Ideas about death?

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religion, media, experiences and age

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ADEC

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Association for Death Education and Counseling

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religion

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morality function provides a framwork for death, who am I and why am I here

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Empirical and Observable

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1) universal-everything dies
2) all inclusive-no exceptions
3) inevitable-will happen eventually
4) Irreversible-final
5) non-functionality-no longer able to function in society
6) personal mortality-oh,oh me too

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necromancy

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corpse prophesy or trance state, spirit of dead people enter the shaman's body.

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death

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irreversible loss of:
flow of vital fluids
soul from the body
capacity for bodily integration
consciousness and social interaction.

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embalming

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temporarily preserving human remains to forestall decomposition and to make them suitable for public display at a funeral.

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components of death system

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people, places, times, objects, and symbols

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people

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funeral director, florist, caterers, life insurance agent, probate lawyers, hospice caretaker, coroner...

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places

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cemetery, funeral home, church, temple, hospital, nursing home, hospice facility, battlefields, murder and accident site

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times

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memorial day, veteran day, day of the dead, good friday, all saints day, 9/11, WWII...

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objects

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hearse, casket, newspaper death notice, headstone, noose, skull & crossbone, color black...

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symbols

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religious, black wreath, stop sign, black band

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Functions of the Death System

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1) warn and protect, 2) prevent death, 3) care for the dying, 4) dispose of the dead, 5) social consolidation 6) make sense of death, 7) killing

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Warnings and predictions-natural disaster warnings, FDA, medical diagnosis
Preventing death-public service announcements, vaccinations, feed the children, etc
Caring for dying-hospice, family, staff, counselors
Disposing of the dead-burial, cremation, service, ambulance
Social consolidation after death-memorial, family gathering
Making sense of death-life's meaning, celebrations ie memorial/veterans day
Killing-death penalty, war, euthanasia

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Philosophy of existentialism

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the meaningless of life

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DNR

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Do Not Resuscitate

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Homicide

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the killing of one human being by another--is separated into two main categories
1)criminal: murder and manslaughter
2)non-criminal: self-defense, war

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Modern health care

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more technology and less personal attention

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Team approach

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both palliative and hospice care requires team approach of physicians, nurses, social workers, pharmacist, physical therapists, chaplains, home health aides a volunteers and family.

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Palliative care

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main aim is to control pain and other physical distress

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Hospice

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oriented toward the need of the dying and their families; a program rather than a place.

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Nursing home/ Skilled nursing facility

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convalescent and extended care facilities, providing long term residential care for the chronically ill whose illness does not require intensive care.

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Home care

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medically supervised care provided in person's home.

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Health care triangle

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patient, staff, and institution

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Caregiver/patient relationship

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implying mutuality of interests

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NHPCO

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National Hospice and Palliative Care Organization--goal is healing rather than cure.

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Death certificate

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constitutes legal proof of death and are required by all jurisdictions of US. Includes, mode of death, cause of death.

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Disclosure of life-threatening diagnosis

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most people want to be told if terminally ill.

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Modes of death

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accidental, suicidal, homicidal, and natural

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Death notification

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delivered in person medical staff, in field notification by government official, police officer, firefighter, EMT or coroner's staff. Goes from the inner circle to the outer circle.

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Informed consent

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a contract between patient and physician whereby each party agrees to perform certain acts intended to achieve the desired results. Patient must be competent, free to give consent, and have adequate understanding.

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End of life decisions--Living Will

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Informed consent
Withhold or withdraw treatment
Nutrition and hydration
DNR Do not resuscitate

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Assisted suicide

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actions by which an individual helps another person die upon their wanting to do so—a concept almost always reserved for people who are terminally ill.

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Suicide

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the act of taking one's own life voluntarily and intentionally.

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Advanced directives

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any statement made by a competent person about choices for medical treatment should that person become unable to communicate or make a decision in the future.

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Probate

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a period of time which allows for the deceased's affairs to be resolved, debts and taxes paid, and arrangements made to receive funds that were owed to the deceased.

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Social death

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for some people dying begins as soon as a terminal diagnosis is made; for some it is the beginning of the fight.

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Phases of Illness

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Acute phase-initiated by diagnosis
Chronic phase-living with the disease
Terminal phase-coping with impending death

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Cancer therapies

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Surgery-removing malignant tumor and adjacent healthy tissues
Radiation-use ionizing radiation to destroy cells that divide rapidly.
Chemotherapy-use of toxic drugs to kill cancer cells
Alternative-psychotherapy, meditation, imagery, hypnosis and biofeedback, yoga, music therapy and prayer.
Unorthodox- medicinal plants.

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Awareness of dying

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Closed awareness--dying person not aware have terminal illness.
Suspected awareness--sick person suspects something wrong but not confirmed
Mutual pretense--I know and you know but we're not going to talk about it.
Open awareness--acknowledged, discussed amongst all involved.

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Concept of hope

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Hope for a cure
Hope for more time
Hope for pain free death
Hope for having lived a meaningful life

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Ways of coping with dying:

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Physical--satisfying bodily needs and minimizing physical distress
Psychological--maximizing security, autonomy, and richness in living
Social--sustaining and enhancing interpersonal relationships and addressing social implications of dying.
Spiritual--identifying, developing, or reaffirming sources of spiritual energy or meaning, and fostering hope.

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Patterns of coping

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Retreat and conservation of energy
Exclusion from the threat of death
Attempting to master or control threat of death

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Two types of pain

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Acute pain-temporary
Chronic pain-constant last longer than 3-6 months

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Pain management

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acute or chronic pain; most common sign of terminal illness.
Stepwise approach:
Non-opiods, such as Tylenol or Ibuprohin
Opiods--epidural or intraspinal drug delivery of morphine and codeine

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Disposal of body

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burial, cremation or donate to science; sanitation main reason regulation

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Funeral

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Acknowledges and commemorates a person's death
Provides a setting for disposal of body
Assist in reorienting bereaved to their lives
Demonstrates economic and social obligations between the bereaved and their social world

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Elements of Funeral Ritual

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Deathwatch-bedside vigil
Preparation of deceased-embalming, cleansing
Wake-visitation hours
Funeral-eulogies, sermon, church service
Procession-convey corpse to resting place
Committal-held at grave site
Disposition of corpse-burial or cremation

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Psychosocial Aspects of Last Rites

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Death notification-from inner circle to outer; phone calls, obits, death notices
Mutual support-primarily family and friends; food, help with children
Impetus for coping with loss--burying mementos with corpse

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Cremation

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involves subjecting a body to intense heat, thereby reducing its organic components to a mineralized skeleton.

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Burial

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encompasses a wide range of practices. It may involve digging a single grave in the soil, or it may refer to entombment in a mausoleum.

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Bereavement

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the objective event of loss that disrupts our lives. (the event)

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Grief

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is the reaction to the loss. It encompasses thoughts and feelings, as well as physical, behavioral and spiritual response.

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Mourning

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closely related to grief, but rather the process by which the bereaved person integrates the loss into life

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Signs of Death

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Brain death--is the irreversible end of all brain activity necessary to sustain life
Clinical death--cessation of heartbeat
Cellular death--breakdown of metabolic processes resulting in complete nonfunctionality