Psyc 412 1st Edition Lecture 17Outline of Last Lecture I. Death across the life spanOutline of Current Lecture II. Advancing IllnessIII. Adjustment to DyingIV. Psychological Management of the Terminally IllV. Alternatives to Hospital Care for the Terminally IllVI. Problems of SurvivorsCurrent Lecture- Advancing Illnesso Continued treatment and advancing illness: treatments may have debilitating side effects patients find themselves repeated objects of surgical or chemical therapyo Is there a right to die? Do Not Resuscitate (DNR) order receptivity of suicide and assisted suicideo 7 out of 10 Americans die in a medical settingo Defensive medicine: run extra tests to prove that doctors did everything they could for the patient, in case they are sued latero Assisted suicide: safer than other methodso Moral and legal issues: euthanasia: ending the life of a person with a painful terminal illness (by a doctor, illegal in all states)  physician-assisted suicide- (1994) Oregon passed law permitting physician-assisted dying- (1997) Supreme Court says that physician-assisted dying is not a constitutional right, but legislation is up to states living will: a request that extraordinary life-sustaining procedures not be used if person is unable to make this decision on his/her own (person near death)o Dr. Death: convicted of murder for ending life of terminally ill mano Durable power of attorney for health care: much broader than living will person does not need to be near death, decisions can relate to life-and-death or other matters gives some other specific persons legal right equal to your own, for yourselfo Advance directive: specific instructions regarding life-sustaining medical intervention in certain circumstances dictate under what circumstances you would want certain procedureso Psychological and social issues related to dying: changes in the patient’s self-concept: difficult maintaining control of biological functions  mental regression, inability to concentrate issues of social interaction: fear that their condition will upset visitors withdrawal may occur for multiple reasons: fear of depressing others fear of becoming an emotional burdeno Communication issues: death is still a taboo subject in U.S.  many people feel it is proper to avoid the topic  medical staff, family and patient:  may believe the others don’t want to discuss deatho The issue of non-traditional treatment: when health deteriorates and communication deteriorates:- patients may turn away from traditional care- patients may seek alternative remedies- life savings may be invested in hopes of a “miracle cure” - Adjustment to Dyingo Kϋbler-Ross’s 5 stages of adjustment to death: denial: a mistake must have been made; test results were mixed up anger: Why me? Why not him? Or her? bargaining: a pact with God, good works for more time or for health depression: a time of “anticipatory grief” acceptance: tired, peaceful (not always pleasant), calm descendso Differing evaluations of Kϋbler-Ross’s theory: her work is invaluable  her work has not identified stages of dying:- there is not a predetermined order- some patients never go through a particular “stage” - her work does not fully acknowledge the importance of anxiety- Psychological Management of the Terminally Illo Medical staff and the terminally ill patient: the significance of hospital staff to the patient: dying need help for simple things, such as brushing teeth or turning over they assist with pain management they are the patient’s source of realistic information they are privy to a most personal and private act: dyingo Difficulties of terminal care for staff: emotionally and physically straining for hospital staff they provide palliative care, care designed to make the patient comfortable, rather than curative care, care designed to cure the patient’s diseaseo Achieving an appropriate death: Avery Weisman’s goals for the staff:- informed consent- safe conduct- significant survival- anticipatory grief- timely and appropriate deatho Individual counseling with the terminally ill: therapy for dying patients is becoming an increasingly available and utilized option thanatologists, those who study death and dying, suggest behavioral and cognitive-behavioral therapies clinical thanatology involves symbolic immortality reminiscence therapyo Family therapy with the terminally ill: family and patient may have different ways of adjusting to the illnesso The management of terminal illness in children: most stressful of all terminal care hardest to accept and psychologically painful family may need counseling as well- Alternatives to Hospital Care for the Terminally Illo Hospice care: designed to provide palliative care and emotional support to dying patients and their families may be provided in the home, but commonly provided in free-standing or hospital-affiliated units called hospices oriented toward improving a patient’s social support systemo Home care: care for dying patients in the home choice of care for many terminally ill patients psychological factors are legitimate reasons for home care very stressful for family members- Problems of Survivorso The adult survivor: little to do but grieveo grief: psychological response to bereavement feeling of hollowness preoccupation with image of deceased person expressions of hostility towards others guilt over deatho most widows and widowers are resilient to their losso The child survivor: may expect the dead person to return may believe a parent left because the child was “bad” may feel responsible for a sibling’s deatho Death education: courses on dying, which may include volunteer work with dying patients, have been developed for college students provides realistic expectations about what modern medicine can achieve and the kind of care the dying wants and