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Questions and Answers
Which component is NOT a part of the definition of whole-brain death?
Which of the following is associated with active euthanasia?
In the context of Voluntary Assisted Dying (VAD), which eligibility requirement is NOT necessary?
Which ethical principle is concerned with ensuring people do not become a burden to others in the context of euthanasia?
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Which statement regarding persistent vegetative state is correct?
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What is the primary purpose of advance directives?
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Which of the following is TRUE about hospice care?
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What distinguishes grief from bereavement?
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What is the main function of advance care planning (ACP)?
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Which statement best describes the grieving process?
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Which type of document allows a person to express their medical treatment preferences when they cannot communicate?
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What is a common misconception about advance care directives?
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Which of the following is NOT one of the stages of grief identified?
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What are the four dimensions of tasks identified in Corr's Contextual Theory of Dying?
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According to the content, death anxiety is reported to be higher in which age group?
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What is one of the suggested ways to cope with death anxiety?
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What is the purpose of the 'Dying to Know Day' event?
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What does death literacy entail?
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What aspect of the final scenario is considered crucial according to the information provided?
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Which theory addresses behaviors driven by deeply rooted concerns about mortality?
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Study Notes
Thanatology
- The scientific study of death and dying, including grief, bereavement, and social attitudes towards these issues.
Definitions and Ethical Issues
- Clinical Death: Lack of heartbeat and respiration
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Whole-brain death: Most widely accepted definition of death today, includes:
- Irreversible loss of all functions of the entire brain
- All brainstem reflexes have permanently stopped working
- Breathing has permanently stopped
Persistent Vegetative State
- Occurs when cortical functioning ceases, while brainstem activity continues.
- People in this state do not recover.
- Brain damage and coma but can display signs of a “sleep-wakefulness” cycle.
- Absence of self-awareness, attention, recognition, stimuli, and learned responses.
- Typically irreversible.
Euthanasia
- Active euthanasia: Deliberately ending someone’s life through intervention or action
- Passive euthanasia: Ending someone’s life by withholding treatment
- Physician-assisted suicide: Provides people with a prescription for self-administered lethal doses of medication.
Voluntary Assisted Dying (VAD)
- In order to access VAD, a person must meet strict eligibility criteria, including:
- Age 18 or over
- Australian citizen or permanent resident, ordinarily resident in Victoria, and resident in Victoria for at least 12 months.
- Decision-making capacity
- Diagnosed with an incurable, advanced, progressive disease, illness, or medical condition causing death within 6 months, and causing suffering that cannot be relieved in a manner that the person finds tolerable.
Euthanasia: Ethical Concerns
- Hippocratic Oath: Do no harm, to benefit the sick. This oath opposes euthanasia.
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Ethical Concerns:
- Beneficence: People have a duty not to be a burden.
- Justice: People should not take more than their fair share.
- Georges and colleagues (2007): 87 relatives of people who died by euthanasia in the Netherlands reported that 92% found euthanasia a favorable contribution to patient quality of life by preventing or ending suffering.
Dealing with Our Own Death: Kübler-Ross's Stages
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Kübler-Ross's Theory:
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
- These stages can overlap and be experienced in a different order.
Dealing with Our Own Death: A Contextual Theory of Dying
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Corr identified four dimensions of tasks that must be faced by those nearing death:
- Bodily needs
- Psychological security
- Interpersonal attachments
- Spiritual energy and hope
- Emphasizes the tasks and issues that a dying person must face.
Death Anxiety
- People’s anxiety or fear of death and dying.
- Terror Management Theory: People engage in behaviors to achieve psychological states based on deeply rooted concerns about mortality.
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Death anxiety consists of several components:
- Public
- Private
- Nonconscious
- Death anxiety may have a beneficial side.
Death Anxiety: Prevalence
- Higher for younger adults and middle-aged than older adults.
- Death anxieties center on annihilation: Complete loss of existence of self and body.
- Cicerelli’s transition model: Those with remaining purposeful goals and a discrepancy between desired and expected life expectancy have more death anxiety.
Coping with Death Anxiety
- Living life to the fullest is one way to cope with death anxiety.
- Koestenbaum proposes exercises to increase one’s death awareness.
- Death education is an increasingly popular way to reduce anxiety.
Dying to know Day
- August 8th: Annual day of action dedicated to bringing to life conversations and community actions around death and dying
- Launched in 2013 and has seen over 350 events and sparked thousands of conversations about death and dying.
- Promotes death literacy.
Final Scenario
-
End-of-life issues:
- Managing the final aspects of life.
- After-death disposition of the body and how someone is memorialized.
- Distribution of assets.
- Making choices about what people do and do not want done.
- Process of separation from family and friends: Bringing closure to relationships.
Death Literacy
- Includes knowledge, skills, and the ability to take action.
- Recognizes the role that everyone has in end of life care and death care.
- Having knowledge helps us make informed decisions.
- Being able to act on that knowledge is empowering.
What Drives People to Plan Ahead (or Not)?
- Recent hospitalization
- Death of a family member
- Education
- Death anxiety
- Belief in physician decision making
- People procrastinate
Advance Directives
- Legally binding medical treatment decisions.
- Living will: A person states his or her wishes about life support and other treatments.
- Durable power of attorney: An individual appoints someone to act as his or her agent for health care decisions.
- The purpose of both is to make one’s wishes about the use of life support known if they are unconscious or incapable of expressing them.
- Can also serve as the basis for Do Not Resuscitate (DNR) medical orders.
Advance Care Plans
- When preferences are not clear, it is difficult to move to palliative care.
- Appoints a substitute decision maker and documents values, beliefs, and preferences to provide clarity for health professionals.
- New residents in RAC 4 times more likely to complete a plan if introduced to ACP.
- But only 5% of residents have documented advance care directives.
Hospice
- An approach to assisting dying people that emphasizes palliative care and death with dignity.
- Hospice care emphasizes quality of life rather than quantity of life.
- The goal is to de-emphasize the prolongation of death for terminally ill patients.
- Both inpatient and outpatient hospices exist.
- The role of the staff is to be with patients, not to treat the patient.
The Grieving Process
- Bereavement: The state or condition caused by loss through death.
- Grief: The sorrow, hurt, anger, guilt, confusion, or other feelings that arise after a loss.
- Mourning: The way we express our grief. Mourning is heavily influenced by cultural norms.
The Grieving Process: Process of Grief
- A complicated and personal process.
- Unlike bereavement, over which we have no control, grief is a process that involves choices:
- Acknowledge the reality of the loss
- Work through the emotional turmoil
- Adjust to the environment where the deceased is absent
- Loosen ties to the deceased
- Grief is an active coping process.
Risk Factors in Grief
- Sudden death vs. prolonged death
- Strong attachments
- Lack of social support
- Kinship
Typical Grief Reactions
- Grief work: The psychological side of coming to terms with bereavement. Grief involves coping, affect, change, narrative, and relationship. Displays of grief vary.
- Physical health may decline while grieving.
- Anniversary reaction
- Grief over time: Grief work tends to peak within the first six months, but people can grieve many years after the loss.
Coping with Grief: Models
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The Four Component Model:
- The context of the loss
- Continuation of subjective meaning associated with loss
- Changing representations of the loss relations over time
- The role of coping and emotion-regulation process
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The Dual Process Model (DPM): Considers two broad types of stressors:
- Loss-oriented stressors
- Restoration-oriented stressors
Complicated or Prolonged Grief Disorder (DSM-5-TR; 2022)
- A. Death that occurred at least 12 months ago, of a person close to the bereaved individual.
- B. Development of a persistent grief response.
- C. Since the loss, at least three of the full list of symptoms have occurred nearly every day for at least the last month.
- D. The disturbance must cause clinically significant distress or impairment in daily functioning.
- E. The duration and severity of the bereavement reaction clearly exceeds expected cultural or social (etc.,) norms.
- F. The symptoms are not better explained by another mental disorder or cannot be better attributed to the effects of a substance or medical condition.
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Description
Test your understanding of thanatology, focusing on the scientific study of death, dying, and related ethical issues. This quiz covers definitions of clinical and whole-brain death, the persistent vegetative state, and forms of euthanasia. Assess your knowledge and explore the complexities surrounding these critical topics.
