Death and Dying Flashcards
2 clinical definitions of death
Irreversible cessation of circulatory and respiratory functions
Irreversible cessation of all functions of the entire brain
Changes in the weeks before death
Minimal appetite, easily digested foods Increased need for sleep, increased weakness Incontinence of bladder and bowel Restlessness and disorientation Increased need for assistance
Changes in the days before death
Decreased consciousness Pauses in breathing Decreased blood pressure Decreased urine volume, darkened urine Murmuring, reaching, picking Need for assistance with all care
Changes in the hours before death
Decreased consciousness or comatose Inability to swallow Pauses in breathing are longer Shallow breaths Weak or absent pulse Knees, feet, hands are cold and discoloured Noisy breathing Skin is pale
Social death
When others begin to dehumanize and withdraw from someone who is terminally ill or has a terminal illness
Ignoring them, talking like they aren’t present, not consulting them, forcing unwanted procedures
Reasons for social death
Don’t know what to say to them
Protective distance: keep them from thinking of themselves of becoming ill
Repeated experience of loss of paid caregivers causes them to distance to prevent continual grief
Perceptions of death in infancy
No true comprehension but can react to the separation caused
Perceptions of death in early childhood
Lack an understanding of death
Difficulty distinguishing reality and fantasy
Don’t see it as permanent
May think they caused it
Perceptions of death in middle-late childhood
Magical thinking, but understand the finality of death
Think that they can bring them back through their thoughts
May think they could have prevented it
May think the death is due to a wrongdoing of the deceased
Perceptions of death in adolescence
Understand death and ponder their existence
May have a fascination with death
Personal fable makes them think they are immune to death
Perceptions of death in early adulthood
Don’t worry much about death, expect a long life
Young adults who are dying often feel cheated, losing what they might have achieved
Perceptions of death in middle adulthood
Greater fear of death due to caretaking responsibilities for children and parents
Perceptions of death in late adulthood
Lower fear of death
Fewer caregiving responsibilities
Less future opportunities
Accustomed to likelihood of death
Curative Care
Focus on overcoming the disease/illness
Complete recovery
Palliative care
Focuses on comfort and relief
Those dying or with chronic illnesses
Hospice care
Team who provide terminally ill patients and family members with support
Lessen pain without invasive treatments
Care of family as a single unit
Personal directive
Documents that identify a health care agent and the health carte initiatives of an individual
Living will
Medical order
Developed in collaboration with a medical professional for a seriously ill patient
Decisions on life-sustaining treatments (do not resuscitate, do not hospitalize etc.)
Cultural differences in death
Influence how health care providers and family members communicate information and decisions
Are patients told about their health or is it concealed?
Decisions by patient, family, or doctor?
Artificial eating?
Advantages of open awareness for a dying individual
Can close life in accord with their own ideals
Complete plans and make arrangements
Opportunity to reminisce
More understanding of their body and treatments
Euthanasia
Intentionally ending one’s life when suffering from a terminal illness or severe disability
Active euthanasia
Intentionally causing death, usually lethal dose of medication
Passive Euthanasia
Life sustaining support is withdrawn
Medical Assistance in Dying
Form of active euthanasia where a physician prescribes the means by which a person can die
Clinician administered or self administered
Eligibility for MAID in Canada (5)
Eligible for health services funded by federal government
At least 18 and mentally competent
Grievous and irremediable medical condition
Voluntary request, no outside pressure
Informed consent
Grief
Normal process of reacting to a loss (physical or social)
Bereavement
Period after a loss when grief and mourning occurs
Mourning
Process by which people adapt to a loss
Influenced by culture
Complicated Grief
Atypical
Disbelief, preoccupation, unable to move on
Mimics major depressive disorder
Disenfranchised grief
Grief that is not socially recognized (suicide of loved one, perinatal death, abortions, loss of pet, psychological losses)
No formal mourning practices
Intensified symptoms due to lack of support
Anticipatory Grief
Death is expected, adjustment after loss is somewhat easier
May have a sense of relief
Dual-process model of grieving
Individuals move back and forth between grieving and preparing for life without loved one
Loss orientation and restoration orientation
Kubler’s 5 stages of grief
Denial, anger, bargaining, depression, acceptance
Denial
Protects the individual, allows the news to enter slowly
Questioning test results
“It can’t be happening to me”
Anger
Protecting the individual, energizes them to fight
Temporary feelings of control
“Why me”
Bargaining
What could be done to turn the situation around
Trying to lengthen life, life for a certain event
“Yes me, but….”
Depression
Preparatory grief
Feel the full weight of loss
May refuse visitors or be silent
Acceptance
Learning how to carry on
Not necessarily happy or content but continuing on
Criticism of the 5 stages of grief (5)
Not empirically tested Researcher's biased perceptions of grief Denial and acceptance could be negative Stages are not a set pattern Contradictory research exists, no evidence for some stages
Loss of children
Increased risk of negative outcomes
Higher scores on grief compared to other bereavement
Intensity of grief increases with child’s age until 17
Intense grief when when children are adults
Loss of parents
More common, less suffering
Loss of parent in childhood associated with negative outcomes
How to discuss death with children
Be straightforward, use words like “died” instead of “passed away” or “left us”
Say “died from cancer” rather than “got very sick” so they don’t fear sickness
Reassurance of love, that they won’t be abandoned
Support groups for grieving benefits
Reduce isolation
Connection to people with similar experiences
Learn ways of coping
4 tasks that facilitate the mourning process
Acceptance of the loss
Working through the pain
Adjusting without the deceased
Starting a new life while maintaining connection to the deceased
Funeral rites
Expressions of loss that reflect personal and cultural beliefs about the meaning of death and the afterlife
Religious practices and death
In most, death is not viewed as the end of existence
Beliefs about death, rituals that deal with death
Hinduism and death
Believe in reincarnation, cremated as soon as possible
Ashes collected and dispersed into holy rivers
Orthodox and death
Deceased are washed, wrapped in white shroud, placed in coffin
Burial as soon as possible
Sitting Shiva (gathering and visitors)
Islam and death
Buried as soon as possible, placed directly in earth (no casket) placed on their right side
Involvement of community
Roman Catholics and death
Before death anointed by priest- prayer and oil to forehead and hands
3 funeral rites
1)the wake, funeral parlour with body present
2)funeral mass
3)blessing of grave
