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Chapter 4

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University of Guelph
PSYC 3800
Jen Lasenby- Lessard

Week5 Death, Society and Human Experience, (Robert J. Kastenbaum, 11 Ed., 2012) Chapter 4: Dying ± Transition from Life ± Summary Notes from Text Dying: Primped and Medicalized $V▯D▯VRFLHW\▯▯ZH▯WHQG▯WR▯XVH▯RWKHU▯ZRUGV▯WKDQ▯µGHDWK¶▯DV▯D▯UHIOHFWLRQ▯RI▯RXU▯HYDVLYHQHVV▯▯▯8VLQJ▯ substituted names seem like denial to what is actually happen and that perhaps using the phrase µG\LQJ¶▯LQ▯PRVW▯FDVHV▯ZRXOG▯EH▯WKH▯EHVW▯WHUPLQRORJ\▯WR▯XVH▯ 2WKHU▯SULPSLQJ▯▯L▯H▯▯GUHVVLQJ▯XS▯▯SKUDVHV▯IRU▯GHDWK▯LQFOXGH▯▯▯H[SLUDWLRQ▯GDWH▯▯³EX\LQJ▯WKH▯IDUP´▯ ▯DGGV▯D▯VHQVH▯RI▯QRVWDOJLD▯▯▯³NLFN▯WKH▯EXFNHW´▯▯HWF▯▯▯1RW▯QHFHVVDULO\▯GHQ\LQJ▯WKH▯IDFW▯WKDW▯RQH▯LV▯ dying, but more familiar and less threatening phrases. The term dying is very vague to describe the process and / or activities that are occurring. Medicalizing serves as a buffer for physicians re this common mortality. The Moment of Death: Is It Vanishing? When life passes into death, takes on different meanings: x Irish folklore ± death invoked a spirit called a banshee x Lugbara of central Africa ± GHVLJQDWHG▯PHPEHU▯RI▯FRPPXQLW\▯XWWHUHG▯WKH▯³FHUH´▯ a whooping kind of melody sounded only at the moment of death x Deathbed scene - climax of the Christian life on earth with salvation / damnation waiting x In a hospital, a husband becomes a widower, crying over the body of his wife Each represents a link to a person dying, whether a painful transition of a soul, acknowledgement WR▯DUUDQJH▯WKH▯GHFHDVHG▯SHUVRQ¶V▯DVVHWV▯▯HPXODWLQJ▯D▯PRGHO▯IRU▯ULJKWHRXV▯OLYLQJ▯DQG▯IDLWK▯▯▯7KH\▯ demonstrate the impulse to draw meaning from the last moment of life. The Slipping Away What is happening today? Less descriptive than traditional perspective, but perhaps, not easy to detect that particular moment of a life ceasing to exist. Reasons: x Medical advances allow patients to survive longer x Alzheimers and related diseases may FDXVH▯SDWLHQWV▯QRW▯WR▯EH▯µSUHVHQW¶▯DW▯WKHLU▯GHDWK x Sedation can reduce awareness x Person dies alone Dying takes many forms depending on the nature and management of the illness, social support and the person involved. We cannot just focus on dying but consider the total pattern and meaning of life that is coming to an end. Dying as Transition It is one of many processes we experience in our life. Also is our first day at school, our first date, the first car, the first job, etc. Many of these are very memorable. The transition from life can be disturbing or comforting. No two people share or bring with them the same thoughts, feelings, accomplishments, etc. The quality of life during the final illness is a reflection of the quality and availability of the individuals most valued relationships. What is Dying, and When does it Begin? Complete exercise in Box 4 ± 1 (page 113) ± Your Death Bed Scene Plan your deathbed scene. Describe the ending of your life in as much detail based upon what you expect is most likely to happen. Include the setting, time, who could / would be there, other details. Onset of the Dying Process: Alternative Perspectives The point when dying begins on a frame of reference: x Consider we begin dying on the same day that we are born (we just do not know when) x The loss of the umbilical cord ± a sign of dying? x Aging may be regarded as slow dying and dying as fast aging (Jeremy Taylor, champlain, 1651) Dying usually begins as a psychosocial event: x When facts are recognized OR x Dying begins when the facts are communicated OR x Dying begins when the patient realizes or accepts the fact OR x Dying begins when nothing more can be done to preserve life (prevention of death to care of the dying) Trajectories of Dying: From Beginning to End Emphasis on the most common pathways to death (i.e. ending in a health care facility). Observations include: x Dying processes take time x All have certain paths through time (e.g. downward spiral, slowly, fluctuating a) Certainty and Time ± yields 4 death expectations i. Certain death at a known time ii. Certain death at an unknown time iii. Uncertain death at a known time iv. Uncertain death at an unknown time b) Lingering Trajectory ± FDUHJLYHUV▯GLVSOD\▯D▯FKDUDFWHULVWLF▯SDWWHUQ▯ZKHQ▯D▯SDWLHQW¶V▯OLIH▯LV▯ slowly fading; i. no rescue scene, ii. NHHS▯SDWLHQW▯FRPIRUWDEOH▯NQRZLQJ▯WKDW▯WKH\▯KDYH▯³GRQH▯DOO▯WKDW▯WKH\▯FDQ´ iii. NQRZ▯WKDW▯WKH▯SDWLHQW▯KDV▯HDUQHG▯D▯³JRRG▯GHDWK´ iv. more acceptable as the patient was considered socially dead (e.g. visits from family members decline sharply) v. gives both the patient and family time to adjust to the idea of dying (organize affairs, work through conflicts, etc.) c) The Expected Quick Trajectory ± most salient features are time, intense organization of treatment efforts, rapidly shifting expectations and volatile, sensitive staff-family interactions i. Pointed trajectory ± patients exposed to risky procedure that could save their lives or result in death 1. Patients are alert and could exercise some opportunities (share precious minutes with a loved one; see that personal matters are acted upon, etc.) ii. Danger-Period trajectory ± patients are in a watch and wait time frame 1. Will the patient be able to survive a stressful experience 2. Patient may be unconscious or partially aware of surroundings 3. Can vary from hours to days iii. Crisis trajectory ± imposes another state of tension 1. No in acute danger at the time but could suddenly be threatened 2. 7HQVLRQ▯ZLOO▯SHUVLVW▯XQWLO▯SDWLHQW¶V▯FRQGLWLRQ▯LPSURYHV▯IRU▯WKH▯ danger to pass or until the crisis requires rescue efforts iv. Will probably die trajectory ± staff believe nothing effectively can be done 1. Keep patient comfortable and wait for the end to come 2. Intense admin pressure to move patient to a palliative care facility (less expensive resources) d) The Unexpected Quick Trajectory ± significance of the interpersonal setting is emphasized as in the EQT i. Usually is developed when an emergency pops up in an area where it is not expected, sparking a crisis (creating the UQT) ii. 6WDII¶V▯QHHG▯WR▯VKLHOG▯LWVHOI▯DJDLQVW▯VXUSULVH iii. Area is usually not prepared for an emergency (life or death situation) iv. Patient dies for the wrong reason Factors that Influence the Experience of Dying 1. Gender 2. Age ± chronological age guides us through this experience
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