Flashcards in Exam 2 Deck (74):
1
What are the differences between active and passive euthanasia?
• Active Euthanasia: actively taking steps to end another person’s life. Illegal – injecting.
• Passive Euthanasia: withholding or withdrawing treatment.
2
What is VSED?
• Voluntary stopping of eating and drinking
• Legal for competent and terminally ill.
• Die by dehydration.
3
What is Double effect?
• Death from treatment is allowed if harm not intended, and if it is a side effect of beneficial action.
o E.g. up doses of meds for pain management but causes breathing problems and patient dies
4
What is Terminal Sedation?
• Alternative selected by physicians who are committed to relieving a dying patient’s distress without resorting to active euthanasia.
• Medications keeps the patient in deep sedation or coma until death.
• Used most often when the patient is suffering severe pain, agitation, or dyspnea.
5
What is Assisted death?
• When a person with a terminal illness ends his/her life with a lethal prescription from a doctor.
6
Where in the U.S. is Assisted death legal?
• Oregon, Washington, California, Colorado, Washington D.C., Montana, Vermont, Hawaii
How old was my very calm, white cat
7
In what countries is assisted death legal?
o Netherlands
o Switzerland
o Canada
o Germany
8
In what countries is euthanasia legal?
o Netherlands
o Belgium
o Canada
9
In what countries can children use euthanasia and assisted death?
o Netherlands (12-17 years)
o Belgium (no age limit)
10
In which country is assisted death legally open to foreigners?
o Switzerland – DIGNITAS
11
What are the arguments for and against assisted death regarding autonomy
people should make their own decisions
12
What are the arguments for and against assisted death regarding kindness
o For: It’s a kind thing to give someone the chance to end their own life with a sense of control.
o Against: not kind, you are abandoning them.
13
What are the arguments for and against assisted death regarding professional integrity
o For: Doctors are there to relieve suffering.
o Against: against oath to do no harm, violates ethics
14
What are the arguments for and against assisted death regarding societal consequences?
o Against: slippery slope – risk to opening it to a lot more people or make them feel vulnerable and forced (mental illness and older people)
• Risk of broadening law.
• Risk feeling like a burden/finances.
15
What is the slippery slope argument?
• slippery slope – risk to opening it to a lot more people or make them feel vulnerable and forced (mental illness and older people).
• Contribute to widespread abuse.
• Pressure people to use it to avoid being a burden or because of health care costs; vulnerable groups can be pressured into it.
16
What happened in the case “It’s over, Debbie?”
• A young physician gave Debbie a dose of morphine sulfate that let her die.
• The woman was suffering from ovarian cancer. She did not respond to chemotherapy and hadn’t eaten or slept in 2 days.
• She said to the physician, “let’s get this over with.”
17
What is an orbitoria?
• centers that have assisted death upon request but also biomedical research on dying and death
18
Who is Dr. Kevorkian?
• Retired pathologist who gave a lethal injection to Thomas Youk.
• Convicted of second degree murder.
• Described his services as assisted suicide.
• Agenda included the establishment of centers in communities across the nation in which people could not only have assisted deaths upon their request, but also in which biomedical research could be done on dying and death – orbitoria.
19
Be familiar with:
Diagnosis of people Dr. Kevorkian worked with
Most of the people were not terminally ill.
Gender bias among his clientele
• Encouraged increased suicidality among women.
20
Dr. Kevorkian’s attempts to treat his client’s depression?
Failure to diagnose or treat their depression.
Overlap between Dr. Kevorkian’s clients and the profile of suicide attempters
• Those assisted by Kevorkian fit the general profile of suicide attempters rather than terminally ill people.
• They have high incidence of depression and dependency and low incidence of the conditions that are the most common causes of death in the US.
21
What happened in the story of Diane?
• 45 year old leukemia sufferer treated by Dr. Timothy Quill for several years.
• Given a 25% change of survival if she did a painful routine of chemo, radiation, and bone-marrow transplant. She refused treatment.
• She wanted to end her life at the right time before the disease had a chance to destroy her body completely and wanted Dr. Quill to help her.
• He prescribed Diane a lethal dose of barbiturates along with the instructions on how to take them for the desired effect.
• She had to repeat her understanding of the treatment, the odds, and what to expect if there was no treatment.
22
What are the eligibility and procedural requirements for the Oregon Death with Dignity Act?
• 18 or older
• Resident of Oregon
• Capable of making and communicating health care decisions for oneself.
• Diagnosed with terminal illness that will lead to death within 6 months.
23
What is the most mentioned reason for using the Oregon Death with Dignity Act?
• Fear of losing autonomy
24
What did Maria Nagy find in her study on children’s comprehension of death?
• She found that three age-related stages could be established.
25
Maria Nagy stages:
• 3-5 years old
o Death is a continuation of life in a diminished form.
o Less alive
o Death is temporary
o Curious about death
o What they know and don’t know can arose anxiety.
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Maria Nagy stages:
5/6-9 years old
o Death is final, but can be avoided.
o Death is personified.
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Maria Nagy stages:
9/10 - adult
o Death is personal
o Universal
o Final
o Inevitable
28
What are the recent findings since Maria Nagy's study?
• Tendency to personify death has diminished.
• Children move through stages earlier.
• Stage 3 – understanding the body can’t perform functions and that this leads to death.
29
What are the physical reactions to grief?
Physical: tired, fatigue, chest tightness
30
What are the Psychological reactions to grief?
Psychological: anger, sadness
31
What are the Cognitive reactions to grief?
Cognitive: difficulty reading or thinking
32
What are the Spiritual reactions to grief?
Spiritual: seeing/hearing person, doubting beliefs, feeling more connected
33
What are the Behavioral reactions to grief?
Behavioral: sleep more/less, crying
34
Freud’s Grief Work theory
o Time consuming (like a job- put the work in to feel better)
o Adaptive response to loss
o Accept reality of death and free self from attachment to the person who died.
35
Bowlby’s attachment theory as applied to grief
o Attachment bonds instill safety and security.
o If attachment threatened → emotional distress
o Grief is response to separation anxiety from severed attachment.
36
Parkes’ 3 components of grief work
o Studied psychosocial transitions – how do people attempt to get on with their lives after bereavement? Under what conditions does grief work fail, leaving the survivor in a state of prolonged social and personal dysfunction?
o Preoccupation with thoughts of the deceased person. - This represents a continuing search process, reminding us of the attachment seeking signals and behaviors Bowlby describes in many species.
o Repeatedly going over the loss experience in one’s mind. - This is a painful process in which the survivor seems to be testing out the reality of the loss (did this terrible thing really happen?).
o Attempts to explain the loss. - It is somewhat easier to accept the reality of a death if the loss makes sense, had a reason behind it. During this part of the grief-work process, the survivor is asking self and others “why?”.
37
Continuing Bond Theory
o Continuing a meaningful relationship with deceased loved one enhances ongoing life.
o Not living in the past.
o Ex: talking to loved ones, guidance in dreams, prayer, mediation, rituals.
38
Rando’s 6 R Process of Grief
o 1. Recognizing the loss
o 2. Reacting to the separation
o 3. Remembering the deceased
o 4. Relinquishing old attachments to the deceased and old assumptions of the world.
o 5. Readjusting to life without deceased person while still maintaining a connection.
o 6. Reinvesting in self
39
Kubler-Ross’s stages of Grief
o Denial is symbolic (can’t believe it happened)
o Bargaining
• Before loss
• Pain with grief
o Acceptance
• Accepting reality of loss
40
How is Kubler Ross’s stages of grief different from her stages of coping with illness?
• Its talking about the survivors.
41
What is disenfranchised grief?
• Grief that can’t be:
o Openly acknowledged
o Publicly mourned
o Socially sanctioned
• Grief can be intensified when it is hidden and as a result health process can be prolonged.
42
What are the five areas in which we see disenfranchised grief?
• The relationship is not recognized
o With ex partners, therapists
• The loss isn’t acknowledged
o Children who had a parent leave them, pets, miscarriage
• Circumstances of death
o Mass shootings, over dose, suicide
• The griever is excluded
o Children not told about death
• Grieving styles
o In society men don’t cry
43
What is ambiguous loss?
• Type of loss where there is:
o No closure
o Question as to whether loss occurred.
44
What are the differences between the two types of ambiguous loss?
o Physical presence and psychological absence.
• Dementia, mental illness, addiction
o Physical absence and psychological presence
• Loss of relationship: adoption, estranged, break-up
45
What is posttraumatic growth and the 5 types of posttraumatic growth that can occur?
• Positive changes following a traumatic event.
o 1. New opportunities that emerge from the struggle.
o 2. Change in relationship with others
o 3. Increased sense of one’s own strength
o 4. Greater appreciation for life.
o 5. Deepening or change in spiritual life
46
What is anticipatory grief and the impact on grief post death?
• Mixed results whether it has impact on grief post death
47
In what ways can anticipatory grief help ease grief post death and hinder grief post death?
How might it help? Address unfinished business, say goodbye, prepare for loss, grieve with loved one
• How might it hinder? Additional worry and stress
48
What unique grief factors are experienced after a sudden death? (I don’t like nutty nougets)
• Increased shock
• Difficulty making sense of death
• No time to address unfinished business
• No time to say goodbye
• Limited social support
49
What are the difference and similarities between CHILDREN, (adolescents and adults) following the death of a parent?
• Children:
o Loss of security
o Changed family structure: responsibility and fears
o Sense of “never having known” the deceased – parent living in shadow
o Guilt
50
What are the difference and similarities between children, ADOLESCENTS and adults following the death of a parent?
o Loss of security
o Changed family structure: taking on adult role and responsibilities
o Challenging or affirming spiritual beliefs
o Gaining a sense of own mortality
o Engaging in risky behaviors
o Loss of future dreams with parent
51
What are the difference and similarities between children, adolescents and ADULTS following the death of a parent?
o Loss of security
o Changed family structure (when you are the oldest generation)
o Sense of own mortality – AARP
o Strain on relationship with partner
o Guilt over caregiving, not being present for death
o Dysfunctional relationships: relief, mourning, potential hope.
52
What is plastination? (you don’t need to know the details of the process)
• Process that converts material into durable objects.
• Currently used to prepare anatomical specimen for biomedical education.
53
When and why was embalming established?
• Began during civil war times, deceased soldiers were sent home for burial.
54
What is embalming?
• A procedure that slows physical deterioration of a corpse by draining the body’s natural fluids and replacing them with a preservative fluid.
• Process can kill disease.
55
What percentage of people in the U.S. choose cremation?
50%
56
In what other nations/continents is cremation the most common practice?
• Europe
• Australia/New Zealand
• Britain
• China
• India
(Ethan And Brandon Can Ice skate)
57
What is involved with the cremation process?
• Pacemakers and medical devices removed
• Body is usually initially refrigerated
• Body is usually placed in a combustible container
• Casket placed in cremation chamber
• Temperature = 1400-1800 F
• Bones are processed into a fine powder
• Entire process takes about 3 hours
• Kills disease.
58
• Advantages of burial:
o Keep traditions of culture
o Place to visit
o Gives closure
59
• Disadvantages of burial:
o High cost
o Unnatural looking
o Bad for environment
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• Advantages of cremation
o Frees up land
o More affordable
o Portable
61
• Disadvantages of cremation
o Emotional difficulty with burning
o Air pollution
o Deciding who gets urn.
62
What is a green burial?
• Alternative to traditional burial and cremation
• Burial in biodegradable caskets, shrouds, blankets.
63
What are 3 advantages to a green burial?
• Reduced environmental impact
• Less resources
• More affordable
64
What movements did the practice of home wakes and funerals stem from?
• Extension of the home birth and home hospice movement.
65
How has society received the rise in women funeral directors?
• The public has had a favorable response. Many client families feel more comfortable in dealing with women. Frequently it is a widow who is making the arrangements. She may perceive a woman funeral director as more understanding and sympathetic.
66
Why was there reluctance in the past to hire women as funeral directors?
• There was enormous amount of lifting that is involved.
67
What are Near Death Experiences (be familiar with both the book and lecture definitions)?
• Images, perceptions, and feelings that are recalled by some people after a life threatening episode.
• Often contains transcendental and mystical elements.
• Instead of panic or despair, there is a sense of serenity and well-being.
68
What are the common features of a Near Death Experience (from lecture)?
• A sense of being dead
• Feeling of peace
• Out of body experience
• Tunnel experience (darkness)
• Religious figures – cultural variations
• Being of light
• Beautiful landscape
• Panoramic life review
• Reluctance to return (told to return, or give a choice)
• Positive personality transformation.
69
How do the following relate to alternative explanations for NDEs?
Lack of oxygen
• Lack of oxygen to the brain produces a dreamlike state.
70
How do the following relate to alternative explanations for NDEs?
Cortical disinhibition
• Lack of O2 to brain causes cells to fire randomly, producing the effect of a bright light in the center of a tunnel
71
How do the following relate to alternative explanations for NDEs?
Endorphins
• Create feelings of peace and pleasure.
72
How do the following relate to alternative explanations for NDEs?
Medications
• Reactions to medications
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How do the following relate to alternative explanations for NDEs?
Creating stories
• We create the story of a NDE to make meaning of a stressful situation.
74