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Typically irreversible, and Canadian courts will permit nutrition and hydration to be withdrawn when persists for 6 months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
End-of-life decisions
Approximately ½ of Australians die in hospital, and 1/3 in RAC
70% want to die at home, but only 14% do
-hospitals and RAC are their least preferred places to die
$5 billion a year is spent on the last year of life for older people (in a health budget of $100 billion).
–only about $100 million is spent on helping people to die at home
few australians over 65 die at home
see slide 18
what is a good death
see slide 19
Advance Directives
Legally binding medical treatment decisions
- Living will: A person simply states his or her wishes about life support and other treatments.
- Durable power of attorney: An individual appoints someone to act as his or her agent for health care decisions
The purpose of both is to make one’s wishes about the use of life support known in the event one is unconscious or otherwise incapable of expressing them.
These can also serve as the basis for Do Not Resuscitate (DNR) medical order which is used when cardiopulmonary resuscitation is needed.
Advance Care Plans
When preferences are not clear, difficult to move to palliative care, as this often involves withdrawing treatments and can include pain relieving treatment that hastens death.
ACP appoints a substitute decision maker and documents values beliefs and preferences to provide clarity for health professionals who provide treatment and services.
New residents in RAC 4x more likely than other residents to complete a plan if introduced to ACP
But only 5% of residents have documented advance care directives
Hospice
Hospice is an approach to assisting dying people that emphasises palliative care and death with dignity
Hospice care emphasizes quality of life rather than quantity of life.
The goal is a de-emphasis on the prolongation of death for terminally ill patients.
Both inpatient and outpatient hospices exist.
The role of the staff is to be with patients, not to treat the patient.
hospice questions
Is the person completely informed about the nature and prognosis of his or her condition?
What options are available at this point in the progress of the person’s disease?
What are the person’s expectations, fears, and hopes?
How well do the people in the person’s social network communicate with each other?
Are family members available to participate actively in terminal care?
Is a high-quality hospice care program available?
Palliative
Designed to control the pain and physical symptoms of those who are dying
Aimed to
Control pain/discomfort
Create intimate and supportive environment
Maintain humanity, dignity, independence
Eligibility typically when have <6 months to live
Postvention Services
Aide to survivors in the year following loved one’s death
Huge savings and benefits
Approx ¼ hospice patients hospitalised compared to approx ½ non-hospice patients
Cost per day in final 60 days 1/3 of non-hospice patients
Live approximately 1 month longer
Better pain management (even with same drugs)
Focus on circle of care
Topics addressed
1. Spiritual matters, 2. Death anxiety
Is hospice covered by insurance?
palliative vs hospice
palliative care is aimed at anyone who has been diagnosed with a lifethreatining illness
- maintain qol
- reduce symptoms
- cancer px who recieive pal care alongside standard tx can live longer
hospice = aimed at px who have been diagnosed with terminal illness
provides dignified pain free death, i
The Grieving Process
Bereavement
The state or condition caused by loss through death
Grief
The sorrow, hurt, anger, guilt, confusion, or other feelings that arise after a loss
Mourning
The way we express our grief
–Mourning is heavily influenced by cultural norms.
