Chapter 17; Death, Dying, and Grieving Flashcards
twenty five years ago, it was simpler than it is today to determine whether someone was dead
yes
twenty five years ago, the end of what biological functions were considered as clear signs of death
- breathing
- blood pressure
- and the rigidity of the body (rigor mortis)
can defining death today be more complex
yes
brain death is the neurological definition of death which states that a person is brain dead when all …
electrical activity go eh brain has ceased for a specified period of time
what does EEG stand for when regarding death
electroencephalogram
a flat EEG (electroencephalogram) recording for a specified period of time is one criterion of
brain death
do the higher or lower portions of the brain often die sooner
high portions rather than the lower
the brains lower portions monitor […] and […], individuals
heartbeat
respiration
can an individual whose higher brain areas have died may continue to breath and have a heartbeat
yes,
b/c
the lower portion hasn’t died and the lower monitors heartbeat and respiration
the definition of brain death currently followed by most physicians includes the death of […] the higher cortical functions and the lower brain stem functions
both
do some medical experts argue that the criteria for death should include only higher cortical functioning
yes
p.s. the lower monitors heartbeat and breathing
if the cortical death definition were adopted, then what could physicians claim a person is dead by
if they don’t have cortical functioning, even if the lower brain stem is functioning
why do supporters of the cortical death policy argue of the functions of the higher cortical part of the brain (intelligence and personality) that we associate with being human, partake in the support for cortical death
that when these functions are lost, the “human being” is no longer alive
advance care planning refers to the process of patients thinking about and communicating their preferences regarding
end of life care
for patients in a coma, can it be clear what their wishes regarding termination of treatment might be if they still were conscious
no
researchers found that advance care planning […] life sustaining treatment, […] hospice use, and […] hospital use
decreased
increased
decreased
is completion of an advance directive associate with a higher or lower probability of receiving life sustaining treatments
lower
what did the organization “Choice in Dying” create after recognizing that some terminally ill patients might prefer to die rather than linger in a painful or vegetative state
the living will, a legal document that reflects the patients advance care planning
the living will, that was created by Choice in Dying organization is a legal document that reflects the patients advance care planning
yes
was advance care planning associated with [improved or decreased] quality of care at the end of life, including [more or less] in hospital death and [greater or less] use of hospice care
improved
less
greater
why were natural death legislations produced over
- physicians concerns over malpractice suits
and - the efforts of people who support the living will concept
what do laws in all 50 states now accept (such as a living will) in the concept of advance care planning
an advance directive
an advance directive states such preferences as whether life sustaining procedure should or should not be used to […] the life of an individual when death is imminent
prolong
in the concept of advance care planning; when must an advance directive be signed
while the individual is still able to think clearly
a study of end of life planning revealed that only […] % of patients 18 years of age and older had a living will
15
since 90 % of the patients reported that it was important to discuss health care wishes with their family, what is the % that had done so
60
do physicians have a positive or negative attitude toward advance directives
positive
in how many states is Physician Orders for Life Sustaining Treatment (POLST), available or being considered
34
the Physician Orders for Life Sustaining Treatment (POLST) is a more specific document that involves the health care professional and the patient or surrogate in stating the […] of the patient
wishes
POLST, (Physician Orders for Life Sustaining Treatment), translates treatment preferences into medical orders such as those involving cardiopulmonary […], […] of treatment, and artificial nutrition via a […]
resuscitation
extent
tube
Euthanasia (“easy death”) is the act of […] ending the lives of individuals who are […] from an incurable disease or severe disability
painlessly
incurable
what can euthanasia sometimes be called
mercy killing
distinctions are made between what two types of euthanasia
passive and active
passive euthanasia occurs when a person is allowed to die by […] available, such as withdrawing a life sustaining device
witholding
e.g.
turning off a respirator or a heart lung machine
Active euthanasia occurs when death is deliberately […] as when a physician or a third party ends the patients life by administering a […] dose of a drug
induced
lethal
can technological advances in life support devices raise the issue of quality of life
yes
in assisted suicide, a physician supplies the […] and/or the […] of committing suicide but requires the patient to self administer the lethal medication and to determine when and where to do this
information
means
(such as giving the patient a prescription for a lethal dose of sleeping pills)
assisted suicide differs from active euthanasia, in which a physician causes the death of an individual through a […] action in response to a request by the person
direct
in which countries is assisted suicide legal
- Belgium
- Canada
- Finland
- Luxembourg
- the Netherlands
- and Switzerland
is assisted suicide legal in the US by the US government
gov. has no official policy but leaves the decision up to the states
what are the six states in the US that allow assisted suicide
- california
- colorado
- montana
- Oregon
- Vermont
- and Washington + DC
in states where assisted suicide is illegal, what type of rim can it typically be considered
manslaughter or a felony
what are the percentages of physician assisted deaths ranging from in the US + Luxembourg and the Netherlands
US + Luxembourg;
0.1 to 0.2 percent
the Netherlands
1.8 to 2.9 percent
has the percentage of assisted suicide cases reported to authorities increased or decreased in recent years
increased
the individuals who are likely to die through assisted suicide are most likely to be females or males
males from 60 to 75 years of age
a recent Gallup poll found that […]% of US adults said euthanasia should be legal, […]% said they would consider ending their own lives if faced with a terminal illness, and […]% reported that physician assisted suicide is morally acceptable
69
51
50
Euthanasia is so controversial because those in favor argue that death should be […] and […], not a […] and […] ordeal. those against, stress that it is a criminal act of […] in most states in the US and in most other countries
calm
dignified
painful
prolonged
murder
what do many religious individuals, especially Christians, say that euthanasia is
taking a life for any reason is against God’s will and is an act of murder
too often death in America is lonely, […], and […]
prolonged
painful
have scientific advances sometimes made dying harder or easier though delaying the inevitable
harder
even though pain killers are available, do many people experience sever pain during their last days and months of life
yes
what is the percentage of dying patients that were in pain in the last year of life and where nearly one third had symptoms of depression and confusion prior to death
61
are care providers increasingly or decreasingly interested in helping individuals experience a “good death”
+
what does it involve
increasingly
+
physical comfort
support form loved ones
acceptance
and appropriate medical care
what does a good death involve for other individuals to accept
accepting one’s impending death and not feeling like a burden to others
what are the three frequent themes identified in articles on a good death
- preference for dying process (94%)
- pain free status (81%)
- emotional well being (64%)
what is a recent criticism of the “good death” concept emphasize about death
that it has shifted from being an event at a single point in time to being a process that takes place over years and even decades
since critics have criticized that death is a long process that takes over years and even decades rather than being an event at a single point in time, what do critics say to do when moving away from the “good death” concept
to a larger vision of a world that not only meets the needs of individuals at their moment of death but also focuses on making their lives better during the last years and decades of their lives
hospice is a program committed to making the end of life as free from
pain, anxiety, and depression as possible
a hospitals traditional goal is to […] illness and […] life
cure
prolong
hospice care emphasizes palliative care which involves reducing pain and suffering and helping individuals…
die with dignity
have US hospitals recently and rapidly decreased or expanded their provision of palliative care
expanded
(more than 85% of mid to large US hospitals have palliative care team)
hospice care professionals work together to treat the dying person’s […], make the individual as […] as possible, show […] in the person and the person’s family, and help everyone involved cope with death
symptoms
comfortable
interest
today more hospice programs are […]-based a blend of institutional and home care designed to […] the end of life experience for the dying person
home
humanize
today in the US, the deaths of older adults account for approx. […]-thirds of the 2 million deaths that occur each year
two
is youthful death more or less common
less
attitudes toward death vary across […]
cultures
in US, life expectancy has increased from […] years for a person born in 1900 to […] gears for someone born today
47
79
the historical changes involving death is
- the increasing complexity of determining when someone is truly dead
- the age group in which death most often strikes
what are the ages in life expectancy in the US for women and men
women - 81
men - 76
as our population has aged and become more mobile, how have a growing number of older adults died (in contrast to the 1900s where most people died at home, cared for by their family)
apart from their families
more than […]% of all US deaths occur in institutions or hospitals
80
as there are changing historical circumstances regarding death in old age, the care of a dying older person has shifted […] from the family and minimized our exposure to death and its painful surrounding
away
cultural variations characterize the […] of death and […] about death
experience
attitudes
in what situations are individuals more conscious of death
times of war, famine, and plaque
most societies have a ritual that deals with death
yes
most societies throughout history have had philosophical or religious beliefs about death
yes
what can death be seen as in some cultures
- punishment for one’s sins,
- an act of atonement
- or a judgment of a just God
what does death mean for some and for others
for some;
- loneliness
- embrace and welcome death
for others;
- quest for happiness,
- redemption a relief from the trials and tribulations of the earthly world
- abhor and fear it
may death be seen as the fitting end to a fulfilled life
yes
from the perspective that death may be seen as the fitting end to a fulfilled life , can how we depart from earth be influenced by how we have lived
yes.
in most societies, death is not viewed as the end of existence- that although the […] body has died, the […] is believed to live on
biological
spirit
in the concept of cultural variations, which culture has an attitude towards death where they believe in reincarnation, and in which is believed to be caused by magic and demons
reincarnation;
Hindu and Buddhist
magic and demons;
Gond culture of India
how can denial take many forms since in the US we are death avoiders and death deniers
- the tendency of the funeral industry to gloss over death and fashion lifelike qualities in the dead
- the persistent search for a “fountain of youth”
- the rejection and isolation of the aged, who may remind us of death
- and the medical communities emphasis on prolonging biological life rather than on diminishing human suffering
do most dying individuals want an opportunity to make some decisions regarding their own life and death
yes
as individuals face death, a majority prefer to be at […] when they are near death
home
some individuals want to complete […] business; they want time to […] problems and conflicts and to put their affairs in […]
unfinished
solve
order
a Canadian study found that […]% wanted to be at home when they die, […]% preferred to be in a hospice/palliative care facility, […]% wanted to be in a hospital, and only […]% preferred to be in a nursing home
71
15
7
2
Knowledge of death’s inevitability permits us to establish priorities and structure our time.
yes
what are three areas of concern when facing one’s own death
- Privacy and autonomy in regard to their families
- Inadequate information about physical changes and medication as death approached
- Motivation to shorten their life
Elisabeth Kubler-Ross (1969) divided the behavior and thinking of dying persons into five stages that are
- denial and isolation
- anger
- bargaining
- depression
- and acceptance
the first stage of Elisabeth Kubler Ross is ‘denial and isolation’ where the dying person […] that death is really going to take place
denies
e.g. “no this can’t happen to me. its not possible”
denial and isolation (the first stage in Elisabeth Kubler Ross’ stage of dying is the most common reaction to
terminal illness and is temporary defense (later replaced with increased awareness)
the second stage in Elisabeth Kubler Ross’ dying stages is anger, in which the dying person recognizes that denial can no longer be marinated. denial often gives way to …
anger, resentment, rage and envy
in the second stage (anger) in Elisabeth Kubler Ross’ stages of dying, once they at the point of anger, the person becomes [increasingly or decreasingly] difficult to care for as anger may become displaced and projected onto physicians nurses, family members, and even God.
increasingly
(realization of loss is great)
the third stage in Elisabeth Kubler Ross’s stages of dying is ‘bargaining’ in which the person develops the […] that death can somehow be postponed or delayed.
hope
(some enter bargaining or negotiation with God to delay their death)
the fourth stage, ‘depression’ in Elisabeth Kubler Ross’ stages of dying, the dying person comes to […] the certainty of death
Accept
(withdrawn, crying, and grieving)
in the fourth stage of dying according to Elisabeth kubler ross, a period of depression or preparatory grief may appear, how can the dying person become
- silent
- refuse visitors
- spend much of the time crying or grieving
(normal b/c is effort to disconnect the self from love objects)
when a dying person is in the fourth stage of Elisabeth kubler ross’ stages of dying, are attempts to cheer up the dying person at that stage encouraged or discouraged according to Elisabeth
discouraged
b/c the dying person has a need to contemplate the impending death
the fifth stage in Elisabeth kubler ross’ stages of dying, ‘acceptance’ is in which the person develops a sense of […], an acceptance of his or her fate, and in many cases, a desire to be left […]
peace
alone
since feelings and physical pain may be virtually absent in the fifth stage (acceptance), how does Elisabeth kubler ross describe this stage as the end of
the dying struggle, the final resting stage before death
what are some of Robert kastenbaum’s problems with Elisabeth Kubler Ross’s approach
- the five stages have not been demonstrated by Elisabeth or independent research
- the stages neglect variations in patients situations, including relationship support, specific effects of illness, family obligations, and the institutional clime in which they were interviewed
what did Robert kastenbaum say in contrast to his critics of Elisabeth Kubler Ross’ approach
- her efforts were important in calling attention to those who are attempting to cope with life threatening illnesses
- encouraging attention to the quality of life for dying persons and their families
Perceived control may be an adaptive strategy for remaining alert and cheerful.
yes
how can perceived control and denial influence older dying adults
- to feel better and live longer
denial can be adaptive or […]
maladaptive
Denial insulates and allows one to avoid coping with intense feelings of […] and […]; however if denial keeps us from having a life saving operation, it clearly is maladaptive
anger
hurt
denial is neither good nor bad; its adaptive qualities need to be evaluated on an individual basis
yes
in the ratings of life stress that require the most adjustment, […] of a souse is given the […] number
death
highest
what are some of the important advantages that hospitals offer through their members and technology
- professional staff members
- technology helps prolong life
more than […]% of Americans die in hospitals
80
nearly […]% of Americans die in nursing homes
20
why do most psychologist believe that dying individuals should know they are dying and for their significant others to know that their loved one is dying.
so they can interact and communicate with each others on the basis of this mutual knowledge
why is open communication with dying people important so they can do
- close their lives in accord with their own ideas about proper dying
- may be able to complete plans and projects and make arrangements for survivors and decisions about a funeral and burial
- have the opportunity to reminisce and converse with others
- have better understanding of what is happening to them
why do some experts believe that conversation should not focus on mental pathology or preparation for death but instead on strengths of the individual and preparation for the remainder of life
because external accomplishments are not possible , communication should be be directed more at internal growth
what are effective strategies for communicating with a dying person 1-5 out of 10
- establish your presence, be at the same eye level; don’t be afraid to touch the dying person-dying individuals are often starved for human touch
- eliminate distractions-e.g., ask if it is okay to turn off the Tv. realize that excessive small talk can be a distraction
- dying individuals who are very frail often have little energy. if the dying person you are visiting is very frail, you may want to keep your visit short
- don’t insist the the dying person feel acceptance about death if the dying person wants to deny the reality of the situation; on the other hand, don’t insist on denial if the dying individual indicates acceptance
- allow the dying person to express guilt or anger; encourage the expression of feelings
what are effective strategies for communicating with a dying person 6-10 out of 10
- ask the person what the expected outcome of the illness is . discuss alternative and unfinished business
- sometimes dying individuals have limited access to other people. ask the dying person if there is anyone he or she would like to see that you can contact
- encourage the dying individual to reminisce, especially If you have memories in common
- talk with individual when she or he wishes to talk. if this is impossible, make an appointment for a later time, and keep it
- express your regard for the dying individual. don’t be afraid to express love, and don’t be afraid to say goodbye
since grief is a complex emotional state that is an evolving process does it have one or multiple dimensions of grieving
multiple
grief is the emotional […], disbelief, […] anxiety, despair, […], and loneliness accompanying the loss of someone loved
numbness
seperation
sadness
since an important dimension of grief is pining for the lost person, what does pining and yearning reflect an intermittent, recurrent wish or need to
recover the lost person
another important dimension of grief is separation anxiety
yes
what does the important dimension of separation anxiety include
not only pining and preoccupation with thought of the deceased person but also focuses on places and things associated with the deceased, as well as crying or sighing
grief may also involve a sense of hopelessness and defeat, depressive symptoms. apathy, loss of meaning for activities that used to involve the person who is gone, and growing desolation
es
older adults who were bereaved had more […] cortisol patterns, indicative of the intensity of their stress
dysregulated
e.g. college students who lost someone close to them in campus shootings and had experienced severe post traumatic stress symptoms four months after the shooting were more likely to have severe grief […] year after the shootings
one
can cognitive factors be involved in the severity of grief
yes
feelings of grief occur […] shortly after a loss
repeatedly
as time passes, does pining and protest over the loss tend to grow or diminish, do episodes of depression and apathy remain or increase
diminish
may remain or increase
in grieving, the sense of separation anxiety and loss may continue to the end of one’s life, but most of us emerge from griefs tears, turning our attention once again to
productive tasks and regaining a more positive view of life
is the grieving process more like a roller coaster ride than an orderly progression of stages with clear cut time frames
roller coaster ride
(ups and downs)
what do the ups and downs of grief often involve
- rapidly changing emotions,
- meeting the challenges of learning new skills
- detecting personal weaknesses and limitations,
- creating new patterns of behavior,
- and forming new friendships and relationships
for most individuals, does grief become more manageable over times, with fewer abrupt highs and lows
yes
do many grieving spouses report that men through time have brought some healing, have they gotten over their loss
many have never
complicated grief or prolonged grief disorder is when they feel numb or detached, believing their life is […] without the deceased, and feel that the future has no […]
empty
meaning
can some individuals have difficulty moving on with their lives six months after their loss
yes
what is the percentage of bereaved individuals who experience prolonged or complicated grief
7 to 10
9.8 is prolonged grief disorder
are younger or older that grieving individual is, the more likely prolonged grief disorder was present
older
is a person who loses someone on whom he or she was emotionally dependent often at greatest risk for developing complicated grief or prolonged grief disorder
prolonged grief disorder
individuals with complicated grief had a higher level of the personality trait of neuroticism
yes
does complicated grief usually have positive or negative consequences for physical and mental health
negative
those experiencing prolonged grief had a greater cognitive increase or decrease than their their counterparts with normal grief
decrease
disenfranchised grief is an individual’s grief involving a deceased person that is a socially ambiguous loss and cannot be
openly mourned or supported
e.g.
ex- spouse
abortion
stigmatized death such as AIDS
(isn’t socially recognized)
can disenfranchised death intensify an individuals grief
yes because it cannot be publicly acknowledged
(may be hidden or repressed)
Death’s impact on survivors are strongly influenced by the death’s […] under which the death occurs
circumstances
what are the types of deaths that are likely to have a more intense and prolonged effect on surviving individuals and make the coping process more difficult for them
- sudden
- untimely
- violent
- or traumatic
the deaths that have a more intense and prolonged effect on surviving individuals may develop
post traumatic stress disorder (PTSD) symptoms
what are some of the PTSD symptoms that can be developed
- intrusive thoughts
- flashbacks
- nightmares
- sleep disturbances
- or problems in concentrating
can the death of a child be especially devastating and extremely difficult for parents
yes
what is one beneficial aspect of grieving that it stimulates in many individuals
to try to make sense of their world
is reliving events leading to the death common
yes
what are the four meaning making process that were identified
- sense making
(seeking biomedical explanations for the death, revisiting parents’ prior decision and roles, and assigning blame) - benefit finding
(exploring possible positive consequences of the death such as ways to help others, providing feedback to the hospital and making donations) - continuing bonds
(reminiscing about the child, sharing photographs, and holding community events to honor the child) - identity reconstruction
( changes in the parents’ sense of self, including changes in relationships, work, and home)
when death is caused by an accident or a disaster, is the effort to make sense of it pursued more vigorously
yes
in a study of more than 1,000 college students was it found that making sense to be an important factor in grieving of a violent loss by accident, homicide, or suicide
yes
the death of an intimate partner brings […] grief
profound
do widows or widowers outnumber the other
widows outnumber widowers b/c women live longer
Age groups and percent of widows
* […]% of 65 to 74 years old
* […]% of 75 to 84 years old
* […]% of those 85 years old and over
14
31
59
widows left behind may endure financial […], […], […] physical illness, and psychological disorders such as […]
loss
loneliness
depression
in one study, being widowed was associated with a […]% increase in risk of mortality
48
widowed women are portably the poorest group in America
yes
can many widows benefit considerably from social support
yes
did the mortality risk increase or decrease in men and women
men - increase if wives deaths were not expected
women - unexpected death of a husband mattered less in terms of their mortality risk
do Mexican American older adults experience a significant increase or decrease in depressive symptoms during the transition to widowhood
yes, increase
(frequent church attendance is a protective factors against increases in depressive symptoms)
in a cross cultural study of widows men and women; a study in the US, England, Europe, Korea, and china, in what year did depression pick of widowhood
first year
in a cross cultural study of widowed men and women; did widowed women or men recover to levels compared to married individuals in all countries
women
in a cross cultural study of widowed men and women; did widowed women or men continue to have high levels of depression 6 to 10 years post widowed everywhere except in europe
men
in a cross cultural study of widowed men and women , becoming widowed is associated with a […]% increase in having an earlier death
48
in a six year longitudinal study of individuals aged 80 and older found that the loss of a spouse, especially in men, was related to higher or lower levels of life satisfaction over time
lower
the widowed people who did not expect to be reunited with their loved ones in the afterlife reported more
- depression
- anger
- and intrusive thoughts at 6 and 18 months after their loss
are bereaved also at an increased risk for many health problems
yes
for either widows or widowers, does having social support help them adjust to the death of a spouse
yes
when did the Widow to Widow program begin and what type of support does it provide
- begun in the 1960s
- provides support for newly widowed women
what might volunteer widows in the widow to widow program do
- reach out to others
- introduce them to others w/ similar problems
- lead group discussion
- and organizing social activites
who adopted the widow to widow program and disseminated it throughout the US as
- AARP
- as Widowed Persons Service
are funerals an important aspect of mourning
yes
do cultures vary in how they practice mourning
yes
in the US how are funerals conducted
- privately and are followed by a memorial ceremony
in 2017 in the US […]% of deaths were followed by cremation
51.6
in 2017 in canada, […]% of deaths were followed by cremation
70.5
projections indicate that in 2022, cremation in the US will increase to […]%
57.5
is cremation more popular in the pacific region of the US or in the South
pacific region
where is cremation more popular; the US, Canada, Japan , and other asian countries
Canada than in uS, and most popular of all in Japan and other asian countries
why have the funeral industry been at controversy in recent years
- directors and their supporters argue the the funeral provides a form of closure to the relationship with the deceased, especially when there is an open casket
- critics claim that funeral directors are just trying to make money and that embalming is groteque
in funerals, one way to avoid being exploited during bereavement is to purchase funeral arrangements in advance
yes
in amish cultures forms of mourning, how do they handle a funeral
the community handles virtually all aspects of the funeral (notifying others e.g)
- held in a barn in warmer months and in a house during colder months
- high level of support given to the bereaved family for at least a year
- visits to the family
- special scrapbooks and handmade items
- new work projects for the widow
- quilting days that combine fellowship and productivitiy
