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HG&D Chapter 19 Dealing with Death and Bereavement (Facing Death and…
HG&D Chapter 19 Dealing with Death and Bereavement
Facing Death and dying
Grief
Grief Work
Grieving Patterns
Classic model
1 Shock and disbelief
3 resolution
2 preoccupation with
memories of the
deceased
Variations of the classic model
absent grief pattern
Chronic grief
especially bad with ambiguous loss
commonly expected pattern
Bereavement
Physical and cognitive changes preceding death
Near Death Experiences (NDE's)
Due to some combo of Anoxia death, genetic predisposition and other factors
terminal drop/terminal decline
Confronting one's own death
Kubler-Ross Model
denial->anger->bargaining-> depression->acceptance
attitudes about death across life span
Childhood and Adolescent
5-7 they understand the following
universal
nonfunctional
inevitable
irreversable
These realizations occur overtime they only start to understand these at 5-7
Manifestations of grief in children
3-5 years
school aged children
Under 3 years
adolescents
Adulthood
20-30 yr olds attitudes when faced with death
feel like their entire world is collapsing at once
Middle aged attitudes when faced with death
Making a will
planning funerals (for themselves and parents)
discuss final wishes
Older adults reaction to death
Life review
Ericksonian Stage Integrity versus Despair
attitudes range from
widower's
More likely to follow their spouse to the grave
Loss of support that a spouse gave throughout a lifetime
examples include reminding spouse to
eat right
all things you aren't concerned about when grieving
exercise
take their medications
males tend to die first
mental and physical problems associated with bereavement
problems with cognition due to bereavement
memory loss
difficulty concentrating
increased risk of mental disorders developing
depressed immune system
exhaustion due to stress of bereavement
Changing meanings of death and dying
The Mortality Revolution
Thanatology
People less likely to die in the following periods
infant death
Live from teenage years to old age
Childbirth death of mother
beat the following diseases
enteritis
tuberculosis
pneumonia/influenzia
Diarrhea
Care for the Dying
Hospice
Palliative Care
Life expectancy x<6 months
Palliative care started early in a terminal illness benefits
better quality of life
better emotional state
longer median survival time
locations
at a facility
at home
honoring the dying
Cultural Context
Different rituals and rites per culture
Never leave a dying person alone
Cremation
Egyptian Embalming
Different ways to cope with death per culture
have alter honoring dead at home (japan)
Laugh and try to feel joyful (Muslim)
Significant Losses
Surviving a spouse
Stresses of widowhood via Bereavement affect
Physical Health
impair immune system
chest pain
indegestion
headache/dizzyness
chest pain
Mental Health
memory loss
difficulty concentrating
heighten risk of developing mental disorders like
Anxiety
depression
insomnia
social dysfunction due all the other mental problems
social relationships correlate highly with good health
you are not exactly social when you grieve
Strength of surviving spouses
___
dead spouse = worse grieving
surviving spouse was economically dependent on dead spouse
poverty ensues
surviving spouse depended on the dead spouse to
say help them walk
be emotionally stable
way bad bereavement
remember their roles or their responsibilities, ,and medications
surviving spouse had structured their
entire life
entire identity
around the dead spouse
way bad bereavement
Losing a parent in Adulthood
can be maturing experience
help realize what is or isn't important in life
help realize their own mortality
help achieve stronger sense of self
bring a family closer togehter
resolve them to solve family dysfunctions
greater the following senses of
__
to others
commitment
responsibility
attachment
resolve a family member to care for and provide for the surviving parent
Losing a child
no matter the age comes as "cruel, unnatural shock"
parents will feel like failures
no matter the quality of their love and care for the child
difficulty letting go
intensity of parental grieving varies upon
Child's age
older the child correlates with worse bereavment
Cause of death
was it?
violent
peaceful
definitely affects grief
accidental
do they have other children
managing grief
sink into your
Hobbies
Interests
work
other social relationships
don'y try to forget your child no matter how much it hurts
best thing: remember them fondly (research backed best way)
religion
total effects of bereavement on parents
heightened risk of hospitalization for mental illness
heightened risk of death themselves
may cause marriage too
end in divorce
be much stronger
Parents of terminally ill child
ex) Childhood leukemia
Should definitely talk to child about death
Couple who have lost a child wished they had,
Conversation is really hard and parents don't want to acknowledge death to child but its best long term
majorly regret not talking about it
a miscarriage
Mourning
japanese
Ritual of Mizuko Kuyo
is a ritual of apology and remembrance
Americans
don't talk about miscarriages usually
very bad practice, best thing to do is find social support and talk about it and grieve to those who care enough to listen
response to losing a child
Female
feeling of grief, loss, or failure somehow on their part
Male
feelings of anger, frustration, and helplessness
find purposes and relief in helping their wives
grieving parents saw the following as
spouse most helpful
family helpful
doctors least helpful
Gestational length correlated to likelihood of divorce
miscarriage occurs prior to 20 weeks gestation
22% increase in likelihood of divorce
miscarriage occurs after 20 weeks gestation
40% increase in likelihood of divorce
Medical, Legal, and Ethical Issues: the "Right to Die"
Hastening Death
Doctor assisted suicide
FROM THIS MOMENT ON I AM SUMMARIZING OTHER PEOPLES ARGUMENTS. NONE OF THIS IS MY PERSONAL OPINION
Medical Arguments
Against Assisted
Misdiagnosis
mistaken Prognosis
telling someone that got a month left to live is way different than telling them, they have 1 year (cause you may have screwed up calculating how much time they likely have left)
possibility of future life saving advancements
For Assisted Suicide
The patient is killing themselves so Doctor doesn't violate "do no Harm" part of Hippocratic oath (and if they are willing to kill themselves they are probably suffering enough you should refer to the alleviate suffering argument
Hippocratic oath Mandates a doctor must relieve "as much suffering as possible"
Legal Arguments
Against Assisted Suicide
Enforceability of safeguards
Fear of lawsuits by family members over wrongful death
For Assisted Suicide
Help them make death quick, clean, and painless.
People will commit suicide regardless
(summary of their argument from here forth only)
Have human decency
1 more item...
Voluntary active euthanasia
Why do people support this (in my opinion) policy ?
They believe killing is morally justifiable and morally permissible in all circumstances as long as you have the informed consent of the person wanting to die
an argument they might make
1 more item...
People will do it anyway with or without you, so might as well regulate it and make it safe
Ethical arguments
For Assisted suicide
Self-determination
it is my choice to die
autonomy
it is my body
Against Assisted Suicide
killing even with consent is wrong
Protection for the disadvantaged (fear of social Darwinism)
say a person has some serious societal disadvantage
they are born disabled or otherwise crippled
1 more item...
They are in extreme poverty
1 more item...
they became crippled
1 more item...
The Death With Dignity Act
Oregon
End of life
Decisions and Cultural Attitudes
When do Americans (on average) favor allowing euthanasia
The terminally ill
Docs who deal with death get asked by dying patients to do
lethal injection (11% of the time Docs got asked for this)
Assist them in dying (18% of the time)
How often do doctors of the dying comply with these requests?
7% of the time
Options and Diversity Concerns
Issues of Hastening Death will becoming more pressing with the "Graying of America"
Different Cultural reactions to death
Chinese
Don't want to know exact details of terminal prognosis like
Exact time of death
Why
they consider any action that frightens or makes the dying sad very cruel and down right possibly evil
1 more item...
African Americans and Hispanics
Value life above all else
Why= more time with family
Will try therefore to live regardless of their quality of life
Navajo avoid negative
thinking
thought
Know the difference between
Suicide
Euthanasia
Passive Euthanasia
"Let them die" (don't help them die, don't prevent them from dying literally just allow them to die
Ways to Hasten Death
Stop Life Prolonging Medication
Stop Food or Water
Turn off Life Supporting devices
Active Euthanasia
Netherlands Active euthanasia
patient MUST be in continuous, unbearable, and incurable suffering
1.8% of total Deaths in Switzerland
"Mercy Killing"
Advanced Directives "Living Will"
Finding Meaning and Purpose in Life and Death
Reviewing a life