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TAMU PSYC 307 - 4.24_b w
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14/24/2008 14/24/2008 2Defining Death• In the past several decades, defining death has become more complex24/24/2008 3Defining Death• In the past several decades, defining death has become more complex• Brain death-- the neurological definition, when all electrical activity of the brain has ceased for a specified period– individual whose higher cortical areas have died may continue breathing and have a heartbeat(Kendall & others, 2007)4/24/2008 434/24/2008 54/24/2008 644/24/2008 7Advanced Directive• Living will -- document filed while the individual can still think clearly which expresses the person’s desires regarding extraordinary medical procedures that may or may not be used to sustain life– advance directive• All 50 states now accept advance directives as reflecting an individual’s wishes4/24/2008 8Euthanasia• Euthanasia -- painlessly ending lives of individuals who are suffering from an incurable disease or severe disability– mercy killing– two types: • active -- when death is deliberately induced– assisted suicide• passive -- when a person is allowed to die by withholding available treatment54/24/2008 9Thursday, 20 March 2008 French euthanasia seeker Chantal Sebire diesFrench woman Chantal Sebire who has been recently in the news because of her attempts to get legal permission for doctors to aid her death has died at her home near Dijon aged 52.The cause of Chantal Sebire’s death is, as yet, unknown.Former teacher Chantal Sebire had an incurable cancerous growth in the nasal cavity known as an esthesioneuroblastoma and she had failed to get her plea for euthanasia accepted.Chantal Sebire had asked a French court to allow doctors to help her die because her tumour had left her blind, disfigured and in intense pain, however, whilst the court agreed that her condition might "inspire compassion" it ruled that the law did not allow assisted suicide.Chantal Sebire had pointed out that she could no longer see properly, taste or smell and she described how children ran away from her in the street because of her appearance.Only 200 cases of esthesioneuroblastoma have been recorded worldwide in the last 20 years.4/24/2008 10End-of-life Care• End-of-life care should include respect for the goals, preferences, and choices of the patient and his or her family– hospice -- program committed to making the end of life as free from pain, anxiety, and depression as possible– palliative care -- reducing pain and suffering and helping individuals die with dignity(International Work Group on Death, Dying and Bereavement & others, 2006) (Rodriquez, Rarnato & Arnold, 2007)64/24/2008 11Circumstances of Death• 200 years ago, many children and young adults died– average life expectancy was 47 years• In 1900, most people died at home, cared for by family• Today, death occurs most often among older adults– average life expectancy has increased to 78• 80% of deaths occur in institutions and hospitals with professional caregivers(Lamb, 2003) (U.S. Census Bureau, 2006)4/24/2008 12Cultural Variations• In most societies, death is not viewed as the end of existence; the spirit is believed to live on• Individuals are more conscious of death in times of war, famine, and plague– Most societies have had philosophical or religious beliefs about death and most have a ritual that deals with death(Lobar, Youngblut & Brooten, 2006) (Hedayat, 2006)74/24/2008 13Kubler-Ross’ Stages of Dying• Dr. Elisabeth Kübler-Ross, psychiatrist and prolific author of the ground- breaking book, On Death and Dying, coined the now famous "5 Stages of Grief." Her work challenged the medical profession to change its view of dying patients. This advanced many important concepts such as living wills, home health care, and helping patients to die with dignity and respect, which is now hospice.• Five stages–denial and isolation–anger–bargaining–depression–acceptance(Kubler-Ross, 1972)4/24/2008 14Denial: "It can't be happening."Anger: "Why me? It's not fair."Bargaining: "Just let me live to see my children graduate."Depression: "I'm so sad, why bother with anything?"Acceptance: "It's going to be OK."84/24/2008 15Evaluation of Kubler-Ross• 5-stage sequence has not been supported by research findings– Stages did not account for individual circumstances of patient and support systems– However, she did much to call attention to the issues of quality of life and coping with dying(Kastenbaum, 2007)4/24/2008 16Coping with Death and Loss• It is best for dying persons and their family members to know that death is immanent and a reality– individuals can close life with their own ideas about proper dying– they can complete some projects and plans and can make arrangements for funeral and for survivors– can reminisce– can experience physical sensations and medical procedures(Banja, 2005) (Kalish, 1981)94/24/2008 17Effective Strategies for Communicating with a Dying Person• Establish presence at same eye level and don’t be afraid to touch the dying person• Eliminate distraction, including excessive small talk• Keep visits short with frail individuals• Don’t prescribe or deny feelings of acceptance• Allow and encourage expressions of feeling4/24/2008 18• Ask the person what the expected outcome of the illness is; discuss alternatives and unfinished business• Ask if there is anyone he or she would like to see or have someone contact• Encourage reminiscences• Talk to the individual when he or she wishes to talk• Express your regard for the dying individual, don’t be afraid to express love104/24/2008 19Dimensions of Grief• Grief -- emotional numbness, disbelief, separation anxiety, despair, sadness, and loneliness that accompany the loss of someone we love• Many dimensions– pining or yearning– separation anxiety– despair and sadness– hopelessness and defeat(Maciejewski & others,


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