End of Life

Question 1

Causes of death

Answer 1

Middle-age: non-accidental (cancer, diabetes, heart disease)
85<: higher disease of heart

Question 2

12 Principles of Good Health

Answer 2

To have control (what happens/ pain relief/ where death occurs/ who is present)
To be afforded dignity/privacy
To be able to issue advance directives
To be able to leave when it is time/ no pointless prolongation
To know when death is coming/ understand expectations
To have access ( info/expertise/spiritual/emotional support/hospice care at any location)

Question 3

3 Broad Themes of Good Death

Answer 3

Control
Autonomy
Independence

Question 4

End-of-life care

Answer 4

Control over individual care passes to medical/family in deteriorating conditions

Question 5

Hospital deaths problems

Answer 5

Low patient-physician communication/knowledge of wishes
ICU can be traumatic and stressful

Question 6

End-life-deaths

Answer 6

Homes 19%
Hospitals 66%
Palliative care 4.3% in hospice

Question 7

Palliative care vs Hospice

Answer 7

Palliative care provides psycho-social support to individuals nearing the end of life with treatments aiding comfort and Hospice specializes in the same support but for more near-death patients

Question 8

The ‘Will’ to live

Answer 8

A psychological component to death
The role of patient state of mind over timing
The role of significant events for individual
The role of socio-cultural factors

Question 9

Timing of death is associated with holidays

Answer 9

People are more likely to die during or shortly after holidays, related to gender and involvement
American-Chinese women in the Harvest Moon Festival
Jewish men in Passover
Men and women at Christmas and Easter
Men and women a month after January 1st

Question 10

Levy: Self Perception and Will to Live of Aging on Dying

Answer 10

Longitudinal 23-year study investigating
IV: self-perception of aging and will to live
DV: mortality
Individuals with more negative views (perception of aging) tend to have earlier deaths.
An average of 7 1/2 year lifespan difference.
The will to live was a mediating factor, an influencing force.

Question 11

Medical Assisting in Dying (MAID)

Answer 11

Third-party as an active force aiding the death of patients, often through pharmaceuticals.

Question 12

MAID (before 2015)

Answer 12

Aid to suicide was a criminal offense.
To avoid premature deaths
In fear of the patient being incapable when reaching intolerable suffering.
No one is entitled to consent to die.
Infringed right of a competent adult to make personal decisions as a result of a grievous medical condition causing intolerable suffering.

Question 13

MAID (Carter V. Canada)

Answer 13

Overboard of ban for non-vulnerable people

Question 14

MAID regulations

Answer 14

MAID options
Clinician-administered: The physician directly administers the substance causing death.
Self-administered: prescription of drug where patient brings their own death.
Eligibility
Canadian, 18 years old and mentally stable, voluntary decision, and suffering of irremediable and grievous condition
Consent is given (consent can always be withdrawn except with MAID)
Condition criteria
Serious illness, disease, or disability that is irreversible and advancing the state of decline. It excludes mental illness and is not only for fatal/terminal conditions.

Question 15

Life after death

Answer 15

Belief in life after death relates to better mental health
Anxiety, depression, obsession-compulsion
The belief has to do more with the agency than religious activity

Question 16

Prayer and symptom severity

Answer 16

A positive relationship where the more prayer the worse the severity of the symptom is observed.
Relationship with worry
The major common aspect of those who develop PTSD and chronic illness from symptoms is high worry.

Question 17

Life after death and Will to live/Perception of aging

Answer 17

Belief in life after death can influence the perception of aging and the will to live.
It can bring closure to others as well.

Question 18

Organ Donation

Answer 18

A health behavior that beliefs can influence.

Question 19

CIHI: organ donor Stats Canada

Answer 19

A high waitlist of people needing donations over donors.
19.2 donors/million
Most die before getting a donation.

Question 20

Shah: Influence on organ donation

Answer 20

Meta-analyses on public attitudes on brain death and vital organ transplantation
3 main issues the public did not understand
1. Uncontested biological factors of brain death - it is an irreversible condition
2. Having a heartbeat when brain death - it maintains the organ alive for donation
3. The legal status of brain death- are they still alive?

Question 21

Breshanhan and Zhuang: communication

Answer 21

Communication and informing the family about the brain death scale aids the possibility of donation.