Soc 220 Final

Front 1

Goals of Hospice Care

Back 1

1) to support individuals and families coping with dying 2) enhance quality of life of patient rather than treat/cure 3) aggressively treat and manage all pain 4) care for the entire person 5) confirm's family's sense of individuality/autonomy/self-worth 6) offer support for individual and family memebers facing grief

Front 2

When was the first US hospice founded?

Back 2

1974 in New Haven

Front 3

How many hospice patients are there today?

Back 3

1 million

Front 4

When was hospice medicare made permanent?

Back 4

1986

Front 5

What is holistic care and what are its goals?

Back 5

1) treat dying patient as a whole individual 2) protect the terminally ill from pain 3) control the symptoms and quality of life of terminally ill 4) care-oriented

Front 6

What services are offered by hospice?

Back 6

1) nursing 2) home health aid 3) chaplin 4) medical social workers 5) grief counselors 6) holistic team approach

Front 7

almost 35% of those served by hospice care die in __ days. Why?

Back 7

7 days; because they've been kept in the hospital for so long, and they pretty much have no hope (but on test use the first reason and stuff)

Front 8

what is the average length of hospice care?

Back 8

50.6 days or just under 2 months

Front 9

What are the stages of dying and describe them

Back 9

1) Denial - "not me"; this stage prevents taking care of unfinished business; think of others (I don't know what that means)
2) Anger - "why me"; difficult for nurses to deal with; need to give the patient time to cool off
3) bargaining - "yes me but..."; many ask God to give one more day in exchange for being better
4) depression "yes me"; difficult to witness, cannot cheer patient up, stop talking, may cry often
5) preparatory grief/sadness - separate self from grief; unfinished business; goodbyes to family
6) acceptance - peace; not sad anymore but peaceful, right before death, ready to go

Front 10

What is the definition of a near-death experience?

Back 10

a lucid experience associated with perceived consciousness apart from the body occurring at death or at threatened imminent death; can occur due to physical trauma, flat-lining, attempted suicide, surgeries, high fevers, comas, severe allergic reactions, seizures, etc

Front 11

What are some after-effects of NDEs?

Back 11

1) become nicer: selfish people become nicer; workaholics spend more time with their family; alcoholics become sober; priorities shift to enjoying life 2) become less afraid of death because they know something good is on the other side, universal belief in life after death 3) lack of interest in material success 4) charitable giving

Front 12

Arguments that NDEs actually happen/exist

Back 12

1) people can describe the things they saw when they should have been unconscious 2) commonality of experiences even in different geographic regions 3) coming back with inexplicable knowledge unknown previously 4) common life-changing after-effects

Front 13

Arguments the NDEs don't exist, that people make them up

Back 13

1) it's easy to make one up, especially after hearing another one (explains commonality) 2) pharmacological - drugs given to patients cause hallucinations 3) the dying brain is spasming - it produces hidden memories from childhood, scenes of life, etc because it's starved of oxygen 4) wish fulfillment (I guess that people want to experience it so they do?? 5) culturally conditioned to expect NDEs 6) reliving of the birth experience 7) brain misfirings

Front 14

Common experiences of NDEs

Back 14

1) hearing that you've been pronouced dead 2) feelings of peace and quiet 3) noise - ringings, buzzings 4) dark tunnel with light at the end 5) out-of-body 'floating' experiences where you can see your own body 6) meeting other dead people or religious figures like family of Jesus 7) the "review" of life, flashbacks 8) reaching the border or limit between life and death and having a decision to make/made for you about whether to go back or not 9) reuniting with the physical body 10) telling others about the experience 11) after-effects on life

Front 15

The most common experience:

Back 15

I think in class it was like light at the end of a tunnel

Front 16

Problems with telling others

Back 16

1) many people realize their story sounds crazy 2) some have actually been told they're crazy so no longer talk about it, as a result they felt alone 3) we're very concerned with the scientific aspect of life today 4) something about not realizing NDEs are everywhere (??) 5) doctors dismiss the reports there are subjective and unimportant to the treatment process

Front 17

How did embalming give rise to the increased role of government

Back 17

Steps/Phases: 1) the use of embalming during the Civil War and for Lincoln's body contributed to rise of death industry 2) funeral home became the norm 3) undertaker became funeral director 4) governmental standards of doing death 5) professional standards of conduct etc

Front 18

What are the legal issues before death?

Back 18

Advanced Directives - instructions that a person might make orally or in writing about actions that they would/wouldn't want to be taken if they were incapacitated, 2 types:

1) living will - convey a set of instructions for situations in which an illness or accident left a person unable to make or express such decisions. Specifically, a directive to withhold or withdraw treatments that prolong dying when there is no reasonable expectation of recovery
2) durable power of attorney - legal document where a person authorizes another person to make decisions for them

Front 19

What are the legal issues at the moment of death?

Back 19

1) Definition of "dead" - "an individual who has sustained a) irreversible cessation of circulatory and respiratory functions or b) irreversible cessation of all functions of the entire brain, including the brain system, is dead"
2) determination - deciding whether or not death has occurred, establishing the condition under which it happened, evaluating the nature of the death, and confirming whether further investigation is needed
3) Certification - since the majority of Americans die under the care of a physician, the physician must decide the time and cause of death and record this on a death certificate

Front 20

What are the legal issues after death?

Back 20

1) organ, tissue, and body donation 2) disposition of the body 3) disposition of the property 4) wills and trusts

Front 21

Four Cultural Consquences of the medicalization of death

Back 21

1) Institutionalization of death - in the 1930s people started dying in hospitals; but death in the home still common until the 1950s. Today, 75-78% of ll deaths occur in institutional settings. Many deaths occur after the patient says they no longer want treatment

2) Fear of dying replacing fear of death - basic cultural fears are shifting; maybe the idea that dying is lonely and drawn-out

3) Medicalization of old age: life expectancy is increasing, old age is viewed as a cultural problem, the older people get the more care they need ($$$), fear of old age derives from medicalization of death

4) Death fuels our culture's quest for immortality: some people ACTUALLY think they can live for 200 years ("immortalists") who think in a few decades we'll be able to live forever; but in 1992 people thought we'd have a cure for cancer and AIDS by now

Front 22

how many deaths are controlled by physicians (in a fraction)

Back 22

7/10

Front 23

"life at whatever cost" ethic

Back 23

preoccupation with the quantity, not the quality of life of a patient; sometimes when a patient wants to die the doctor will not allow it

Front 24

"latrogenic" definition

Back 24

Greek for "physician-induced," today this term applies to anyone within the medical institution who has done anything causing death or disease

Front 25

how many deaths do physicians cause a year? (gay liberal question)

Back 25

48,000 Someone should do something!

Front 26

Kubler-Ross "What is it like to be dying?"

Back 26

this reading talks about the difficult and uncomfortable relationship between doctors and dying patients

Front 27

Lofland's six factors that give the dying process its present form

Back 27

1) a high level of medical technology 2) early disease detection 3) a complex definition of death 4) a high prevalence of chronic disease 5) a low incidence of fatal injuries 6) active intervention in the dying process

Front 28

How does Kearl explain the persistence of the death penalty in the US?

Back 28

Only 3 countries have executed more people than us. Why? 1) US has extreme individualism (thus absence of moral code) 2) militaristic history 3) racial and ethnic heterogeneity 4) extreme gap between the 'haves' and the 'have-nots' 5) MOST IMPORTANT: our culture of violence and guns (ex: taming of the wild west?)

Front 29

What are the six societal factors of the modern dying process?

Back 29

1) high level of medical technology 2) early disease detection 3) complex definition of death 4) high prevalence of chronic disease 5) low incidence of fatal injuries 6) active intervention in the dying process

Front 30

Types of interactions that exist between a physician and a dying patient

Back 30

1) Save life at all costs - death is defined as a failure; physician aggressively uses technology to delay the inevitable
2) avoidance/neglect - physician avoids dying patient more and more as they become sicker; when death becomes inevitable, the physician's job is over
3) detached, sympathetic support - physician is responsive to patient's emotional and social needs; talks to dying patient and family; remains professionally detached and relatively emotionally uninvolved

Front 31

4 types of awareness of death regarding patient and staff

Back 31

1) closed awareness - medical staff are aware that patient is dying but patient is not 2) suspected awareness - patient begins to suspect they are dying and question medical staff 3) mutual pretense - patient and staff know the truth but pretend otherwise, charade of denial 4) open awareness - patient and staff know the truth and openly acknowledge it with each other

Front 32

What is egoistic suicide?

Back 32

too little social integration (ex: retired elderly widow)

Front 33

What is altruistic suicide?

Back 33

too much social integration (ex: Japanese kamikaze pilots)

Front 34

What is anomic suicide?

Back 34

too little regulation (ex: someone who used to be rich but is now poor, their social situation and norms have changed and become much less stable)

Front 35

What is fatalistic suicide?

Back 35

too much regulation (ex: slavery, prison)

Front 36

What is anomic suicide?

Back 36

too little regulation (ex: having too little norms, being out of place, no guidelines for behavior)

Front 37

How are William Burke and William Hare asoociated with the Anatomy Acts in the 1830s?

Back 37

Anatomy Acts - that no one can sell or purchase a dead body
William Burke and William Hare went on a killing spree to take advantage of the money being offered for dead bodies. We know of at least 20 people they killed. But they were caught when some medical students were working on the dead body of a local prostitute they all knew (Mary). Most of the students were familiar with her and knew her to be in generally good health; this case caused an uproar and Anatomy Acts of 1832 came about because of it

Front 38

How have scientific advances from the use of cadavers changed the historically negative image associated with death into a more positive light?

Back 38

Using dead bodies is central to doctors learning to fix and extend life - thus now it's needed, positive; also human cadavers needed for bone screws and other stuff
So politicians want to increase incentives for donating body for medical use

Front 39

Give and example of medical cannibalism from Mary Roach's "Stiff"

Back 39

"mellified man:" made from dead human remains steeped in honey and administered topically and orally as medicine; drinking human urine from a public latrine to treat diabetes; treatment of anthrax and plague with human excrement (for the phosphorus); digestion of human fat to treat rheumatism, joint pain and "falling-away limbs"

Front 40

8 uses of cadavers that benefit mankind

Back 40

1) medical research 2) organ donation 3) human crash test dummies 4) surgery practice 5) testing effects of weapons 6) crucifixion experiments (questionable but interesting) 7) turning cadavers into compost (rather than cremating them) and using them to grow trees, also good for the carbon cycle 8) use in forensics (ex: studying decomposition in different situations)

Front 41

How human remains are used to explain plane crashes

Back 41

"by studying victims wounds - the type, severity, which side of the body they are on - an injury analyst can begin to piece together the horrible unfolding of events"
for example: intense heat may produce intracranial steam resulting in blowout of the cranial vault, simulating injuries from impact; injuries can tell the locations of the bomb on the plane; people close to explosions break up, so severity of the injury can tell you their location in relation to explosives; the number and the trajectory of foreign bodies embedded corpses; chemical burns only on the back indicate that a body was floating and then was covered by burning fuel; looking at orientation of thermal burns could trace the pattern of fire; extreme internal trauma indicates "extreme water impact"

Front 42

Define euthanasia

Back 42

Active Voluntary Euthanasia: where a doctor actually does whatever causes death (ex: injects lethal substance); today, it's the administration of death to a dying person, the hastening ot the advancing of death

Front 43

physician-assisted suicide

Back 43

a doctor provides the means for a person to kill themselves (or tells them how) but the physician doesn't actually administer death; ex: the doctor says "be careful to take x amount of y, z amount of y is fatal"

Front 44

What is voluntary euthanasia?

Back 44

when a patient asks for their life to be taken, or for life-saving intervention be stopped, with full knowledge that they will die

Front 45

What is non-voluntary euthanasia?

Back 45

when a patient's life is ended without requesting to die or expressing a wish to live

Front 46

What is involuntary euthanasia?

Back 46

When a patient's life is ended but they expressed that they did not want to die = murder

Front 47

What is active euthanasia?

Back 47

taking the necessary measures to actually kill the patient. This includes lethal injections or overdosing on pain killers

Front 48

What is passive euthanasia?

Back 48

withdrawaing some sort of medical treatment that will result in the patient's death, such as turning off a respirator. It also includes "do not resuscitate" orders

Front 49

What is passive-voluntary euthanasia?

Back 49

a patient decides they want to forgo treatment and just die from their disease or disorder

Front 50

What is active-involuntary euthanasia?

Back 50

a patient is killed by doctors using a method such as lethal injection after the patient has explicitly stated that they want to live

Front 51

What is important about memory in burial?

Back 51

both the gravestone and the cemetery are used to trigger memories; people are allowed one last look at the body before its closed

Front 52

The importance of place in burial

Back 52

localized to a cemetery or other burial areas (ex: church or tomb), and even further to plot of land around gravestone

Front 53

The importance of time in burial

Back 53

time is stopped for the dead after burial, and the living remember them forever as they were at that point. Time is also represented by the dates on the grave marker

Front 54

cremation v. burial

Back 54

cremation doesn't focus on time, place, and memory like burials do

Front 55

memory and cremation

Back 55

because there is no gravestone, other forms of memorials are needed; this has led to online memorials and physical objects for remembrance

Front 56

place and cremation

Back 56

since they're ashes there's no place, only where the ashes were released

Front 57

time and cremation

Back 57

see burial and time minus the gravestone bit

Front 58

woodland burial

Back 58

similar to normal burials, but use trees or natural markers instead of gravestone

Front 59

memory, time, and place for woodland burial

Back 59

whole woods trigger memory instead of small plot, as well as tree marker; the whole woods is the place; time is same as normal burials

Front 60

"technological imperative"

Back 60

"If we have the technology to do something, we feel that we should do it;" medicine always subject to this; advanced directives and living wills intended to free people from this; medical technology is also reason for euthanasia

Front 61

What are arguments for euthanasia?

Back 61

1) prevents suffering 2) enhances liberty, people free to live as well as not live 3) improve one's quality of life

Front 62

What are arguments against euthanasia?

Back 62

1) preservation of life - do we really want to involve the state in this? 2) medicine is uncertain, we never truly know how much longer someone will live, whether they're terminal 3) it undermines patient/physician trust - do you want a doctor to suggest killing you? 4) "slippery slope to auschwitz" argument

Front 63

Who is Dr. Death in the US?

Back 63

Dr. Jack Kevorkian, who has assisted about 20 suicides

Front 64

What is the only state to allow some form of euthanasia?

Back 64

Oregon

Front 65

What is the difference between mercy killing and euthanasia?

Back 65

Mercy killing is killing someone with a non-medical type of death committed with a compassionate motive, while euthanasia is the "administration of death to a dying person"

Front 66

What are the physical ramifications of grieving, according to Moller?

Back 66

shock, numbness, stress, anger, anxiety, sadness, and despair