ch. 19 death dying and bereavement
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3 phases of death
- agonal phase, clinical death, and mortality
- -for 3/4 of people dying is long drawn out process. people who die suddenly are usually from a heart attack.
the agonal phase
-refers to gasps and muscle spasms during the first moments in which the regular heartbeat disintegrates
clinical death phase
a short interval follows in which heartbeat, circulation, breathing, and brain functioning stop but resuscitation is still possible
the individual passes into permanent death. within a few hours the newly lifeless being appears shrunken, not at all the person they where when alive.
- irreversible cessation of all activity in the brain and brain stem.
- -people often remain in a persistent vegetative state, the cerebral cortex no longer works but brain stem remains active.
- fear and apprehension of death.
- -older adults are less anxious than younger.
- -beliefs in religion and so on predict less anxiety.
- -makes sense in terms of the individuals pattern of living and values and at the same time preserves or restores signifigant relationships and is as free of suffering as possible.
- -nature of disease, personality, coping strategies all play a part.
- -how people respond to their own dying and the extent to which they have an appropriate death.
- a comprehensive program of support services for terminally ill people and their families. it provides patients and families ability to prepare for death in ways that are satisfying to them.
- -although most people want to die at home, many do not
- -hospice provides palliative/comfort care where they focus on the quality of remaining life rather than prolonging it.
practice of ending the life of a person suffering from an incurable condition
- life sustaining treatment is withheld permitting a patient to die naturally.
- -widely accepted and practiced.
- -people can best ensure their wishes will be followed by preparing a written advance medical directive aka living will. this contains instructions for treatment.
- -opposite of living will, durable power of attorney names another person to make decisions on one's behalf
voluntary active euthanasia
- doctors or others who act directly at a patients request to end suffering before a natural end to life.
- -public support is high but it is still considered a criminal offense in most countries.
- -people fear it will lead us down a slippery slope to the killing of vulnerable people who did not ask to die.
-less public support for assisted suicide than voluntary active euthanasia. but bcuz the final act is solely the patients, some experts believe that legalizing suicide is preferable over vol. act. euthanasia
- the experience of losing a loved one by death
- -grief, instense stress physical and mental
- -mourning, thoughts and feelings designed to help work thru their grief.
- -men experience less grieving than bereaved women.
dual process model of coping with loss
- effective coping requires people to move back and forth btwn dealing with the emotional consequences and attending to life changes. which offer temporary distraction from painful grieving.
- -grieving is not done in orderly phases but more like a roller coaster
acknowledging that the loss in inevitable and preparing emotinally for it.
Kubler Ross Theory of dying stages (DAB-DA)
- -dying people typically express 5 responses initially proposed as "stages": denial, anger, bargaining, depression, and acceptance.
- -these do not occur in a fixed sequence.
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