week 10 Flashcards
Learning Objectives
Understand definitions of death
Describe types of euthanasia and the controversy surrounding it
Describe theories of how we deal with our own impending death
Understand the concept of death anxiety
Understand end-of-life decisions
Explain why people plan or not and the implications of this
Describe the differences between hospital and palliative care
Understand the grieving process
Definitions and ethical issues
Clinical death: Lack of heart beat and respiration
Whole-Brain death is most widely accepted today.
- Includes eight specific criteria, all of which must be met:
- No spontaneous responses to any stimuli
- No spontaneous respiration for at least 1 hour
- Total lack of responsiveness to even the most painful stimuli
- No eye movements, blinking, or pupil responsiveness
- No postural activity, swallowing, yawning, or vocalizing
- No motor reflexes
- A flat EEG for at least 10 minutes
- No change in any of these when tested again 24 hours later
Persistent vegetative state occurs when cortical functioning ceases; the person does not recover.
Thanatology
Scientific study of death and dying, including the associated practices and processes
Persistent Vegetative State
Severe brain damage and coma but also show signs of a “sleep-wakefulness” cycle without awareness
-Absence of self-awareness, attention, recognition, stimuli, learned responses
Typically irreversible, and Canadian courts will permit nutrition and hydration to be withdrawn when persists for 6 months
Terry Shiavo
Euthanasia
Active euthanasia
-Deliberately ending someone’s life through some sort of intervention or action
- Passive euthanasia
- -Ending someone’s life by withholding treatment
- Physician-Assisted Suicide
- –Provides for people to obtain prescriptions for self-administered lethal doses of medication
- Netherlands:
- Patient is of sound mind
- Patient suffering irremediable and unbearable
- Second physician agrees
- Patient aware of all options
Euthanasia
ethical concerns
Hippocratic Oath
Do no harm, to benefit the sick
In opposition to euthanasia
Ethical Concerns
Beneficence: People have a duty not to be a burden
Justice: People should not take more than their fair share
Georges and colleagues (2007)
87 Relatives of people who died by euthanasia in the Netherlands because of suffering, loss of dignity, no prospect of recovery
92% of relatives found euthanasia favourable contribution to patient quality of life by preventing/ending suffering
Near Death Experiences
- -OBE
- -Darkeness
- -Deceased relatives
- -Being of light
- -Judgement/review
- -Transcendence
- The impact of NDEs
- -Has a profound impact on people
- –People report coping more effectively with death
- -Increased religiousity/faith
What are NDEs?
- -Evidence of life after death?
- -Hallucinations ?
- -Children have similar NDE –than adults
- -Many similarities across cultures
Dealing with our own death
Kübler-Ross’s theory
Kübler-Ross’s theory 1Denial 2Anger 3Bargaining 4Depression 5Acceptance
These stages can overlap and be experienced in a different order.
Individual differences are great.
Dealing with our own death
A Contextual Theory of Dying Corr identified four dimensions of tasks that must be faced. -Bodily needs -Psychological security -Interpersonal attachments -Spiritual energy and hope
Emphasizes the tasks and issues that a dying person must face, and although there may be no right way to die, there are better or worse ways of coping with death
Death Anxiety
People’s anxiety or fear of death and dying.
-Terror Management Theory: addresses why people engage in certain behaviors to achieve particular psychological states based on their deeply rooted concerns about mortality.
Death anxiety consists of several components that can be accessed at the public, private and nonconscious levels.
Death anxiety may have a beneficial side.
Death anxiety
young vs older
centre on what, cicerllis model, how to cope
Higher for younger adults and middle-aged than older adults
Death anxieties center on annihilation
–Complete loss of existence of self and body
Cicerelli’s transition model
–Those with remaining purposeful goals and a discrepancy between desired and expected life expectancy have more death anxiety
Living life to the fullest is one way to cope with death anxiety.
- -Koestenbaum proposes exercises to increase one’s death awareness.
- –An increasingly popular way to reduce anxiety is death education.
Final Scenario
End-of-life issues
- Managing the final aspects of life
- After-death disposition of the body and how one is memorialized
- Distribution of assets
Making choices about what people do and do not want done
A crucial aspect of the final scenario is the process of separation from family and friends.
Bringing closure to relationships
Dying to know day
August 8th
Annual day of action dedicated to bringing to life conversations and community actions around death, and dying
Launched in 2013 and has seen over 350 events and has sparked thousands of conversations about death and dying
Promote death literacy
Kerrie Noonan – My friend Jude
https://www.youtube.com/watch?v=ouEVusy7sQk
Death literacy
Includes knowledge, skills, and ability to take action.
Recognises the role that everyone has in end of life care and death care.
Having knowledge helps us make informed decisions
Being able to act on that
knowledge is empowering.
For example do you know:
- what an advance care plan is and how it is used?
- how to access palliative care in your area?
- about alternatives to traditional cremation/burial in your local area?
Many of us are looking to build our death literacy so we can make informed decisions about our dying, end of life care and death.
What drives people to plan ahead (or not)?
Recent hospitalisation Death of a family member Education Death anxiety Belief in physician decision making People procrastinate
