Chapter 19- Death, Dying, and Bereavement Flashcards
This definition of death is a period during which vital signs are absent but resuscitation is still possible.
Presumably, near death experiences occur in this state.
a. clinical death
b. brain death
c. social death
A
This definition of death is the absence of vital signs, including brain activity; resuscitation is no longer possible.
The person is considered legally dead.
a. clinical death
b. brain death
c. social death
B
This definition of death is the point at which family members and medical personnel treat the deceased person as a corpse.
Family and friends must begin to deal with the loss. This is the point when we say that the person is dead.
a. clinical death
b. brain death
c. social death
C
What are three examples for preparing for death?
- obtaining life insurance
- making a (living) will
- advance funeral planning
These are directions given by a competent individual concerning what and/or how and/or by whom decisions should be made in the vent that, at some time in the future, the individual becomes incompetent to make certain decisions.
Advance directives
Those near to _____ became increasingly more conventional, docile, dependent, and non-introspective.
death
______(increasing/declining) neuroticism and ______(increasing/declining) conscientiousness may signal that an older senior is in terminal decline.
Increasing, declining
Sharp declines in life satisfaction, commencing in the ___ years prior to death
4
There tends to be a gradual, but accelerating, decline in overall cognitive functioning over the course of roughly ___ years.
6
A sudden, steep drop in _____ intellectual ability, in particular, seems to signal that death is imminent.
crystallized
According to Elisabeth Kubler-Ross, what are the 5 stages of dying?
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
In this stage of dying, people confronted with a terminal diagnosis use this as a psychological defense that may be useful in the early hours and days after such a diagnosis.
Denial
_____ (stage of dying) often expresses itself in thoughts that life is not fair, but may also be expressed toward God, or toward doctors, nurses, or family members.
Anger
In this stage of dying, the patient tries to make “deals” with doctors, nurses, family, or God.
Bargaining
When bargaining fails as a result of declining physical status, the patient sinks into ______.
depression
Kubler-Ross views depression a s a necessary preparation for the final step of _______, since a person must grieve for all that will be lost with death; when such grieving is finally done, the individual is ready to die.
Acceptance
In Kubler-Ross’s stages of dying, ____ and _____ relevance of the stages has been questioned because she only had 200 sample individuals who were mostly adult cancer patients with Westernized, individualistic critical values.
generalizability, cross-cultural relevance
Schneiderman suggests “____” to the dying process, rather than stages.
themes
Corr suggests four “tasks” for the dying person to take care of:
- satisfying bodily needs and minimizing physical stress
- maximizing psychological security, autonomy, and richness of life
- sustaining and enhancing significant interpersonal attachments
- identifying, developing, or reaffirming sources of spiritual energy and thereby fostering hope.
Do attitudes and behavioral choices have any effect on the physical process of dying?
YES
Greer classified women’s attitudes three months after they were diagnosed with breast cancer. These attitudes (5) are:
- denial (positive avoidance)
- fighting spirit
- stoic acceptance (fatalism)
- helplessness/hopelessness
- anxious preoccupation
Greer found out that those whose initial reaction was ______ _____ were less likely to die of cancer.
fighting spirit
There is a growing body of evidence suggesting that suffering can be lessened while survival can be prolonged by ____ interventions
psychological
Cunningham and colleagues investigated the impact of psychological self-help on survival rates among medically incurable cancer patients and they found out that the third of patients who became most engaged in self-help lived much _____ (about 3x on average) than the third who were least engaged.
longer
In Canada, the majority of deaths (67%) occur in ___
a. hospitals
b. hospice care
A
_____ is a holistic approach to care for the terminally ill that emphasizes individual and family control of the process of dying. This can be provided in a home, nursing home, hospitals
- this does not attempt to cure or slow down the disease process
Hospice care
In hospice care, medical care should be primarily ____ care rather than curative
palliative
This is a form of care for the terminally ill that focuses on relieving patients’ pain and symptoms, rather than curing their diseases or disorders.
Palliative care
WHO (2016) defines _____ as an approach that improves quality if life of patients and their families who are facing the problems associated with life-threatening illnesses.
palliative care
In 2010, they found out that although 90% of Canadians who die can benefit from palliative care, only 16-30% have access to or received palliative care or end of life services.
What are two explanations for this?
- there’s a lack of awareness of services
-financial considerations
______ care may be combined with life prolonging treatments, whereas ____ care doe snot aim to prolong life or to cure disease.
Choices: palliative, hospice
palliative, hospice
_____ care is appropriate for patients in any stage of illness- terminal or not while ____ care are for those with terminal illness.
Choices: palliative, hospice
palliative, hospice
Hospice palliative care helps dying patients and their families to address ______, _______, _______, _______, and _____ issues, as well as their associated expectations, needs, hopes, and fears
physical, psychological, social, spiritual, and practical
Hospice palliative care complements traditional curative biomedical care with a wellness, ______-person orientation
whole
_____-based care has a numerous benefits for the patient
Dignityy
The Canadian Society of Palliative Care Physicians estimates that integrating palliative care into existing health care systems would provide about 30% in ____ in direct health care costs.
savings
_____ for dying patients have a considerable burden, including a grief response.
Caregivers
_________ enables health care professionals to interact directly with informal care providers.
Provides access to a range of palliative hospice care services
Brings medical expertise to the home and to rural and remote areas of Canada.
Canadian virtual hospice
This is the most important bioethical issue wherein a physician or nurse prescribes a drug that is self-administered to cause death.
This is also known as physician-assisted suicide or physician-assisted death.
Medically assisted suicide
Eligibility criteria for medical assistance in dying (5)
- be eligible for federal or provincial healthcare services
- be at least 18 years old and mentally competent
- have a grievous and irremediable medical condition or unbearable physical or mental suffering that cannot be relieved
- make a request for MAID that is not a result of outside pressure and influence
- give informed consent to receive MAID
This is the natural response to the loss of someone or something that is very dear to a person, which may or may not involve death, e.g., the death of a pet, the loss of a job or a home.
Grief
What are the common elements (4) of grief?
- yearning
- longing
- sorrow
- thoughts and memories of the person or thing that is gone
What are the psychosocial functions (4) of death rituals?
- they help family members manage their grief by giving them a specific set of roles to play, providing shape to the first hours and days.
- they bring family members together; they can strengthen family ties, clarify the new lines of influence or authority within a family, and pass on the torch in some way to the next generation
- they may help survivors understand the meaning of death itself, in part by emphasizing the meaning of the life of the person who has died.
- they may give some transcendent meaning to death itself by placing it in some philosophical or religious concept.
Knowing that a loved one is ill and in danger helps _____cope with the loss in advance, just a sit does for those who are older.
children
_____ may be more likely to experience prolonged grief than children or adults, due to cognitive characteristics.
Teens
Widows who have cared for spouses during a period of _____ prior to death are less likely to become depressed after the death,
illness
_____ and ____ deaths evoke more intense grief responses
sudden and violent
_____ survivors may be more likely to experience long-term negative effects.
suicide
______ is a term that refers to the loss of a spouse
widowhood
Effects of widowhood on physical health (3)
- immune system functions are suppressed somewhat immediately after the death
- most return to normal by a year after the death
- the immune dysfunction can last beyond obvious signs of grief.
In the year following bereavement, the incidence of ______ among widowers rises substantially.
depression
Grief symptoms for more than __ months following the loss of a loved one may indicate a prolonged grief disorder.
2
Grief lasting longer than ___ months can lead to long-term depression, a decreased quality of life, and physical ailments.
6
This approach to managing grief can be helpful in preventing grief-related depression
“talk-it-out”
Returning from work to soon following death of a loved one can contribute to _____ and _____.
illness and depression
There is substantial ____(rise/decline) in mortality for both men and women following the death of their spouse, universally and independent of cause of death.
rise
The sudden loss of whatever social and emotional buffering effects that marriage provides may play a role in the ____ effect.
widowhood
_____ report a sense of being cheated by death.
a. young adults
b. middle-aged adults
c. older adults
A
_____ begin to confront their own mortality and undergo a change in their sense of time lived and time until death.
a. young adults
b. middle-aged adults
c. older adults
B
______ are more accepting of death
a. young adults
b. middle-aged adults
c. older adults
C
_____ is the apprehensive, uneasy, or nervous feeling brought on by the awareness of death.
Death anxiety
Paul Wong suggests that our fear of death stems from six existential uncertainties. What are these?
- The finality of death
- The uncertainty of what follows
- Annihilation anxiety or fear of non-existence
- The ultimate loss
- Fear of the pain and loneliness in dying
- Fear of failing to complete life work
This aspect of death means there is no reversal, no remedy, no more tomorrow. Therefore, death signifies the cessation of all hope with respect to this world.
The finality of death
In this aspect of death, Socrates has made the case that, since we really don’t know what will happen, we should not fear. But uncertainty coupled with finality can create a potential for terror.
The uncertainty of what follows
This aspect of death implies that the concept of nonbeing can be very threatening, because it seems to go against a strong and innate conviction that life should not be reduced to nonbeing.
Annihilation anxiety or fear of nonexistence
This aspect of death implies that when death occurs, we are forced to lose everything we have ever valued. Those with the strongest attachments toward things of this world are likely to fear death most. Loss of control over affairs in the world and loss of the ability to care for dependents also contribute to death anxiety.
The ultimate loss
This aspect of death implies that many are afraid that they will die alone or die in pain, without any family or friends around them.
Fear of the pain and loneliness in dying
This aspect of death implies that many people are more afraid of a meaningless existence than death itself; their fear if death stems from fear of not being able to complete their mission or calling in life.
Fear of failing to complete life work
For _____, the sense of unique invulnerability probably prevents intense fears of death.
young adults
_____ adults are most fearful of death. A belief in one’s own immortality begins to break down, resulting in increasing anxiety about the end of life.
Middle-aged
By late life, the inevitability of death has been ____, and anxieties are focused on how death will actually come about.
accepted
Older adults are ____(more/less) likely to fear the period of uncertainty before death than they are to fear death itself.
more
______ and _____ beliefs are protective factors against fear of death
religious and spiritual
The belief that God exists _____(increases/decreases) with age; The belief in life after death ___(increases/decreases) with age.
increases, decreases
Ley and Van Bommel state that the spiritual search for meaning in our lives is often intensified by the ____ of death. This is an important aspect in palliative care
reality
Adults have less fear of death if: (2)
- they have accomplished goals or believe they have become the person they set out to be
- believe that life has purpose or meaning.
fear of death may be an aspect of the _____ described in Erikson’s theory of ego integrity vs. despair
despair
By the age of ____, most children seem to understand both the performance and universality of death because it is the end of Piaget’s preoperational stage.
7
Unrealistic beliefs about personal death appear to contribute to adolescent _____
suicide
Like those of children, ____’s ideas about death are affected by their personal experiences
adolescent
This is the belief that bad things, including death, happen only to others.
This is in early adulthood
Unique invulnerability
In ____, many individuals switch the way they think about time from “time since birth” to ‘time until death”
middle age
The most pervasive meaning of death for adults of all ages is ___
loss
In this theory, you have a feeling of time running out, a person’s social goals shift from being knowledge-related to emotion-related
Socioemotional selectivity theory
At what point must friends and family begin to deal with the loss of a loved one?
a. social death
b. clinical death
c. brain death
d. legal death
A
When the cortex shows no electrical activity but the brain stem is not affected, the person may
a. be treated as a corpse.
b. be declared legally dead.
c. survive for long periods in a vegetative state.
d. have a near-death experience.
C
All of the following would be elements of hospice care except
a. encouraging the dying person to talk openly about the death.
b. viewing death as something that is a normal part of life.
c. utilization of invasive techniques that can prolong life.
d. family involvement in the patient’s care.
C
Which of the following statements about hospice care is true?
a. Although the idea of hospice care sounds good, patients and caregivers actually prefer traditional hospital care.
b. Hospice care relieves the dying patient and the family of the need to make decisions about the dying process.
c. Hospice care can take place in a person’s home.
d. A hospice is the best choice for a dying person who is seeking experimental treatment for his or her condition.
C
Middle-aged and older adults who think about life in terms of “time remaining”
a. are less fearful of death than those who think of their lives as “time flies.”
b. usually fail to develop a sense of ego integrity in old age.
c. are more fearful about their inevitable death than those who think in terms of “time lived.”
d. have less fear of death than those who think of their lives as “time lived.”
D
Research on the effect of religious beliefs on attitudes toward death indicates that adults who
a. are deeply religious have the greatest fear of death because they fear their lives have not been good enough or pure enough.
b. are deeply religious and those who are totally irreligious report less fear of death than those who are uncertain about or uncommitted to any religion.
c. have not committed to any religious convictions have the lowest level of fear of death.
d. have only recently developed strong religious beliefs are the most fearful because they don’t feel that they have enough time remaining to redeem their lives.
B
There tends to be a gradual, but accelerating, decline in overall cognitive functioning over the course of roughly six years prior to death. In particular, a sudden, steep drop in ______________ seems to signal that death is imminent.
a. short-term memory abilities
b. fluid intellectual ability
c. crystallized intellectual ability
d. language abilities
C
Which of the following is one of the tasks of dying proposed by Charles Corr?
a.ignoring or avoiding sources of spiritual energy
b. minimizing bodily needs
c. sustaining and enhancing significant personal attachments
d. minimizing autonomy
C
The scientific study of death and dying is called
a. euthanology.
b. tocology.
c. thanatology.
d. entomology.
C
Among grieving people, death in the context of a natural disaster tends to be associated with
a. prolonged grieving and development of symptoms of PTSD.
b. a sense that the death was not without purpose.
c. high levels of denial.
d. feelings of rejection and anger.
A
The widowhood effect refers to the finding that
a. widows but not widowers are greatly impacted by the death of a spouse.
b. the risk of death from any cause is increased by 30–90% among widows and widowers during the first three months of bereavement.
c. after an initial phase of grieving, life satisfaction often increases greatly during widowhood.
d. the risk of death from any cause is decreased by 30–90% among widows and widowers during the first three months of bereavement.
B
What has research shown helps widows and widowers manage grief?
a. returning to work as soon as possible to avoid complicated grief
b. withdrawing from social activities in the early months of bereavement
c. developing a coherent personal narrative of events surrounding the spouse’s death
d. waiting at least a year before discussing the events surrounding the spouse’s death
C
he vast majority of people in Canada die
a. in nursing homes.
b. in hospitals.
c. in relatives’ homes.
d. at home.
B
Which group of people is most afraid of death?
a. men
b. older adults
c. middle-aged adults
d. young adults
C
Older adults who are experiencing the terminal decline experience all the following except a
a. decline in life satisfaction beginning about four years before death.
b. change toward being more conventional, docile, dependent, and non-introspective three years prior to death.
c. slow and steady decline in cognitive functioning from about six years before death.
d. sudden significant drop in all physical and mental functioning a few months before death.
D
Which of the following is not an accurate statement about criticisms of Kübler-Ross’s model of the psychological stages of dying?
a. Reactions to dying may be culturally conditioned, and Kübler-Ross’s model may not apply to other cultures.
b. Clinicians and researchers do not agree that the emotions are experienced in the order specified in the model.
c. The model has been criticized for failing to convey clear ideas or meaningful concepts about the process of dying.
d. Other researchers have failed to replicate the findings of Kübler-Ross, including the universal experience of the five stages.
C
Research into the relationship between an individual’s emotional response to impending or probable death and the actual outcome suggests, in general, that
a. emotional response to a condition does not affect outcome or survival rate.
b. difficult patients who express their anger and hostility openly die sooner.
c. individuals who question and challenge and have a fighting spirit have a more difficult recovery experience.
d. emotional responses contribute to disease progress.
D
How does involvement in self-help exercises affect cancer survival?
a. Those who are most engaged in self-help live longer.
b. Those who practise self-help need less medical treatment.
c. Those who engage in self-help die sooner but more happily.
d. Practising self-help does not affect outcome or survival.
A
Which of the following is not a typical psychological function of death rituals?
a. bringing family members together
b. giving some transcendent meaning to death
c. helping the survivors understand the meaning of death itself
d. showing others how much the survivors loved the person who died
D
Which of the following is not an accurate statement about the way widowhood affects physical and mental health?
a. Depression is a universal symptom of grief that is unaffected by cultural factors.
b. Older adults who enter widowhood with a history of depression are more likely to experience depression after the death of their spouse.
c. In the year after bereavement, the incidence of depression among widows and widowers rises significantly.
d. The experience of widowhood has a negative effect on immune system functioning.
A
Which of the following is not an accurate statement about prolonged grief? Prolonged grief is characterized by
a. intense emotional pain.
b. guilt or anger.
c. complete denial of the loved one’s death.
d. persistent yearning or preoccupation for the deceased.
C
