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Psych 357 Ch 13.docx

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Department
Psychology
Course
PSYC 357
Professor
Dagmar Bernstein
Semester
Spring

Description
Psych 357 Ch 13 (Death and Dying) • Technical perspectives on death: o Medical/legal: death is point when there’s irreversible cessation of circulatory and respiratory functions/ when all structures of brain have ceased to function o Dying= period during which organism loses its vitality  New technology makes it hard to determine point of death (ie brain dead but alive on ventilators)  Brain death= permanent absence of all brain functions including those of the brain stem • No brain stem reflexes, cranial nerve and cortical functions o Medical aspects of death: death experience different for all ppl, tho some commonalities in physical changes in last few hours/days  Asleep a lot, disorientation, irregular breathing, visual/auditory hallucinations, diminished vision, producing less urine, mottled skin, cool hands/feet, overly warm trunk, excessive secretions of bodily fluids • Likely unable to walk/eat, difficulty recognizing family members, constant pain, difficulty breathing • Common is Anorexia-Cachexia syndrome: loss of appetite (anorexia) and atrophy of muscle mass (Cachexia) o In many cancer patients, AIDS, dementia  Anxiety, depression, confusion, bowel problems, dry mouth, bloating (liquid in abdomen)  Acceptance in final stage of dying implies ability to transcend these final painful physical symptoms  Cause of death must be verified by coroner/medical examiner and record info on death certificate • Often code based on symptoms prior to death while indiv under medical supervision o External physical examination or autopsy to confirm cause o Need permission of next of kin for autopsy and to determine what, if any, materials are to be retained from body o Mortality facts and figures:  Mortality data for what influences course of human life • Mortality ultimate DV b/c unlike rating scales there’s no question of validity • Normally see deaths as clear environmental or disease based cause • Mortality rates calculated based on deaths per 100,00 estimated population in specific group of ppl o Age specific death rates (number of deaths/100 000 of particular age group in question) o Age adjusted death rate is used to copare relative mortality risk across groups and over time  Calculated by obtaining weighted averages of age specific death rates (reflecting proportion of indivs in that age group in pop)  Takes into account the fact that older ppl w/higher death rates and less prevalent in population o Improvements in public health measured in terms of age adjusted mortality rates (lower the rate, the healthier the pop)  Better when less disability before death, not necessarily living longer • Compression of morbidity (zero to moderate risk during life leads to shorter duration of disability before death) o Women lower mortality rates than men, blacks higher than whites too  Marriage and higher education also protective (never married then twice the age adjusted rate of death vs married) • Greater disparity for marriage in males than F  Lower SES, higher mortality (exposure, labor related injuries) • Men w/string of unrelated jobs w/higher rates of early mortality than stable career progressions  Disparities b/c poorer sanitation, nutrition, housing, stress (amnt of ctrl over pace and direction of work-less ctrl, higher risk mortality)  Higher income, lower mortality (even when ctrl for health risk behaviros, age, sex, race, urbanicity, education) • Income relating to cigarette smoking prevalence o Discrepancy in mortality rates in US on the decrease since 1980s after which it soared to record levels (esp for M)  Increase b/c of differential rise in HIB, homicide and heart disease in black men  Decline from 1993-2003 b/c decrease in HIV and homicide deaths • Tho still gaps b/c of hypertension, hear disease and colorectal cancer o Thru 20 century global mortality rates decreased starting in European countires- improvements in nutrition, sanitation and water supply + higher income  Also improvements in health care  Exception= AIDS in Africa and adult males in central/eastern Europe • Cultural perspectives: o Sociocultural perspective with important features of death as interpretations that society/culture places on life ending processes  Meaning of death from prevailing philosophy, economics and family structure  Ppl learn social meaning of death from language, arts and death related rituals of culture  A culture’s “Death Ethos” is their prevailing philosophy of death (infer from funeral rituals, tx of the dying, belief in ghosts/afterlife and language to describe death • Death seen as sacred/profane, unwanted extinction of life, or welcome release from worldly existence  See alterations in western cultural meanings and rituals over time (ie ancient Egyptians and mummifying body so permanent home for spirit of deceased- buried w/possessions so have them in afterlife)  Before middle ages saw death as “tame” (accepted as natural part of life, neither avoided nor exalted) • Early middle ages death viewed as ending of self (final reckoning w/God and ppl attach significance to tombs/epitaphs) • 1700s rise of scientific thinking death was punishment/break w/life to be avoided and denied • 1800s and romanticism where death glorified and noble if for a cause • 20 century of invisible death where denial of death and medicalizaiton of dying process o Ppl put faith in science which took ctrl of dying in div o Not shared experience, private now • Current media portrayal of death sensationalized (mass murder, bombings, etc..) o Images represent ppl’s worst fears- tragic, premature, following long/agonizing/painful/expensive process  Religion comfort for some? Emphasize afterlife, reason behind events, reunion in heaven • Death release from pain of world • Death removed from visibility in world- more fear and mystery (also shows fear of aging and growing old) • America youth oriented culture despite Baby boomers  Fear of process of Social death (treated as nonpersons by family/health care workers as we’re left to spend final time in palliative care)  Terror management theory: ppl regard w/panic and dread te thought of the finitude of their lives  Engage in defensive mechanisms to protect selves from anxiety and threats to self esteem that this awareness produces  Technology cloud the issue of death/life (brain dead?)  Death w/dignity= idea that death should not involve extreme physical dependency or the loss of control of bodily functions • Emerges from desire of patients and their families to avoid lengthy and protracted dying process  Dr Kevorkian- physician assisted suicide (make it possibly for terminally ill ppl to complete suicide) • Similar to euthanasia where dr administers lethal dose • Reflects dread in our society about losing ability to ctrl this most important aspect of life • The Dying process: o Most discussions of “dying” when person expected to die w/in period of days to months  Tho ppl w/life threatening illness also seen as “dying” o Dying trajectory: rate of decline in functioning prior to death  2 major features: duration and shape • Ppl who have drop in function and die suddenly • 2 and 3 trajectories: advance warning of terminal illness and ppl who experience lingering period of loss of function o Steady downward trajectory applies to ppl whose disease causes them to undergo steady and predictable decline (ie cancer) o Stages of dying:  Universal? By Kubler Ross- applying to terminally ill patients  1-Denial= informed of terminal diagnosis and refuse to accept  2-Anger  3-Bargaining= attempt to strike a “deal” with whoever is seen as causal force (God usually)  4-Depression= sense of loss, acknowledge finality of disease  5-Acceptance= no longer fight or regret disease • Regard death as natural end and even release from suffering • To reach acceptance must be allowed to talk openly w/family members and health care workers (not hide diagnosis)  Many variations in steps- not universal or invariant sequence, revisit stages, not everyone reaches acceptance • Age affecting initial denial (more in young than old/already sick) • No empirical research o Psychological perspectives on the dying process:  Instead of specific stages, some suggest that as we sense end of life approaches we attempt to make sense out of past patterns of our lives  Awareness of finitude= when indiv passes age at which loved ones have passed (ie parents, siblings) • When pass this embark on Legitimization of Biography (attempt to gain perspective on past life events) o Prepare “story” of life  Personality- if believe in fate/change/luck as determining what happens then higher self esteem • As predicted by Terror management theory ppl w/higher self esteem less likely fear death as end to self  Erikson’s ego integrity (vs despair) w/life review • Relive events, attempt to achieve peace w/past mistakes and things that can’t be changed • Issues in end of life care: o Improvements in medicine made new issues w/approach to terminally ill  Clinicians now far more sensitive to emotional and physical needs of dying patients (rework some standard approaches to end of life care) o Advance directives and the patient Self determination Act:  Patient self determination act (PSDA)- in all organiziations receiving Medicare/Medicaid which guarantees right of all competent adults to write and Advance Directive (AD) to participate in and direct their own health care decisions, and to accept or refuse tx • Passed in response to growing recognition of burden placing on dying/their families by advances in medicine to make it poss to prolong life by articifial means • So before becoming ill write down wishes for end-of-life tx • AD aka living will including preferences for medical i
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