In class on Tuesday, we decide to reschedule the date for the last test.
The final test over Chapters 14,15,16,17, & 18 has been moved to Tuesday, July 7!
Tonight, we will have two student presentations [Suicide & Cultural Differences on Death & Dying] and we will cover the final chapter in the textbook.
Thursday, July 2, 2009
Lecture Notes/Outine: Chapter 18 - Death & Dying
Chapter 18
Death & Dying
Thoughts & Fears about Death - “The irrevocable cessation of life functions”
Denial:
Historically: people were much more familiar with death; saw it more realistically in some ways; as a “Natural Event”. Family & friends cared for the
Modern times: technological death; invisible death – hospitals, medical caregivers, morticians
1969 study (Kubler-Ross) – once Dx of terminal illness made, drs. & nurses paid less attn. to patients; talked to them less, provided only most necessary contact, usually did not tell pt. of terminal Dx, discouraged pt. from talking about feelings of impending death.
1998 study (Kastenbaum) – showed this situation changed. All nursing programs & many programs for doctors include elements of “death education” emphasizing “pt.’s right to know”. “Good outcomes”: 1.) death with dignity, 2.) chance to express final sentiments to family & friends, 3.) faces death in manner consistent with values & lifestyle
Preoccupation:
Personal, religious & cultural meanings of death are major determinants of anxiety about death. Personal beliefs & convictions are most important.
Psychoanalytic theory says fear & anxiety about death are “normal”; this is not necessarily true
What research shows:
Managing the anxiety associated with one’s own death
1. Our biologically motivated desire for life is in direct contradiction with our knowledge that we will die at some point
2. “Terror Management theory” - We cope with the terror of death by developing our self esteem and becoming competent, attached, and important to other people
3. Death can be a force that encourages us to move forward in our lives
· Older people are actually less likely to be anxious & fearful of death than younger people
· 1970 study (Jeffers & Verwoerdt) – only 10% of older adults said they were afraid to die. However many said they were afraid of a prolonged, painful death.
What would you do if you had only 6 mos. to live? (Kalish 1987)
· Younger adults: Travel, fulfill dreams, do things haven’t been able to do, but always wanted
· Older adults: contemplation, meditation, inner focused activities, spend time with family & close friends
· Although older people may think about death more often, they are generally not anxious or fearful of it & often surprisingly calm about it.
· People with strong religious convictions & personal believes & convictions generally have less depression & anxiety about death – afterlife; transition, rather than end –BUT – personal believes & convictions may be more important
· Those who do not believe in afterlife may be terrified by approaching death but not necessarily.
People who find meaning & purpose in life incorporate the knowledge that death as a natural part of life into their “meaning & purpose”. Death is seen as natural & even peaceful.
· Anxiety about impending death changes over time. People diagnosed with possibly fatal disease often show marked anxiety initially but, anxiety is gradually reduced over several weeks & months. (Belsky, 1984)
Confronting One’s Own Death
The Final Stage of development: Young, healthy people can “put off” thoughts of death. But, in cases of serious illness & in old age thoughts of death are unavoidable. Dealing with one’s own death becomes a developmental task.
Time allows one to adjust to the idea of death. Those not facing imminent death often spend time adjusting to the idea by reviewing their life… reliving events… searching for self-awareness & an understanding of their life.
Quote from textbook: “…this life review is a very important step in the lifelong growth of the individual. At no other time is there as strong a force toward self-awareness as in older adulthood. The process often leads to real personality growth; individuals resolve old conflicts, reestablish meaning in life, and even discover new things about themselves (Butler, 1968, 1980 – 1981). Only in coping with the reality of approaching death can we make crucial decisions about what is important and who we really are. Death lends the necessary perspective (Kubler-Ross, 1975). Paradoxically, then, dying can be ‘a process of re-commitment to life’ (Imara, 1975).” –page 634?
[slide #2] Stages of Adjustment: study of people who had just been told they had a terminal illness and a short time to live. (Kubler-Ross, 1969)
· Denial
· Anger, resentment, envy
· Bargaining
· Depression
· Acceptance – Can we accept/ be prepared when were young?
Not everyone goes through these stages and most do not necessarily go through them in a particular order. We should, therefore, not assume what person is experiencing or “force” them into a set pattern of stages.
Kastenbaughm (1998, 2000) - …allow people to follow their own path to dying…give the opportunity, if they want, to talk about their feelings, what they are experiencing, concerns, past experiences, conflicts that are troubling them, have questions answered, get their lives in order, see relatives and friends, to forgive and ask forgiveness.
6 Practical suggestions for care-givers: Page 636, fig. 19.1
Alternative directions, paths & courses
The particular course of a disease affects one’s reaction to death….
How much pain, suffering, & medical intervention are experienced?
“Time left to live” issue: How much time is there to adjust & accept?
· Idea of Trajectories
o Think about the meaning of the word…what to expect:
§ Ideal? – Live healthy live to 85+, put affairs in order, die suddenly in sleep without pain? Most would prefer a sudden death, especially the young.
o How much control over that trajectory does the individual have? Can they control the level of Tx. to affect it?
· The case of AIDS:
o emotionally loaded illness
o victims often young
o long, slow death process
o often very incapacitating
o exhausting on care-givers
· Suicide [Slide #3]
o Rate among older people, especially men [4X higher than women].
o Most suicides are people over 45 of those, most are over 65.\
o the rate (%) for men continues to increase beyong age 80
o “Passive” Suicide
§ [slide #4] Submissive Death: “Surrendering to death”; “Just letting yourself die”
§ [slide #5] Suicidal Erosion: “Killing Myself By Degree”
o [slide #6] ASSISTED SUICIDE – providing people with a terminal illness the means to end their own life, such as by allowing them to self administer a lethal drug
o Euthanasia [slide #7]
§ Active - taking steps to bring about another person’s death, specifically in cases of terminal illness
§ Passive– withholding or disconnecting life sustaining equipment so that death can occur naturally
· Is there a Humane Death? [slide #8]
o The Right To Die – Death is a right to be exercised at the individual’s discretion
o Hospice – a philosophy of care designed to help people with a terminal illness live out their days as fully and independently as possible by giving the needed care, counseling, support, pain management, and other assistance for people with a terminal illness and their families
v [slide #9 ] PALLIATIVE CARE – care that attempts to prevent or relieve the emotional distress and physical difficulties associated with a life threatening illness
v END OF LIFE CARE – care that specifically addresses the concerns and the circumstances associated with impending death
v [slide #10] Living Wills – “A Formal Request”: a legal directive signed by a person indicating that the person does not wish that extraordinary measures be employed to sustain life in case of terminal illness
v Medical Power of Attorney -
Grief & Bereavement [slide #11]
GRIEF OF WORK –dealing with the emotional reactions to the loss of a loved one
Anticipatory grief - grief experienced as people emotionally prepare themselves for the death of a loved one, as in cases of prolonged terminal illness
BEREAVEMENT OVERLOAD – a stress reaction experienced by people who lose several friends or loved ones during a short period of time; often characterized by depression
CHRONIC GRIEF – an ingrained, pathological mourning process in which the person never overcomes the grief
Bereavement Across Cultures
o Western cultures think proper grieving occurs by recovering and returning to normal as quickly as possible
o Other cultures stress maintaining a bond with the deceased
o Todos Santos: The Day of the Dead
Rituals and customs
o Funerals and memorial services are common and can impart a sense of order, decorum, and continuity
o Survivors take comfort from the rituals
o Rituals make the end official and are helpful in dealing with grief – provides “closure”
Death of a Child
o Caregivers and loved ones play a major role in managing the circumstances surrounding the death
o [slide #12] Death rates for infants and children have fallen dramatically
[slide #13] Grieving when a child dies
o Grieving is particularly intense
o Grieving children may not have an understanding of death and make the questions difficult to address
The Circle comes to Closure [Slide 14]
Each person’s “Life Cycle” is entrenched in biological & cultural contexts. They interact through out the life cycle, including the stage of life called death.
Death and the individual’s understanding & perception of it often gives new meaning to life [the cancer survivor’s reaction].
Death & Dying
Thoughts & Fears about Death - “The irrevocable cessation of life functions”
Denial:
Historically: people were much more familiar with death; saw it more realistically in some ways; as a “Natural Event”. Family & friends cared for the
Modern times: technological death; invisible death – hospitals, medical caregivers, morticians
1969 study (Kubler-Ross) – once Dx of terminal illness made, drs. & nurses paid less attn. to patients; talked to them less, provided only most necessary contact, usually did not tell pt. of terminal Dx, discouraged pt. from talking about feelings of impending death.
1998 study (Kastenbaum) – showed this situation changed. All nursing programs & many programs for doctors include elements of “death education” emphasizing “pt.’s right to know”. “Good outcomes”: 1.) death with dignity, 2.) chance to express final sentiments to family & friends, 3.) faces death in manner consistent with values & lifestyle
Preoccupation:
Personal, religious & cultural meanings of death are major determinants of anxiety about death. Personal beliefs & convictions are most important.
Psychoanalytic theory says fear & anxiety about death are “normal”; this is not necessarily true
What research shows:
Managing the anxiety associated with one’s own death
1. Our biologically motivated desire for life is in direct contradiction with our knowledge that we will die at some point
2. “Terror Management theory” - We cope with the terror of death by developing our self esteem and becoming competent, attached, and important to other people
3. Death can be a force that encourages us to move forward in our lives
· Older people are actually less likely to be anxious & fearful of death than younger people
· 1970 study (Jeffers & Verwoerdt) – only 10% of older adults said they were afraid to die. However many said they were afraid of a prolonged, painful death.
What would you do if you had only 6 mos. to live? (Kalish 1987)
· Younger adults: Travel, fulfill dreams, do things haven’t been able to do, but always wanted
· Older adults: contemplation, meditation, inner focused activities, spend time with family & close friends
· Although older people may think about death more often, they are generally not anxious or fearful of it & often surprisingly calm about it.
· People with strong religious convictions & personal believes & convictions generally have less depression & anxiety about death – afterlife; transition, rather than end –BUT – personal believes & convictions may be more important
· Those who do not believe in afterlife may be terrified by approaching death but not necessarily.
People who find meaning & purpose in life incorporate the knowledge that death as a natural part of life into their “meaning & purpose”. Death is seen as natural & even peaceful.
· Anxiety about impending death changes over time. People diagnosed with possibly fatal disease often show marked anxiety initially but, anxiety is gradually reduced over several weeks & months. (Belsky, 1984)
Confronting One’s Own Death
The Final Stage of development: Young, healthy people can “put off” thoughts of death. But, in cases of serious illness & in old age thoughts of death are unavoidable. Dealing with one’s own death becomes a developmental task.
Time allows one to adjust to the idea of death. Those not facing imminent death often spend time adjusting to the idea by reviewing their life… reliving events… searching for self-awareness & an understanding of their life.
Quote from textbook: “…this life review is a very important step in the lifelong growth of the individual. At no other time is there as strong a force toward self-awareness as in older adulthood. The process often leads to real personality growth; individuals resolve old conflicts, reestablish meaning in life, and even discover new things about themselves (Butler, 1968, 1980 – 1981). Only in coping with the reality of approaching death can we make crucial decisions about what is important and who we really are. Death lends the necessary perspective (Kubler-Ross, 1975). Paradoxically, then, dying can be ‘a process of re-commitment to life’ (Imara, 1975).” –page 634?
[slide #2] Stages of Adjustment: study of people who had just been told they had a terminal illness and a short time to live. (Kubler-Ross, 1969)
· Denial
· Anger, resentment, envy
· Bargaining
· Depression
· Acceptance – Can we accept/ be prepared when were young?
Not everyone goes through these stages and most do not necessarily go through them in a particular order. We should, therefore, not assume what person is experiencing or “force” them into a set pattern of stages.
Kastenbaughm (1998, 2000) - …allow people to follow their own path to dying…give the opportunity, if they want, to talk about their feelings, what they are experiencing, concerns, past experiences, conflicts that are troubling them, have questions answered, get their lives in order, see relatives and friends, to forgive and ask forgiveness.
6 Practical suggestions for care-givers: Page 636, fig. 19.1
Alternative directions, paths & courses
The particular course of a disease affects one’s reaction to death….
How much pain, suffering, & medical intervention are experienced?
“Time left to live” issue: How much time is there to adjust & accept?
· Idea of Trajectories
o Think about the meaning of the word…what to expect:
§ Ideal? – Live healthy live to 85+, put affairs in order, die suddenly in sleep without pain? Most would prefer a sudden death, especially the young.
o How much control over that trajectory does the individual have? Can they control the level of Tx. to affect it?
· The case of AIDS:
o emotionally loaded illness
o victims often young
o long, slow death process
o often very incapacitating
o exhausting on care-givers
· Suicide [Slide #3]
o Rate among older people, especially men [4X higher than women].
o Most suicides are people over 45 of those, most are over 65.\
o the rate (%) for men continues to increase beyong age 80
o “Passive” Suicide
§ [slide #4] Submissive Death: “Surrendering to death”; “Just letting yourself die”
§ [slide #5] Suicidal Erosion: “Killing Myself By Degree”
o [slide #6] ASSISTED SUICIDE – providing people with a terminal illness the means to end their own life, such as by allowing them to self administer a lethal drug
o Euthanasia [slide #7]
§ Active - taking steps to bring about another person’s death, specifically in cases of terminal illness
§ Passive– withholding or disconnecting life sustaining equipment so that death can occur naturally
· Is there a Humane Death? [slide #8]
o The Right To Die – Death is a right to be exercised at the individual’s discretion
o Hospice – a philosophy of care designed to help people with a terminal illness live out their days as fully and independently as possible by giving the needed care, counseling, support, pain management, and other assistance for people with a terminal illness and their families
v [slide #9 ] PALLIATIVE CARE – care that attempts to prevent or relieve the emotional distress and physical difficulties associated with a life threatening illness
v END OF LIFE CARE – care that specifically addresses the concerns and the circumstances associated with impending death
v [slide #10] Living Wills – “A Formal Request”: a legal directive signed by a person indicating that the person does not wish that extraordinary measures be employed to sustain life in case of terminal illness
v Medical Power of Attorney -
Grief & Bereavement [slide #11]
GRIEF OF WORK –dealing with the emotional reactions to the loss of a loved one
Anticipatory grief - grief experienced as people emotionally prepare themselves for the death of a loved one, as in cases of prolonged terminal illness
BEREAVEMENT OVERLOAD – a stress reaction experienced by people who lose several friends or loved ones during a short period of time; often characterized by depression
CHRONIC GRIEF – an ingrained, pathological mourning process in which the person never overcomes the grief
Bereavement Across Cultures
o Western cultures think proper grieving occurs by recovering and returning to normal as quickly as possible
o Other cultures stress maintaining a bond with the deceased
o Todos Santos: The Day of the Dead
Rituals and customs
o Funerals and memorial services are common and can impart a sense of order, decorum, and continuity
o Survivors take comfort from the rituals
o Rituals make the end official and are helpful in dealing with grief – provides “closure”
Death of a Child
o Caregivers and loved ones play a major role in managing the circumstances surrounding the death
o [slide #12] Death rates for infants and children have fallen dramatically
[slide #13] Grieving when a child dies
o Grieving is particularly intense
o Grieving children may not have an understanding of death and make the questions difficult to address
The Circle comes to Closure [Slide 14]
Each person’s “Life Cycle” is entrenched in biological & cultural contexts. They interact through out the life cycle, including the stage of life called death.
Death and the individual’s understanding & perception of it often gives new meaning to life [the cancer survivor’s reaction].
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