Death and Canadian Social Institutions Flashcards
Describe death and dying in between the 1500s - 1800s
- death was common
- lower life expectancy
- higher infant mortality
- leading cause of death = infectious diseases
- care for the dying in the home
- shorter dying process
- inadequate health care
Describe death and dying between the 1900s - 2000s
- public health measures
- antibiotics and vaccines
- 1930s: leading cause of death shifts from infectious to chronic illnesses
- care for dying in hospital and nursing homes
- 1960s: development of life saving procedures (heart surgery), CPR, transplants, etc.
- 2015: decriminalization of MAID
Describe dying and death in Canada
- ~285,000 people die in Canada each year
- life expectancy has increased due to public nutrition, sanitation, advances in medical procedures, treatments and technologies
- in the past many deaths were sudden (heart attack or accidents)
- as the population ages there is greater prevalence of chronic, life limiting illness
Describe what happens when death moves from the home to the hospital
- deaths increasingly occur in professional settings of the hospital & long term care facilities
- death sometimes positioned as a failure of the medical system
- death is ‘hidden’ in hospitals
- people have limited experience with death, limited knowledge and coping mechanisms due to lack of regular exposure
- death becomes unfamiliar, distance created between family and dying relative
- may contribute to death denial or anxiety
What were the main takeaways from the “technology and glorification + death denial = false hope” podcast
- All the medicine and science in the world cannot save everyone and we will all eventually die
- Death is not black and white
- Number of ways you can be dead: brain dead, semantically dead, etc
- Many patients are in this grey state, no resuscitation is going to work, once you are on these machines death takes a long time but the percentage of recovery is very very small
- We don’t know how to die and we often think we will never die
- Media portrays that they bring back 90% of deaths but in reality it is 10% successful resuscitations
- No real conversation on what happens after resuscitation, physical and mental repercussions
- Definition of death is changing
- Moral distress, health care professionals are shamed in a sense for not providing the ‘optimal’ level of care for your patients
Define death
- the cumulation of the dying process
- end of cognitive and physical functioning
- technological advances have clanged how we define death (CPR, organ transplant, ventilators, irreversible coma)
What are the resources needed at end of life care?
- people often require high-intensity healthcare at end of life
- homecare typically does not provide 24hr support (may be insufficient)
- death at home requires support and planning
- majority of long term care homes have cognitive impairments, like dementia, physical frailty or chronic health conditions that make living and dying at home difficult
Why is there a need for palliative care?
- with more chronic, life limiting illnesses, there is a need for access to palliative care to provide for quality of life at the end of life
- early delivery of palliative care reduces unnecessary hospital admissions
- other than those who die suddenly, most people would benefit from palliative care
- few people access this type of care
- issues of accessibility in rural, remote and northern areas
Define palliative care
Core principles:
- provides relief from pain and other symptoms
- affirms life and regards dying as a normal process
- intends to neither hasten nor postpone death
- integrates spiritual and psychological aspects of care
- offers support to patients to live as actively as possible until death
- support is offered to families to help them cope with illness and bereavement
- interdisciplinary team approach to address needs of patients and families
- will enhance quality of life
- is applicable in early course of illness, can be used alongside treatments
What are some myths of palliative care?
- is only for those actively dying
- it means you have given up
- association of palliative care with death leads to late referral, thus limiting the ability of the care to maximize its potential benefits
- remember the bow tie model
What are the role of loved ones in care?
- ability to provide a good death or death at home often requires intensive support of an at home care giver
- most caregivers continue to be women
- has a significant impact on workforce
- can be physically and emotionally taxing
- conflict at the end of life; strain within family
- need to openly discuss preferences, make plans in advance
- anticipatory grief
- can lead to anxiety, conflict, anger and frustration
What were the legislative changes in the right to die?
1972: suicide removed from criminal code
1992: decisions on withholding and withdrawal of care
1993: law created that prohibited any form of assisted suicide
Define withholding and withdrawing treatment
Withholding: not initiating treatment that is available (refusing treatment or DNR)
Withdrawing: stopping treatment that has been initiated previously (removing life support)
Describe MAID
- in 2015 the supreme court ruled that parts of the criminal code that prohibited medical assistance in dying were no longer valid
- SC found the prohibition of physician-assisted death limits: right to life, liberty and security of the person, deprives some individuals of life, denies people the right to make decisions, can leave them in an intolerable state of suffering
- in 2016 parliament passed federal legislation allowing eligible adults to request MAID
- 2021 revied legislation was passed to change eligibility
2024: possible expansion for eligibility for mental illness
What is the eligibility for MAID
- eligible for health services
- be at least 18 years old and mentally competent
- have a grievous and irremediable medical condition (has to be in advanced state of decline, cannot be reversed. causes unbearable physical or mental suffering that cannot be relieved under conditions you find acceptable)
- make voluntary request for MAID that is not the result of outside pressure or influence
- give informed consent to receive MAID
