Death and Dying W11

Question 1

Dying people generally go through the following 5 stages:

Answer 1

➢ First stage: denial => shock, denial, isolation; No, it can’t be me
➢ Second stage: anger => denial is substituted by feelings of anger, rage, envy and resentment; Why me?
➢ Third age: bargaining => negotiate – openly with health professionals and secretly with god to postpone death (can be the reward for a promise of good behaviour)
➢ Fourth stage: depression => great loss => depression
➢ Fifth stage: acceptance => family needs more support than the patient; for patient struggle is over

Question 2

Places of Death

Answer 2

➢ Home (big stress f/ informal carers)
➢ Hospital (death is medicalized, doctors try to save dying patients)
➢ Hospice (holistic, non-hierarchical care by interdisciplinary teams)

Question 3

Bereavement: sudden death vs terminal illness

Answer 3

➢ Sudden death is more difficult to get over
➢ Terminal illness gives time to mourn before the actual event of death

Question 4

Stages of mourning

Answer 4

• A short period of shock: from death to funeral
• A period of intense mourning: withdrawal from social activities and physiological changes
• A period of being re-established socially and physiologically

Question 5

The role of funerals (4):

Answer 5

• Funerals are contexts of expressing intense feelings
• They offer to the living a framework of understanding and control death
• They are thought to complete a cycle – nothing is pending afterwards
• They can be linked with a place of burial – a place of reference and communication with the dead

Question 6

Biological death -

Answer 6

the end of life

Question 7

Social death -

Answer 7

person is no longer capable of mastering their own life and relies on others to act on their behalf (e.g. brain injured, coma, brain death etc)

Question 8

medicalisation: what it is and what it leads to?

Answer 8

• more and more aspects of daily life have been brought into the biomedical sphere of influence (* pregnancy, ageing, and dying*)
• leads to cultural iatrogenesis - biomedicine undermines people’s ability to manage their own health, and the ability to cope with pain, suffering, and death

Question 9

Medicalisation of death (3):

Answer 9

➢ Death is hospitalised
➢ Dying is presented as a disease within the hospital environment => death as curable
➢ The phenomena of ‘over-treatment’ and ‘heroic
medicine’ are characterising the treatment of the dying

Question 10

Awareness contextsof Death in Hospitals by Glaser and Strauss (1965) (4):

Answer 10

1. Closed awareness: staff know about the patient’s impending death but the patient does not
2. Suspicion awareness: Doctors and nurses act in a way where they don’t have to talk about death, whilst the patient does not press the issue although recognising his/her ‘terminality’
3. ** Mutual pretence**: Both doctors and patients pretend like nothing is wrong
4. ** Open awareness**: patient is openly informed by healthcare professionals that he/she is dying; requires much greater emotional commitment by staff; concept of good death

Question 11

Good death by Kellehear’s (1990) -

Answer 11

Death can be good in the sense that the dying person closes any pending issues

Question 12

5 features of Good death:

Answer 12

1. Awareness of dying: the dying person, family,
   friends, health care professionals know that the
   person is dying.
2. Personal preparations and social adjustments: i.e. to settle emotional accounts =>
   resolve family disputes
3. Public preparations: i.e. to settle practical accounts => i.e. sorting out wills.
4. The relinquishing of formal work roles: to prepare a soft withdrawal from the work place.
5. A Good death involves formal and informal farewells (to family, friends and staff).