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Chapter 12

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PSYC 328
Blaine Ditto

PSYC328 Chapter 12 Notes How Does Death Differ Across The Life Span: Death in Infancy Or Childhood: • About 100 years ago, people died primarily form infectious diseases such as tuberculosis, influenza or pneumonia. • Now, most people die from cancers or heart diseases. This fact means, that instead of facing a rapid, unanticip- ated death, the average Canadian may know what he or she will die from 5, 10, or even more years prior to the ac- tual death. • Children’s Understanding of Death • Infant mortality rate in Canada is still high (5.1 per 1,000), even with our technological advancements. • During the first year of life, the main causes of death are congenital abnormalities and sudden infant death syndrome (SIDS). • 3 babies a year die of SIDS in Canada. • The causes of SIDS are not entirely known, but it is more likely to occur in lower-class urban environ- ments, when the mother smoked during pregnancy, and when the baby is put to sleep on stomach or side. • Most parents don’t take this well, and they feel guilty, and feel the baby’s death was there fault. • Also, there were some cases where the children were killed purposely and blamed it on SIDs and this has not helped parents of actual SIDS babies cope well. • However, now, most parents know about SIDS and make their baby sleep on its back in order to avoid it from happening. • After the first year, external causes are the main cause of death among children under the age of 15. • Ex: Car accidents, accidental drowning, poisoning, or falls in the home. Before, car accidents were the main cause of death in children, but now it is no longer the case because • of the increasing attention to the these causes and the preventive technologies, such as infant care seats, that have resulted. • Cancer, especially leukaemia, is the second leading cause of death in children. • However, treatments have become better and the chances of survival are now at 80%. • Overall, the mortality rates for most causes of death in infants and children have declined. Death in Young Adulthood: • Death rate in adolescence is low (about 2,450 per 100,000 for youths ages 15 to 24). • The major cause of death in this age group is unintentional injury, mainly involving cars. • Second is suicide, third is cancer, fourth is homicide, and heart and respiratory diseases are the remaining causes. • Reactions to Young Adult Death • Death of an adolescent is considered very tragic because of the seeming waste of life and because they are robbed of the chance to develop and mature. • Adolescents that are diagnosed with a terminal illness usually feel angry and their parents feel cheated of the chance to see their children grow up and develop. Death in Middle Age: • At this age, death becomes more realistic because it is more common and because people develop the chronic health problems that may eventually kill them. • Fear of death is more prominent in middle age than it is in later adulthood. • Middle age people start to fear death for different reasons: midlife crisis, the death of a parent or acquaintance or friend, bodily signs that one is aging, physical appearance, sexual prowess, athletic ability, etc. • Premature Death The main cause of premature death in adulthood – that is, death that occurs before the projected age of 79 – • is sudden death due to heart attack or stroke. • Most people would prefer a sudden death because it is painless and you don’t suffer. • Sudden death is, in some ways, kinder to the family members as well because they don’t have to go through the emotional torment of watching the patient’s worsening condition. • A study found that the likelihood of a family member dying before the age of 65 was increased for those who experience negative childhood events (neglect, abuse, domestic violence, and criminal acts by family mem- ber). • Overall, death rates in the middle-aged group have declined, however, there are some gender differences. • Fewer men die from lung cancer than women. • Heart disease kills men and women equally. Death in Old Age: • Death may be easier in old age because they are more prepared to face it than the young. • They see other old people die around them and they feel ready for it as well. • Typically, the elderly die of degenerative diseases, such as cancer, stroke, heart failure, or just general physical decline that predisposes them to infectious disease or organ failure. • Terminal phase of illness is generally shorter for them. • Why do some elderly die at the age of seventy, while other die at the age of ninety and older? • New illnesses and the worsening of pre-existing conditions. • Psychological distress • Health goals for the elderly now focus less on the reduction of mortality and more on improving quality of life. • People in non-industrialized countries average to 64 years. • Women now average to age 82, while men to age 77. What Are The Psychological Issues In Advancing Illness? • Since most of the terminally ill know that they are going to die for some time before their death, as a consequence, a variety of medical and psychological issues arise for the patient. Continued Treatment and Advancing Illness: • Advancing and terminal illness frequently brings the need for continued treatments with debilitating and unpleasant side effects. • Ex: radiation therapy and chemotherapy for cancer produces negative side effects. • Each procedure raises a new threat of death. • Patients find themselves repeated objects of surgical or chemical therapy, and after several efforts, the patients may resist any further intervention. • What is a Good Death • According to the Institute of Medicine, a good death is defines as “one that is free from avoidable suffering for patients, families, and caregivers in general accordance with the patients’ and families’ wishes”. • Six components that enhance the quality of dying: pain and symptom managements, clear decision making, preparation for death, completion, contributing to others, and affirmation of the whole person. • Other approaches have focused on assessing a good death using a self-report scale. • Ex: The Good Death Inventory  assesses 10 dimensions associated with quality of death outcomes for patients (not being a burden to others; having physical, psychological and spiritual comfort, etc.) • For some conditions, attaining the ideal of the good death may be difficult or impossible. In such cases aid in dying may be seen as the only option to die with dignity. • Is there a Right to Die? • The right to die is still illegal in Canada, however, in 1992, the right-to-die issue became highly debated in Canada after Sue Rodriquez, a woman suffering from Lou Gehrig’s disease, challenged the legislated ban against aid in dying by arguing for her right to die. • She brought the case all the way to the Supreme Court, but lost. • In recent years, more and more people think that we should have the right to die. • However, patients who supported the right to die were not in more pain or closer to death, instead, feeling more fatigued, depressed, and more of a burden to others was associated with considering aid in dying. • Moral and Legal Issues Our culture must struggle with the issue of euthanasia. • • Canadian physicians do not believe that legalizing euthanasia is a good idea because it conflicts with their oath to “do no harm”, goes against the basic principle of respecting the sanctity of life and accordingly doing all that can be done to either heal or make their patients as comfortable as possible during their last days. Also, the Canadian physicians fear that it will reduce rather than support patients’ autonomy by putting the decision in the hands of those of the medical profession, and lead the patients to being killed against their will. • More passive measures to terminate life have also received attention. • Advance directives (also referred to as living wills) are also advocated by those who believe that people should have choice in dying. • Advance directives can request that extraordinary life sustaining procedures not be used in they are un- able to make this decision on their own. • This will is signed in front of people when the person is diagnosed as having a terminal illness. • Unfortunately, research suggests that many physicians ignore the wishes of their dying patients and needlessly prolong the pain and suffering. Psychological and Social Issues Related to Dying: • Changes in the Patient’s Self-concept • For patients with progressive diseases such as cancer or severe diabetes, life is a constant act of readjusting expectations and activities to accommodate an ever-expanding patient role. • Advancing illness can threaten the self-concept. It may become difficult for them to maintain control of biolo- gical and social functioning (unable to control urination or bowel movements); drooling, distorted facial ex- pressions; shake uncontrollably. • They may be intermittent pain; may suffer from uncontrollable retching or vomiting; may experience deteriora- tion in appearance; etc. • Such losses may be due either to the progressive nature of the disease itself or to the tranquilizing and disori- ented effects of painkillers. • Issues of Social Interaction • The threats to the self-concept that stem from loss of mental and physical functioning spill over into threats to social interaction. Although terminally ill patients often want and need social contact, they ma be afraid that their obvious mental • and physical deterioration will upset visitors. Family and friends are therefore prepared to control their reac- tion while visiting the patient. • Some disengagement from the social world is normal and may represent the grieving process through which the final loss of family and friends is anticipated. • In other cases, withdrawal may be cause by fear of depressing others and becoming an emotional burden. The family may believe that the patient wishes to be left alone, but in reality, they need to make a strong effort to draw out the patient. • Another cause of withdrawal may be the patient’s bitterness over impeding death and resentment of the liv- ing. In this case, the family needs to understand that such bitterness is normal and that it usually passes. • Communication Issues • As long as the patient’s prognosis is favourable, communication between doctors and family is usually open. However, when prognosis worsens, communication starts to break down. • Medical staff may become evasive when asked about the patient’s status. • Family members may be cheerfully optimistic with the patient but confused and frightened when they try to elicit information from the medical staff. • The potential for a breakdown in communication as illness advances can be traced to several factors. • First, death itself is still a taboo topic in our society. • People try to avoid it and not bring it up. • A second reason that communication may break down in terminal illness is because each of the parti- cipants – medical staff, patient, and family – may believe that others do not want to talk about the death. Some patients do not want to hear the answers to their unanswered questions because then they • will have to cope with them. Family members may wish to avoid confronting and lingering guilt (Did they do enough to prevent • the patient form dying?) • Medical staff may fear having to cope with the upset and angry approaches of family members or the patient over whether enough was done. Are There Stages In Adjustment To Dying? Kubler-Ross’ Five-stage Theory: • Stages of dying: A theory, developed by Kubler-Ross, that maintains that people go through five temporal stages in adjusting to the prospect of death: denial, anger, bargaining, depression, and acceptance, believed to character- ize some but not all dying people. • A lack of empirical support for the five-stage model has led some researchers to call into question its validity; HOWEVER, the popularity of this model persists and it is still widely used in many end-of-life care settings. • Denial • Denial is the patient’s initial reaction on learning of the diagnosis of terminal illness. • The diagnosis of a terminal illness can come as a shock to a person, and denial is a defence mechanism by which people avoid the implications of an illness. • Short-term denial is all right, but long-term denial needs therapeutic intervention. • Anger • The angry patient is asking the question “Why me?” • Anger is one of the harder responses for family and friends to manage because they may feel that they are being blamed by the patient for being well. • Bargaining • At this point, the patient abandons anger in favour of a different strategy: trading good behaviour for good health. • Bargaining frequently takes the form of a pact with God. • A s
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