Chapter 17

Question 1

State the 4 components of the Harvard Medical School definition of brain death and discuss the issues is raises

Answer 1

1. Irreversible loss of functioning in entire brain
2. Loss of control over basic life processes
3. Unresponsive to stimulii
4. EEG shows no brain activity

Question 2

Distinguish between active euthanasia, assisted suicide, and passive euthanasia.

Answer 2

Active euthanasia - mercy killing; deliberately and directly causing a person’s death
Assisted suicide - not directly killing someone but making available to the person the means by which she may end her life
Passive euthanasia - allowing a terminally ill person to die of natural causes

Question 3

Describe gender and cultural differences in life expectancy in the US

Answer 3

Higher for females
Highest for Hispanics; medium for non-Hispanics, lowest for African Americans
Lower life expectancy in poorer areas

Question 4

List Kubler-Ross’s stages of death and dying and describe 4 problems with her theory

Answer 4

1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance

Four problems:
Emotional responses to dying are not stagelike; the nature and course of an illness affects reactions to it; individuals differ widely in their responses; and dying people focus on living, not just dying.

Question 5

Describe the Parkes/Bowlby attachment model of bereavement and compare how it is similar to and different from Kubler-Ross model.

Answer 5

Parkes/Bowlby four reactions to death

1. Numbness
2. Yearning
3. Disorganization and despair
4. Reorganization

Studies show that this is stagelike. Correlates to Kubler Ross except no bargaining stage.

Question 6

What oscillates in the dual process of bereavement?

Answer 6

The bereaved oscillate between coping with the emotional blow of the loss and coping with the challenges of living.
Loss-oriented coping - reconciling oneself to loss
Restoration-oriented coping - focused on managing daily living

Question 7

Summarize the 4 key components of an understanding of biological death and when they develop in childhood.

Answer 7

Finality
Irreversibility
Universality - children between 3-5 have understanding
Biological causality - age 5-7 understand concept of death

Question 8

Define disenfranchised grief and illustrate with an example of when it might occur

Answer 8

Not fully recognized or appreciated by other people and therefore might not receive much sympathy and support.
Example - loss of elderly grandparent

Question 9

Define posttraumatic growth. Describe the relationship between posttraumatic growth and posttraumatic stress.

Answer 9

Post traumatic growth - positive psychological change resulting from highly challenging experiences such as diagnosis or loss
Posttraumatic stress - May prevent growth from happening

Question 10

How does the hospice/pallitative care approach differ from the standard medical approach to dying patients and how it affects the patient and their families?

Answer 10

Dying person and family determine the support needed
De-emphasis on prolonging life
Pain control emphasized
Home setting - not medical setting
Bereavement counseling before and after.

Ability to die with dignity, free of pain and surrounded by loved ones.