Week 11 Ageing and Dying b Flashcards
Biological death
the end of life
Social death
Social death occurs when a person is no longer capable of mastering their own life and relies on others to act on their behalf (e.g. brain injured, coma, brain death etc)
Social and biological death
➢ In the past biological death occurred before social death
➢ Funerals and mourning customs work as contexts for helping people cope with unexpected loss and uncertainty
➢ Therefore, some families may find difficult a separation before biological death (e.g. brain death) - there are no coping contexts for social death
Changes in the Perception of Death
➢ Michael Bury (1997) wrote: “today death is wild, feared and unfamiliar”
➢ Death has been privatised
➢ A decline in exposure to death and dying – death is not observed in public spaces
➢ Due to lack of exposure to death and the fact that death is likely to occur later in life, people are more likely to be afraid of death
➢ A scientific understanding of death in modern societies
➢ A decline in the importance of the “sacred” in the experience of death
Medicalisation of life
➢ Medicalisation asserts that more and more aspects of daily life have been brought into the biomedical sphere of influence
➢Examples: pregnancy, ageing, and dying
➢ Medicalisation leads to “cultural iatrogenesis”:
biomedicine undermines people’s ability to manage their own health, and the ability to cope with pain, suffering, and death
Medicalisation of death
➢ Death is hospitalised
➢Dying is presented as a disease within the hospital
environment – death as curable
➢ The phenomena of ‘over-treatment’ and ‘heroic
medicine’ are characterising the treatment of the dying
(3. Awareness of Death in
Hospitals)
Glaser and Strauss (1965):
4 forms of what they termed “awareness contexts”
- Closed
- Suspicion awareness
- Mutual pretence
- Open awareness
(i) Closed awareness
➢ Where the staff know about the patient’s impending death
but the patient does not
➢ Reflects a belief that patients don’t want to know they are dying
(ii) Suspicion awareness
➢ Doctors and nurses act in a way where they don’t have to talk about death, whilst the patient does not press the issue although recognising his/her ‘terminality’
(iii) Mutual pretence
➢ Both doctors and patients pretend like nothing is wrong
(iv) Open awareness
➢ The patient is openly informed by healthcare professionals that he/she is dying
➢ A context of ‘open awareness’ requires much greater emotional commitment by nurses and medical staff
➢ Open awareness is associated with the concept of good death
Good Death
➢ Kellehear’s (1990) idea of the Good Death is an example of open awareness
➢ Death can be good in the sense that the dying person
closes any pending issues
➢ Good Death has 5 features
Five features of Good Death
- Awareness of dying
- Personal preparations and social adjustments
- Public preparations
- The relinquishing of formal work roles
- A Good death involves formal and informal farewells (to family, friends and staff)
A patient is rushed to the hospital after he had
a terrible accident. The accident left him
unconscious. Doctors made effort to help him recover
but he is heavily brain injured. Doctors think that he
will not make it but they will keep a close eye on him in
the intensive care unit, maintain him alive as long as
possible and keep trying to help him recover. They agree
that he is dying but they are not sure whether they
should tell his family.
[one week later]
The patient has been unconscious for a week now. His
wife Christine says, “what a torture for all of us. I can’t
handle all this wait”.
What type of death has the experienced? Why?
-He has experienced social death because he cannot
communicate with others and has to rely on them.
Has his imminent death been medicalised? In which
ways?
-Yes. Though he is dying, doctors keep treating him
What type of death awareness could be utilised in his case? Which one is more beneficial for the patient?
-Based on the literature, open awareness is the most
commonly used form of awareness in western hospitals. Open awareness is linked with “good death” which gives the dying person the opportunity to close and pending matters and say goodbye
