Death, dying and bereavement

Question 1

What is the trend with invisible death?

Answer 1

it is decreasing in both males and females

Question 2

What is invisible death?

Answer 2

“We ignore the existence of a scandal we have been unable to prevent; we act as if it did not exist, and thus mercilessly force the bereaved to say nothing. A heavy silence has fallen over the subject of death” Aries ‘93

Question 3

If Aries is correct what 2 major factors can we attribute to invisible death?

Answer 3

The movement of dying and death from the family and home into the hospital, meaning much death occurs “behind closed doors”

Increasing secularisation of society means less death ritual and perhaps more fear

Question 4

What did Hertz (1960) argue?

Answer 4

he argued most societies have 2 kinds of death:

• biological death = the end of the biological organism
• social death = the end of the person’s social identity

Usually but not always biological death comes first

Question 5

What did Hertz mean by social death?

Answer 5

He suggested that it occurs through ritualistic ceremony e.g. mourning, remembrance or a funeral
“where society bids farewell to one of its members and reasserts its continuity without him or her”

Question 6

What is the function of the death ritual?

Answer 6

• living say goodbye, and progress with their lives
• living feel they have been able to respect the deceased person
• alleviates feelings of guilt for survivors
• increases visibility by exposing to the death
• perception of having some control over the death process

Question 7

Where does death occur?

Answer 7

Increasingly medicalised setting - hospital not home

Conflict between a “natural” death and one mediated by doctors with aggressive medical intervention

Medicalised death can involve (traumatic) negotiation between doctor, patient and loved ones

Conversely, pain here can be managed and death made more comfortable

Negotiation between control and awareness

Question 8

What percentage of deaths occur in different places?

Answer 8

hospital - 65%
home - 20%
other setting - 7%
hospice - 6% 
other house - 2%

Question 9

What are the roles of doctors?

Answer 9

symptom control 
facilitating care
counselling and therapy
drugs management 
maintaining hope 
preparation for the future

Question 10

When were death certificates introduced?

Answer 10

instigated by Victorians following “panic” relating to premature inhumation

• treating doctor would sign it, stating cause of death, sealed and addressed to the local registrar of births, deaths and marriages
• referred to the coroner if the cause was unknown

Question 11

What happens with death certificates nowadays?

Answer 11

Post-shipman enquiry (2000) all death certificates are validated by an independent medical examiner

Question 12

What did Saunders introduce in 1967 (St. Christopher’s London)?

Answer 12

idea of “total pain” which included physical, emotional, social and spiritual distress

A safe place to suffer

Half-way between hospital and home - medical care in a non-medicalised environment

Question 13

What did some people say about Saunders introduction in 1967?

Answer 13

Can be perceived as white, middle class christian institution - demand exceeds supply 
Funding fragile

Question 14

What are the bereaved at greater risk of?

Answer 14

depression 
social isolation 
alcohol misuse
use of prescribed and OTC drugs 
self-harm (ideation)

Question 15

What are William Worden’s tasks of mourning?

Answer 15

Accept the loss
Work through grief
Adjust the environment (from which the deceased is missing)
Emotionally relocate the deceased (and move on with living)

Question 16

What did Glaser and Strauss invent?

Answer 16

Invention of the grounded theory - examined interactions between relatives, the dying and medical personnel

• focus on expectation/awareness of death
• focus on timeframe/trajectory of dying

Question 17

What did Glaser and Strauss awareness of dying include?

Answer 17

1) closed awareness- staff aware of poor prognosis, patient is not aware
2) suspicion - patient suspects poor prognosis, but has not been told
3) mutual deception - both patient and staff know prognosis is poor but do not talk about it - pretend it is not real
4) open awareness- both patient and staff know prognosis is poor and discuss it openly

Question 18

What are Glaser’s and Strauss’ trajectories of dying?

Answer 18

Simple premise: people die at different paces, often different from those predicted by families or healthcare teams - deaths vary in form and duration
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 19

What are the 5 stages of grief?

Answer 19

1) denial
2) anger
3) bargaining
4) depression (defeated)
5) acceptance

Question 20

What are the criticisms of the 5 stages of grief?

Answer 20

• does a death “journey” have to have moral progress
• does the positioning of “acceptance” promote sentimentalisation and reinforce the notion of “a good death”
• have we crested a “death and dying” industry?
• the model has become the predominant way professionals to approach grief and tragedy

Question 21

What are the defences to the criticisms of the 5 stages of grief?

Answer 21

Was not intended to be sequential…
or to be used as a “self help” guide
Stages were an attempt to describe the experiences her interviewees reported
they were not obligatory stages of a dying journey