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1

Thanatology is

  • the study of death, dying, grief, bereavement and social attitudes towards these issues

2

Legal and medical definitions of death

  • Clinical death: lack of heartbeat and respirations
  •  
  • Whole brain death (to be declared dead): (all 50 states use this method)
  • No spontaneous movement in response to any stimuli including painful stimuli
  • No spontaneous respiration for at lease an hour
  • No eye movements, blinking, pupil response
  • No postural activity - swallowing, yawning, vocalizing
  • No motor reflexes
  • Flat EEG for 10 min
  • No change 24hr later

3

Persistent vegetative state

  • cortical functioning ceases while brainstem activity continues but person does not recover
  • Drug OD
  • Severe head injury
  • Disruption of blood flow to the brain

4

Bioethics is

  • the study of interface between human values and technological advances in health and life sciences
  • Grew out of 2 bases:
  • Respect for individual
  • Impossibility of establishing one single version of morality by rationality or common sense

5

euthanasia

  • ending life for reasons of mercy

6

euthanasia: active and passive 

  • Active : deliberate ending based on a clear statement of the person's wishes or made by someone else who has the legal authority to do so
  • Passive : allowing someone to die by withholding treatment

7

Physician assisted suicide 

  • physicians provide a fatal dose of medication that the patient self-administers
  • Most americans favor it in cases of terminal illness/pain
  • Netherlands was the 1st country to legalize it

8

Cost of life sustaining care

  • One side says Needlessly keeping people on machines is costing a burden on society
  • Other side says humans should not play god and decide when it is time to end it
  • Only 7% of hospital people die every year but end of life accounts for 25% of hospital bills

9

developmental pattern for thoughts about death

  • Older adults are less anxious and more accepting than other age groups but anxiety is worse for the younger-old adults
  • Older ones are more resigned to it and used to the idea since many of their friends have died too
  • Shift from formal operational thinking to post-formal thinking could be important in young adults' contemplation of death, lessening the feeling of immortality
  • Midlife is when you confront death of your parents - until then people don't think much of death
  • Once your parents die, you are next in line - perspective shifts from how long you've lived to how long you have left to live - may lead to an occupational shift or bettering of bad relations

10

  • KUBLER ROSS
    • 5 steps that can overlap and be experienced in different order

  • 1) denial
  • 2) anger
  • 3) bargaining
  • 4) depression
  • 5) acceptance

11

Contextual Theory of Dying 

  • Difference between this and kubler is that this holistic approach acknowledges individual differences and rejects broad generalizations
  • 4 dimensions a person faces
  • Bodily needs
  • Psychological security
  • Interpersonal attachments
  • Spiritual energy and hope
  •  
  • Need to have an inclusive and wide view of the different ways in which people die
  • Socio-environmental where dying occurs context changes over time and must be recognized

12

Death anxiety

  • people's anxiety and fear of death
  • Complex, multi-dimensional construct
  • Measurement of death anxiety is complex but can include: 

    Pain

    Body malfunction

    Humiliation

    Rejection

    Nonbeing

    Punishment

    Interruption of goals

    Being destroyed 

    Negative impacts on survivors 

13

Terror management theory 

  • addresses the issue of why people engage in certain behaviors to achieve particular psychological states based on their deeply rooted concerns about mortality
  • How can I continue my life: art, offspring
  • Some suggest that old people present an existential threat to younger people because they remind us of death, so plastic surgery etc

14

15

Dealing with death anxiety

  • Older adults tend to have less death anxiety than younger adults
  • Men fear the unknown more but women are fearing of the dying process
  • Live life to the fullest so you have fewer regrets
  • Write your own obituary, plan your own funeral
  • Death education programs combine factual info with psychological strategies for dealing : philosophy, ethics, psych, drama, religion, medicine, art ; increase awareness of complex emotions felt and expressed by dying people and their families
  • Participating in workshops lowers death anxiety in younger, middle-aged and older adults

16

End of life issues

  • management of the final phase of life, after death disposition of body, memorial services and distribution of assets
  • Parents and gparents of baby boomers rarely discussed things so baby boomers are much more likely to plan things like
  • Advance directives
  • Nursing home decisions
  • Euthanasia
  • What happens to one's body

17

Final scenario

  •  making choices known about how they do and do not want their lives to end
  • It all adds to a sense of personal control
  • Helps family and friends interpret one's death especially when it is created openly between spouses 

    Respective others perspective helps to create a good final scenario 

     

18

Hospice is

  • an approach to assist dying people emphasizing pain management, palliative care and death with dignity
  • Emphasis is on person's quality of life
  • Dignity: appearance, personal grooming are important 

Who:

Cancer, aids, cardio, pulmonary, neuro, dementia, 2/3 over 65 and in last 6 months of life 

19

Palliative care

  • is focused on providing relief from pain and other symptoms of disease at any point during the disease process

20

2 types of hospice: 

  •  inpatient and outpatient
  • Outpatient, a hospice nurse visits them at home and becoming increasingly popular because of cost

21

Considerations upon deciding to go to hospice: 

  • Is the person completely cognizant about their prognosis
  • What options are available - any new options to treat?
  • What are their expectations, hopes, fears
  • How well do people in the person's social network communicate - best to have open communication about death and dying
  • Are family members able to actively participate in hospice care?
  • Is a high quality hospice care program available?
  • Is it covered by insurance?

22

Living will vs health care power of attorney 

  • Living will a person simply states his or her wishes about life support and other treatments in a health care power of attorney an individual appoints someone to act as his or her agent for health care decisions

23

Do not resuscitate DNR means

  • CPR is not to be started should one's heart and breathing stop

24

Two types of determination regarding end of life: 

  • Capacity  Functional assessment and clinical determination  made by PHYSICIAN  Can change over time
  •  
  • Competency  global assessment and LEGAL determination  made by a JUDGE  Very difficult to change, requires new court case, evidence

25

Bereavement is

  • the state or condition caused by loss through death

26

Grief is

  • sorrow, hurt, anger, guilt, confusion and other feelings that arise after suffering a loss

four aspects to confront: 

1) reality of loss

2) emotional turmoil

3) adjusting to the environment

4) loosening the ties with the deceased 

27

Mourning concerns 

  • the way you express your grief

28

anticipatory grief 

  • supposedly buffers the impact of the loss

29

Grief work is 

  • the psychological side of coming to terms with bereavement

30

Muller Thomson grief work model

  • Coping: what will help
  • Affect: emotional reaction
  • Change: way your life changes as a result
  • Narrative: stories they tell about the loved one
  • Relationship: who the deceased was and what they meant to the survivor