Lecture 9 Death, Bereavement, Healthy Aging Flashcards
What is Death (explain the three types)
The cultural definition of death varies around the world.
Clinical death: lack of heartbeat or respiration
Whole-brain death:
1.) The person has an irreversible loss of all functions of the entire brain
2.) All brainstem reflexes have permanently stopped working (irreversible)
3.) Breathing has permanently stopped so that a ventilator must be used to keep the body functioning
- Brain death must be diagnosed by a physician trained in diagnosing death
- Can be controversial among religions
Persistent vegetative state:
- A person’s cortical functioning ceases while brainstem activity continues.
- A person can not recover from this
- There’s a heart beat and respiration but no consciousness
- Caused by: severe head injury or overdose
- Brain functioning ends (no consciousness) but body is still sorta working (must be irreversible)
Ethical issues concerning death
Bioethics
What are the types of euthanasia?
What conditions is “MAID” applicable in?
Bioethics:
Balance between individual choice, minimizing harm and maximize good
- The study of the interactions between our values as people and technological/science advancements.
ex.
Fertilization outside of uterus, if someone accidentally fertilizes 6 eggs. Do/can they abort some of them?
- We have the ability to do these things but should we? Is it ethical?
ex.
Euthanasia: Practice of ending a life out of mercy.
1.) Active euthanasia: deliberate ending of one’s life
- must be person’s wishes or someone with legal authority
- Mercy killing (assisted suicide)
ex. administrating a drug overdose
2.) Passive euthanasia: allowing someone to die by withholding available treatment
ex. Disconnecting a ventilator, taking someone off life support, ending cancer treatment for someone with terminal cancer…
Medical assistance in Dying (MAID) (Canada law passed in 2021). Physician assisted suicide with fatal dose of medication.
- 18+ decision-making
- Eligible for public healthcare
- Make a voluntary request, not due to external pressure
- Must be mentally competent while making decision.
- Have a serious incurable illness, disease or disability (excluding mental illness until 2027)
- be in an advanced state of irreversible decline in capacities and have suffering that can’t be eased
What are Kübler-Ross’ 5 Stages of Dying?
How was the study developed?
What is it used for?
The study:
200 interviews with people that were terminally ill convinced girly pop that most people experience these 5 reactions to deal with death:
1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance
6. Meaning-making (added recently)- idea that our healing and processing can lead to different ways of understanding why something has happened
- Not everyone experiences these emotions, and they don’t happen in a distinct sequence
Why:
- These stages were originally developed with people with terminal illnesses, expanded to people who are experiencing grief or loss.
Critiques to the Theory (5 stages)
Interpretation of the framework:
This range of emotions is not always experienced in a stage like linear process
- Used to help foster understanding of what the normal and wide ranges of emotions felt within the giving or dying process are
- Viewing these stages as linear harms the dying individual
Goal in applying this theory is to help people achieve an appropriate death.
What is a “Good Death?”
A good death is our perception of how death “should be”.
- Culturally specific
- See this when you react differently to different kinds of deaths.
1. Minimizes pain and suffering (not traumatizing, it’s as peaceful as it can be)
2. Maximizes psychological security and
control, minimizes fear and anxiety (the person is as in control over the situation as it can be)
3. Be close emotionally to the people we
care about
4. Have the sense that there was integrity
and purpose in our lives (feeling comfortable about dying is associated with feeling generativity - like your life had purpose)
Helpers of death
- Palliative Care: Begins at treatment, often done during terminal illness.
Goal: make the person feel more comfortable with treatment - Relatively holistic and comprehensive
- can be at home or in centre
- Hospice care: begins at the end of treatment to try and make someone more comfortable with the end of their days.
- This person is going to die, it’s just a matter of when
- Help them die with dignity
- Helps individuals with 6 months or less left to live
- medical, physical, phycological, social care
- can be at home or in centre (depends on what emotionally and logistically a family can do) - Death doulas:
- An umbrella term to identify lay people, primarily women, who provide a variety of nonmedical supports—social, emotional, practical, and spiritual—for people nearing the end of life, including individuals close to them
What is Bereavement, Grief and Mourning?
Bereavement: The state or condition caused by loss through death.
Grief: The sorrow, hurt, anger, guilt, confusion, and other feelings that arise after suffering a loss.
Mourning: The way we express our grief.
- expression of feelings
- varies culture to culture
Acknowledge reality of loss
- rather than living in denial of loss
- working through emotions of loss
- Adjust to person being gone
- loosening ties to the dead (find effective ways to say goodbye to the person)
Five themes in Grief
Grief is highly variable (varies between individuals and cultures)
* Coping: things done in an attempt to deal with loss
- looks different from person to person
- Affect: emotional reaction to death
- Change: the ways that survivors lives change
- Rearranging life without this person
- Narrative: stories told about the person who died.
- Relationship: The stories that people tell about the dead often include relationship
Thematic coding (coding for themes): look for common themes in data
Symptoms of Grief
- Psychological symptoms:sadness emotional instability anger resentment, fear anxiety relief
- Physiological symptoms: fatigued changes to sleep, appetite changes, nausea, muscle aches, increased clumsiness, lower immune system.
- Often elevated with time
- Dates may reintroduce grief symptoms after initial symptom reduction
- Anniversary reaction: symptoms of grief come back on anniversary of loss
- Grief looks different for different people.
ex. first week after death, people often don’t show emotions - type of death influences grief
What is the four component model of Grief
- Context of loss:
- was death expected
- What were the circumstances? - Meaning associated with the loss
- What does loss mean for this person’s life
- Large existential questions
- Or day-to-day impact - Changing representations of the lost
relationship over time
- Changes of relationship over time
- Cant remember voice anymore
- Feelings of estrangement or distant - A broad understanding of coping
mechanisms used and ways of
regulating emotions
- People cope in different ways
Dual Process Model
The dual process model
- The DPM defines two broad types of stressors:
* Loss-oriented stressors: concern the loss itself, such as the grief work that needs to be done.
*Restoration-oriented stressors: adapting to the survivor’s new life situation, such as building new relationships and finding new activities.
- people zigzag back and forth between moving on and feeling the loss
ex. compartmentalizing grief
Widowhood and Mourning
Mourning pathway
- Common for surviving spouse to continuously think over deceased spouse’s last moments within the few months after the death
- Especially if death was sudden
- First year= decline in mental health
- Second year starts to go back up
Why?
- self-efficacy lowers after loss
- over course of year levels return
- routine, taking back control over lives
- exchange theory in marriage, spouse does something you can’t do by self
- over the course of a year you relearn skills or lean on new people to provide support
Widowhood mortality effect
- higher risk of death for surviving spouse
- 2/5 people will experience chronic depression
social support
-Support from friends who have also lost a spouse are the most helpful
- going to family= bad because they are also grieving
Ways for managing grief
- Try to get back to daily routine. Having routine gives control
- Practice regular hygiene-change your clothes daily (personal hygiene)
- Express feelings
- Chunk your time. Try to get through each day each week - chunk your time so that you feel less overwhelmed
- Try and find an activity to keep you focused on
What is Healthy Aging?
Book definition of healthy aging: Involves avoiding disease, being engaged with life, and maintaining high cognitive and physical functioning.
Jess: Healthy aging is a human right
- combating ageism
- build and promote age friendly environment
- Integrative care that covers all domains of development
- Long term care
- Elevating social isolation and loneliness
- Avoid disease
- Help people be engaged with their lives
- Boost and maintain functioning
- Physical and cognitive
What is Salutogenesis?
What is a sense of coherence?
What are GRRs?
Why is this stuff important?
- Rather than focusing on eliminate bad
Emphasis things that support people and promote health - Sense of coherence: supporting a life that is meaningful for people, manageable and able to be understood
- Interaction between sense of coherence, life experiences, and generalized resistance (GRRs)
GRRs: generalized resistance resources
- Our resources that help use deal with stressors
- individual or environmental resources that help us cope
- Avoid stressors and manage stressors.
-Importance: shifts perspective away from the negative can be flexibly applied
