Week 10 - Dying and Grief_Students.pdf

Week 10: Death, Dying, 3012PSY and Bereavement Learning Objectives Understand definitions of death Describe types of euthanasia and the controversy surrounding it Describe theories of how we deal with our own impending death Understand the concept of d...

Week 10: Death, Dying, 3012PSY and Bereavement Learning Objectives Understand definitions of death Describe types of euthanasia and the controversy surrounding it Describe theories of how we deal with our own impending death Understand the concept of death anxiety Understand end-of-life decisions Explain why people plan or not and the implications of this Describe the differences between hospital and palliative care Understand the grieving process Thanatology 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 ­ Whole-brain death is most widely accepted today ­ Includes three aspects: 1. Irreversible loss of all functions of the entire brain 2. All brainstem reflexes have permanently stopped working 3. Breathing has permanently stopped Persistent Vegetative State ­ Persistent vegetative state: occurs when cortical functioning ceases while brainstem activity continues; the person does not recover ­ Severe brain damage and coma but also show signs of a “sleep-wakefulness” cycle without awareness ­ Absence of self-awareness, attention, recognition, stimuli, learned responses ­ Typically irreversible Euthanasia ­Active euthanasia ­ Deliberately ending someone’s life through some sort of intervention or action ­Passive euthanasia ­ Ending someone’s life by withholding treatment ­Physician-assisted suicide ­ Provides for people to obtain prescriptions for self-administered lethal doses of medication Voluntary Assisted Dying In order to access VAD, a person must meet strict eligibility criteria, including that the person must: be aged 18 or over; be an Australian citizen or permanent resident, ordinarily resident in Victoria, and, at the time of making a first request for VAD, have been resident in Victoria for at least 12 months; have decision-making capacity; and be diagnosed with a disease, illness or medical condition that is: incurable; advanced, progressive and will cause death; is expected to cause death within six months; and is causing suffering to the person that cannot be relieved in a manner that the person finds tolerable Euthanasia ­Hippocratic Oath ­ Do no harm, to benefit the sick ­ In opposition to euthanasia ­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 because of suffering, loss of dignity, no prospect of recovery ­ 92% of relatives found euthanasia favourable contribution to patient quality of life by preventing/ending suffering Dealing with our own death ­Kübler-Ross’s theory 1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance ­These stages can overlap and be experienced in a different order Dealing with our own death A Contextual Theory of Dying ­ Corr identified four dimensions of tasks that must be faced ­ Bodily needs ­ Psychological security ­ Interpersonal attachments ­ Spiritual energy and hope ­ Emphasises the tasks and issues that a dying person must face, and although there may be no right way to die, there are better or worse ways of coping with death Death Anxiety ­People’s anxiety or fear of death and dying ­ Terror Management Theory: Addresses why people engage in certain behaviors to achieve particular psychological states based on their deeply rooted concerns about mortality ­Death anxiety consists of several components that can be accessed at the public, private and nonconscious levels ­Death anxiety may have a beneficial side Death Anxiety ­ 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 ­ Living life to the fullest is one way to cope with death anxiety ­ Koestenbaum proposes exercises to increase one’s death awareness ­ An increasingly popular way to reduce anxiety is death education 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 has sparked thousands of conversations about death and dying ­ Promote death literacy https://www.youtube.com/watch?v =ouEVusy7sQk Final Scenario ­End-of-life issues ­ Managing the final aspects of life ­ After-death disposition of the body and how one is memorialized ­ Distribution of assets ­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 ­ Bringing closure to relationships  Death Literacy ­ Includes knowledge, skills, and ability to take action ­ Recognises 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 ­ Many of us are looking to build our death literacy so we can make informed decisions about our dying, end of life care and death What drives people to plan ahead (or not)? ­Recent hospitalisation ­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 simply 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 oneʼs wishes about the use of life support known in the event one is unconscious or otherwise incapable of expressing them ­ These can also serve as the basis for Do Not Resuscitate (DNR) medical order which is used when cardiopulmonary resuscitation is needed  Advance Care Plans When preferences are not clear, difficult to move to palliative care, as this often involves withdrawing treatments and can include pain relieving treatment that hastens death ACP appoints a substitute decision maker and documents values beliefs and preferences to provide clarity for health professionals who provide treatment and services New residents in RAC 4x more likely than other residents to complete a plan if introduced to ACP But only 5% of residents have documented advance care directives Hospice ­Hospice is an approach to assisting dying people that emphasises palliative care and death with dignity ­Hospice care emphasizes quality of life rather than quantity of life ­ The goal is a de-emphasis on 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 The Grief Process ­ A complicated and personal one ­ 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 The Grieving 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 ­ People can grieve many years after the loss Coping with Grief ­ The Four Component Model 1. The context of the loss 2. Continuation of subjective meaning associated with loss 3. Changing representations of the loss relations over time 4. The role of coping and emotion-regulation process ­ The Dual Process Model (DPM) ­ Considers two broad types of stressors: ­ Loss-oriented stressors ­ Restoration-oriented stressors Complicated or Prolonged Grief Disorder ­ Debate & Controversy ­ Prolonged Grief Disorder (DSM-5-TR; 2022): A. Death that occurred at least 12 months ago, of a person close to bereaved individual B. Development of a persistent grief response. One of the following symptoms must have occurred nearly every day for at least the last month: 1. Intense longing/yearning for the deceased; 2. Preoccupation with thoughts and memories of the deceased person. C. Since the loss, at least three of the full list of symptoms (see 9th edition textbook for the full list of symptoms for criterion C), have occurred nearly every day for at least the last month. Examples: identity disruption, feeling that life is meaningless, emotional numbness, difficulty reintegrating into one’s relationships and activities. 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. * some of the DSM 5 criteria has been shortened for brevity. Deaths Death of a young child Death of an adult child Death of a sibling Death of a parent Death due to suicide Disenfranchised or Stifled Grief Circumstances of the death Relationships ­ Suicide ­ Historically – LGBTQIA+ ­ Stigmatized diseases ­ Ex-spouses ­ Executions ­ Friends ­ Substance abuse ­ Colleagues Expression ­ Companion animals ­ Strong affective response ­ Stoicism Particular losses ­ Miscarriage ­ Workplace ­ Prisoners