Textbook Notes - Chapter 19

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Family Relations and Human Development
FRHD 1010
Triciavan Rhijn

Chapter 19: Life’s Final Chapter Today, only a small minority of Canadians – typically those who are in advanced old age or who are gravely or terminally ill – die in their own homes. Did you know: • A person may stop breathing and have no heartbeat but still be alive. o People whose hearts and lungs have ceased functioning can often be revived using cardiopulmonary resuscitation (CPR). • The five stages of dying provide insight into the dying process but they should not be used as a template. o Though Kubler-Ross identified five stages that dying individuals commonly experience, other factors also appear to affect the adjustment of the dying individual. • Even the medical community is divided on the hot-button issue of physician- assisted suicide. o 84% of highly religious physicians object to physician-assisted suicide. • People with living wills can hope their wishes will be carried out if they become unable to speak for themselves. o A living will may not be carried out for many reasons. Specific advance directives have a better chance of being carried out than general guidelines. • When helping someone cope with a death, don’t expect to have all the answers. o Sometimes there are no right answers. Simply listening and being supportive is a wise course of action. Death holds the gift of wisdom. We parcel thoughts about death and dying into a mental file cabinet to be opened later in life, along with terms like retirement, Old Age Security, and varicose veins. But death can occur at any age – by accident, violence, or illness. We can also be affected deeply at any stage of life through the deaths of others. Denial of death is deeply embedded in our culture. How doe we know when a person has died? Are there stages of dying? What is meant by the ‘right to die’? Do people have a right to die? What is a living will? Is there a proper way to mourn? Are there stages of grieving? L01: Define death and dying, and evaluate views on stages of dying Death is commonly defined as the cessation of life. Many people think of death as a part of life, but death is the termination of life and not a part of life. Dying, though, is a part of life. It is the universal end-stage of life in which bodily processes decline, leading to death. Yet life holds significance and meaning even in the face of impending death. Charting the boundaries between life and death How do we know when a person has died? Is it the stoppage of their hearts? Of their breathing? Of their brain activity? • Medical authorities use brain death as the basis for determining that a person has died o Absence of activity of cerebral cortex – flat EEG reading; the sense of self and all psychological functioning has ceased • Whole brain death – death of the brain stem which is responsible for certain automatic functions such as reflex of breathing; a brain dead person can continue to breathe • Death is a legal matter – considered legally dead in Canada when there is irreversible cessation of breathing and circulation or when irreversible cessation of brain activity occurs, including activity in the brain stem, which controls breathing Are there stages in dying? Overview of process influenced by the work of Elisabeth Kubler-Ross. Common responses to news of impending death 1. DENIAL. In this stage, people think, “It can’t be me. The diagnosis must be wrong.” Denial can be flat and absolute, or it can fluctuate so that one minute the patient accepts the medical verdict, and the next, the patient chats animatedly about future plans. 2. ANGER. Denial usually gives way to anger and resentment toward the young and healthy and, sometimes, toward the medical establishment: “It’s unfair. Why me?” or “They didn’t catch it in time.” 3. BARGAINING. People may bargain with God to postpone death, promising, for example, to do good deeds if they are given another six months, or another year. 4. DEPRESSION. With depression come feelings of grief, loss, or hopelessness – at the prospect of leaving loved one and life itself. 5. FINAL ACCEPTANCE. Ultimately, inner peace may come as a quiet acceptance of the inevitable. This “peace” is not contentment; it is nearly devoid of feeling. The patient may still fear death, but comes to accept it with a sense of peace and dignity. • Offer help by understanding the stages; Retsinas comments that stages are limited to cases in which people receive diagnosis of terminal illness • Life and Death Issues: A Blurring Line ~ living longer, delaying death; living longer does not mean continued quality of life; physician-assisted suicide for incurable disease (ALS, etc.); consider living wills  instruction directive sets out what types of treatment a person does not want in the event that these decisions cannot be voiced at the appropriate time; proxy directive allows an individual to select in advance, someone who can make health care decisions on his/her behalf • Shneidman agrees that dying people may have same 5 stages of feelings but generally behave as they behaved before as they confronted stress, failure and threat L02: Identify settings in which people die, distinguishing between hospitals and hospices Where people die: a hundred years ago, most people died in their homes, surrounded by family members. Most people respond that they would prefer to die at home with loved ones, yet 70% die in hospita. In the hospital • Impersonal places to die, function to treat diseases; patients in hospital often face death alone, cut off from their usual supports; however family may assume that this is the best place to try to avert death Hospice care • Only 16-30% of Canadians who die will have access to or receive hospice services • Demand for these services will continue to rise • Hospices make final days as meaningful and pain-free as possible • When necessary, hospices can provide care in inpatient services but most hospice care is provide in patent’s home • Hospice workers work in teams – physicians, nurses, social workers, mental health/pastoral counsellors, home care aides who also work with/for family for support • Bereavement specialists • Resuscitation or DNR • Hospices: o Offer palliative care (treatment focused on the relief of pain and suffering rather than cure) o Treat person, not disease – all needs: medical, emotional, psychological, spiritual – of patient and family o Emphasize quality, rather than length of life, neither hastening nor postponing death o Considers the unit of care to be entire family, not just patient; bereavement counselling is provided after death o Help and support available 24/7 Supporting a dying person • Put yourself at the same eye level and don’t withhold touching • Be available to listen, to talk, to share experiences • Give person opportunity to talk about death and to grieve o Don’t be afraid to talk about the ongoing lives of mutual acquaintances • Often need to focus on topics other than impending death and some enjoy humorous stories • May want to hear about your concerns, joys, worries, etc. • Emotional state may vary from day to day • Don’t attempt to minimize the person’s emotional pain or need to grieve by refusing to acknowledge it or changing the subject • Be sensitive to person’s feelings, offer consolation and support L03: Discuss various kinds of euthanasia and controversies about them Euthanasia: Is there a right to die? Euthanasia means good death; mercy killing; purposeful taking of a person’s life through gentle or painless means to relieve pain or suffering. Active euthanasia: Mercy killing or murder? • Active euthanasia: lethal treatment (usually drug) administered to cause quick and painless death; spouse or family administers it o Voluntary active euthanasia: assisted suicide; illegal in Canada, still in court process; not illegal in some countries though protocols must be followed o Physician-assisted suicide: legal in USA, patients with terminal or incapacitating illnesses who wish to die, provide lethal doses of drugs administered when patient is too ill to administer drugs themselves (Dr. Kevorkian – Dr. Death); most physicians do so without publicity for fear of legal prosecution o Involuntary active euthanasia: one person causes the death of another person without that person’s informed consent (moral, ethical and legal issues); cases of involuntary euthanasia usually involve patients who are
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