Lecture 10: Death & Dying Flashcards
(19 cards)
Process of death
- Majority of people have a long, drawn-out
death - Physical suffering is not uncommon
- Shortly before death, see a decrease in:
– Activity level
– Interest in surroundings
– Body temperature
– Blood pressure
– Breathing regularity
Phases of death
- Agonal phase
- Struggle - Clinical death
- No vital signs but can be resuscitated - Mortality
- Permanent death
Honesty surrounding death
Attitudes toward death
- Young generations often reach adulthood without
experiencing death of someone they know - Death more often occurs in medical setting, under
medical care - Rare to directly discuss death
- Fear of death common
Death anxiety
- Many individual and cultural variations in
death anxiety
– Among Westerners, spirituality > religious
commitment limits death anxiety
– Death anxiety declines with age - lowest in late adulthood
– Regardless of age, in both Eastern and Western
cultures, women are more anxious about death
than men
– Experiencing some anxiety about death is normal
Measuring death anxiety
- Collett-Lester Fear of Death Scale-Revised (CL-R)
- Measures fear of one’s own death and dying and
fear of someone else’s death and dying. - Rate on a scale of 1-5:
– How disturbed are you about: - The shortness of life?
- The pain involved in dying?
- The lack of control over the dying process?
- The loss of someone close to you?
- Watching someone suffer from pain?
Another death anxiety test
- Death Anxiety Scale
– Templer (1970)
– 15 T/F statements
– Two-factor model - Death anxiety is driven by
– psychological health
– life experiences relating to death
– DAS-Extended (2006) - 51 items
Stages of dying: Kübler-Ross
- Denial: person denies seriousness of terminal illness to
escape prospect of death - Anger: to die without having a chance to do all they wanted
to - Bargaining: person tries to strike a deal for extra time
- Depression: person becomes depressed about dying
- Acceptance: typically reached only in the last weeks or days
Theory misunderstood, what it was meant to be
She didn’t want her five stages viewed as a fixed sequence
or a universal pattern.
* But simplistic interpretation of her theory has sometimes
hurt medical care approaches:
– health professionals to try to push patients through the
sequence
– dismiss a dying patient’s legitimate complaints about treatment
* The five reactions can be viewed as coping strategies that
anyone may call on in a situation of loss
– But dying people react in many additional ways
* Main drawback: theory looks at dying patients’ thoughts
and feelings without the contexts that grant them meaning
in their lives
What is a “good death”?
– clarifies the meaning of one’s life and death
– give sense of control over remaining time
– maintains sense of identity, continuity with past
– maintains/enhances relationships
Contextual Influences on
Adaptations to Dying
Appropriate death: a death that makes sense in
terms of the person’s pattern of living and
values while preserving or restoring significant
relationships. As free of suffering as possible.
Contextual Influences on
Adaptations to Dying
- Nature of the disease
- Personality and coping style
- Family members’ and health professionals’
behavior - Spirituality, religion, and culture
Music in Palliative Care
- 25 adults (ages 18-90) in inpatient hospice
care for end-stage terminal disease. - Randomly assigned to:
– experimental group: received a single music
therapy session by a trained musical therapist or,
– control group: received a single session with a
hospice volunteer who interacted with the patient
but did not engage in any musical activities
Results
- Assessed changes in anxiety level using
standardized anxiety scale before and after the
session. - Results:
– Greater decline in anxiety in experimental group
– Less fatigue following session in experimental group - Implications: music may have a stimulating/
uplifting effect on palliative care patients. - Other work has shown that music can enhance
the effects of pain medication.
The right to die
- Many countries/states have laws to honor patients’ wishes
re withdrawal of treatment in cases of terminal illness or
sometimes in cases of a persistent vegetative state
– But vast differences in right-to-die laws - Passive euthanasia: life-sustaining treatment is withheld or
withdrawn and permits a patient to die naturally
– widely practiced as part of ordinary medical procedure - Important to have guidelines documented while still able
to advocate for self
– living will
– power of attorney for health care
Grief process as a set of tasks
- accepting the reality of loss
- On hearing the news, survivor experiences shock,
then disbelief
– “emotional anesthesia” - working through the pain of grief
– mourner begins to confront reality of the loss;
grief most intense
– Wide range of emotional reactions
– Loss of sleep and appetite are common - adjusting to a world without the loved one
- dual-process model of coping: to cope effectively,
people alternate between dealing with emotions and
attending to life changes
- restoration-oriented events (e.g., visiting friends,
attending religious services), reduce the stress of
grieving
– As grief subsides, emotional energies shift toward
forging a symbolic bond with the deceased and
moving on with life
Personal and Situational Variations
- Gender
– Men express distress and seek social support less - Quality of relationship with deceased
- Sudden unanticipated vs. Prolonged expected
deaths - Death of a child
Young people grieving
– Parent’s death: basic sense of security and being
cared for is threatened
– Sibling’s death: deprives children of a close friend,
makes clear their own vulnerability
– school-age children usually more willing to confide
in parents than adolescents
Bereavement Overload
- Can occur when a person experiences several
deaths in succession - depletes the coping resources of even welladjusted people,
– emotionally overwhelmed, unable to resolve grief - Elders at high risk
- Funerals and other rituals help manage grief
