1) All cultures __
2) __ and __ also vary in different cultures.
3) Death can be a truly __, such as when major tragedies occur.
4) Death can be __ and __
have their own views
mourning rituals and states of bereavement
cross-cultural experience
personal and public
How do we determine someone has died?
clinical death: lack of heart beat and respiration; used for 100s of years as determining factor
Today's determination: whole brain death
criteria for whole-brain death
- no spontaneous responses to any stimuli
- no spontaneous respiration for at least one hour
- total lack of responsiveness to even the most painful stimuli
- no eye movements, blinking, or pupil responsiveness
- no postural activity, swallowing, yawning, or vocalizing
- no motor reflexes
- a flat EEG for at least ten minutes
- no change in any of these when tested again 24 hours later
Persistent vegetative state
occurs when cortical functioning ceases but brainstem can still be active
the person does not recover
allows for spontaneous heartbeat and respiration, but not for consciousness
whole-brain standard not met
Bioethics
examines the interaction between human values and technological advances
Grew from two bases:
- respect for individual freedom
- impossibility of establishing any single version of mortality by rational argument or common sense
The most important bioethical issue is __, which is __
euthanasia; the practice of ending life for reasons of mercy
Two types of euthanasia
active: deliberately ending someone' slife through some sort of intervention or action; based on a person's wishes or power of attorney; ex: drug overdose or mercy killing
passive: ending someone's life by withholding treatment (ex: stopping chemo)
Controversy with euthanasa
religious and political beliefs
True or False:
Some ethicists and medical professionals don't differentiate between active and passive.
true
Physician assisted suicide
provides for people to obtain prescriptions for self administered lethal doses of medication
Research on PAS
70% of amerians favor having a choie
Where is PAS allowed?
in several countries--Belgium, Switzerland, and Columbia
Oregon and Washington
Rules of PAS
physician must explain illness and discuss alternatives
two oral and one written request with 15 days between each
PAS seems to have __.
What is an argument against it?
psychological benefits
who has the right to play God
A Life Course approach to Dying
Young adults report what?
Middle aged adults do what?
Older adults do what?
young: report a sense of being cheated by death
middle aged: begin to confront their own mortality; undergo a change in their sense of tie lived and time until death; when their aprents die, they realize thy are the oldest generation
older adults: are less anxious and more accepting of death
Kubler Ross theory
Denial
Anger
Bargaining
Depression
Acceptane
These stages can overlap and be experineced in a differnt order
Individual differences are great
Corr'scontextual theory of dying
Corr ID'ed four dimensions of tasks that must be faced:
1) bodily needs
2) psychological security
3) interpersonal attachments
4) spiritual energy and hope
Death anxiety
people's anixety or fear of death and dying
Death anxiety may have a beneficial side. How so?
it reduces impulses
Death anxiety consists of several components that can be accessed at the __, __, and __ levels.
public
private
noncounscious
Examples of related behaviors in response to death anxiety.
cosmetic surgery
having children and raising them properly
Age and gender in terms of death anxiety
older adults have less anxiety
men are more fearful of the unknown
women are more fearful of the dying process
teens engage in risky behaviors because of their low death anxiety
Terror Management Theory
addresses why people engage in certain behaviors to achieve particular psychologial states based on their deeply rooted concerns about mortality
Neuroimaging research supports the use of this theory in understanding death anxiety
Selecting behaviors that serve as buffers and keep you alive
How does one deal with death anxiety?
living life to the fullest
exercises to increase one's death awareness, such as writing obituaries and planning funeral services
death education
End of life issues
managing the final aspects of life
after death disposition of the body and how one is memorialized
distribution of assets
writing a will
Grandparents and parents of baby boomers in terms of end of life issues
rarely made plans
today' generation has a much more "matter of fact" stance
A final scenario
making choices about what people do and do not want done
a crucial aspect of the final scenario is the process of separation from family and friends (bring closure to relationships)
Health care workers understand the importance of __.
__ and __ is critical.
__ is also important
the final scenario
open and honest communication
respecting an individual's decisions
The hospice option
an approach to assisting dying people that emphasizes pain management (palliative care) and death with dignity
Hospice care emphasizes __ rather than __.
- The goal is a deemphasis on the __.
Both __ and __ exist, the latter being cheapter
quality of life; quantity of life
prolongation of death for terminally ill patients
inpatient and outpatient hospices
The role of the staff in hospice
to be with the patients, not to treat them
grooming and appearance
leads to more mobility, less anxiety and depression, more participation
Making your end-of-life intentions known
living will
durable power of attorney
living will
a person simply states his or her wishes about life support and other tx
durable power of attorney
an individual appoints someone to act as his or her agent for health care decisions
many are not told
The purpose of making your end of life intentions known?
to make one's wishes about the use of life support known in the event one is unconscious or otherwise incapable of expressing them
End of life intentions an also serve as the basis for __
DNR (do not resuscitate)
medical order which is used when cardiopulmonary resuscutation is needed
What is the Patient Self-determination and competency evaluation
health care facilities must provide info in writing about patients' rights
What are the two types of determination as to whether a person can make decisions?
capacity to make decisions (clinical(\)
competency (legal)
True or False: Surrogate decision makers are often right about what patients really want.
False: They are usually wrong
bereavement
the state or condition caused by loss through death
(the situation you're in after the death; ex: widow)
grief
the sorrow, hurt, anger, guilt, confusion, etc. that arise after a loss
the emotion
mourning
the way we express our grief (ex: crying)
The grief process
a complicated and personal one; described as reflecting on many themes and issues that people confront
Unlike bereavement, over which we __, grief is a process that __
have no control
involves choice
A person, in the grief process, must do four things
acknowledge the reality of the loss
work through the emotional turmoil
adjust to the environment where the deceased is absent (outsiders have to help with this)
loosen the ties to the deceased
Recover and the grief process?
it's misleading; we need to learn how to live with it
Dual process model
ther e are two types of stresors
loss oriented: concern the loss itself
restoration oriented stressors: involve adapting to the survivor's new life situation
there is a cycle back and forth
What distinguishes prolonged grief?
separation distress: preocupied with the deceased to the point that it interferes with everyday life
traumatic distress: disbelief about the death; the experience of physical presence of the deceased; mistrust, anger, and detachment from others
