Death, dying and bereavement

Question 1

Describe what is meant by the term ‘invisible death’

What may this be attributed to?

Answer 1

The disappearance of death as a common social experience

• The movement of death and dying away from the family and the home, and into the hospital, so that death occurs behind closed door rather than in public.
• The increasing secularisation of society, leading to less ‘death ritual’ and increased fear

Question 2

What is the difference between biological and social death? Hertz 1960
When does social death occur?

Answer 2

Biological = the end of the biological organism
Social = the death of the person’s social identity
Usually biological precedes social death
Occasionally this can occur the other way round.
Social death occurs through a series of ritualistic ceremonies, including the funeral, mourning and remembrance

Question 3

What is the function of death ritual?

Answer 3

• enables people to say goodbye
• enables the living to fell they have respected the dead, alleviiating feelings of guilt and betryal for continuing to live without the deceased
• exposure to death - increases visibility
• percieved assertion of control over the forces of nature

Question 4

1. Death is becoming increasingly managed in a ………….. setting
2. A dying person now sees a ……… rather than a ……….., and dies an a …………. rather than at ………..
3. Conflict between a ‘natural death’ and a death mediated by doctors accompanied by aggressive ………….. ………..
4. …………….. death involves negotiation between patient, doctor and family and can be very traumatic
5. Conversely, it can mean …….. can be managed, and death can be ………….
6. There has to be a negotiation between …….. control and …………….

Answer 4

1. medical
2. doctor, priest, hospital, home
3. medical intervetion
4. Medicalised
5. pain, comfortable
6. pain, awareness

Question 5

What is the role of doctors in death?

Answer 5

symptom control
facilitaing care
counselling and therapy
prescribing and administering drugs
painting hope and helping to prepare for the future
- your presence itself may be therapeutic
death certification

Question 6

Describe death certification

Answer 6

Medical certificate sign by doctor treating patients if cause of death is known, sealed and addressed to the local registrar of births, deaths and marriages.
Referred to coroner if cause unknown
Following Shipman inquiry, all certificates are sent to an independent medical examiner to be validated.
Death certification was paced in the hands of doctors following Victorian ‘panic’ over premature inhumation (buried alive)

Question 7

What is the hospice movement?

Answer 7

Founded by Cecily Saunders in 1967.
‘A safe place to suffer’
The hospice is half way between the hospital and the home; providing medical care and pain control in a homely and ‘non-medicalised’ environment

Question 8

What are the 3 problems with the hospice movement?

Answer 8

Perception as white, middle class, Christian institution
Supply cannot meet demand
Fragile funding

Question 9

What are 2 social consequences of bereavement?

Answer 9

1. Bereaved are at a greater risk of depression, social isolation, alcohol abuse, increased use of prescribed and OTC drugs, suicidal ideation
2. Social expectation - to accept the loss, work through tried, adjust to the environment in which the deceased is missing, emotionally relocate the deceased and move on with life

Question 10

What are Glaser and Strauss’ 4 types of awareness of dying?
Grounded theory: theory that comes from the data
Examined interactions between relatives, the during and medical personnel

Answer 10

Closed awareness: staff aware of poor prognosis, patient is not aware
Suspicion: patient suspects poor prognosis, but has not been told
Mutual deception: both patient and staff know prognosis is poor, but do not talk about it - pretend its not real
Open awareness: both patient and staff know prognosis is poor and discuss

Question 11

What are Glaser and Strauss’ 4 trajectories of dying?

Answer 11

Gradual slant - long slow decline
Downward slant - rapid decline
Peaks and valleys - alternating patterns of remission and relapse
Descending plateaus - decline, stabilisation, decline stabilisation etc.

Question 12

What are the 5 stages of grief?

Elisabeth Kubler-Ross

Answer 12

Denial - This is not happening to me
Anger - Why me?
Bargaining - If you do this, ill do that
Depression - I can’t bear to face going through this
Acceptance - Im ready, i don’t want to struggle anymore

Question 13

What are the criticisms of Kubler-Ross?

Answer 13

Why does the death journey have to be some sort of moral progress?
People think that they have to go through them and think that to have a good death they need to have acceptance
Everyone knows this model so there is pressure

Question 14

How is Kubler-Ross defended?

Answer 14

Never intended to be sequential
Never intended to be used as a self-help guide
The stages were an attempt to describe the experience of her interviewees, not obligatory stages of a dying journey

Question 15

What are the 4 task based approached to aiding the dying?

Answer 15

Physical e.g. washing and toilet facilities downstairs
Psychological e.g family support
Social e.g. organising funeral, family affairs
Spiritual e.g. chaplaincy

Question 16

Copp: A review of current theories of death and dying.

Points to consider in clinical practice:

Answer 16

• feelings and responses of individuals to death
• interactions between the dying person and other individuals
• the trajectory of the dying process itself
• the nature of the tasks of dying
• implications for carers (respite care?)