Textbook Notes (369,204)
Canada (162,462)
Psychology (773)
PSYC 314 (33)
Chapter 12

Chapter 12 notes (2).docx

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PSYC 314
Frances Chen

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Psy 314 Chap 12 Notes - Psychological Issues in Advancing and Terminal Illness Chapter 12 - Psychological Issues in Advancing and Terminal Illness How Does Death Differ Across the Life Span? - On average, Canadians can now expect to live 81 years; when death does come, it will probably stem from a chronic illness or non-communicable disease Death in Infancy or Childhood - Canada's infant mortality rate is high relative to some Western European nations - Low SES and First Nations have higher infant mortality rates - Main causes of eats are congenital abnormalities and sudden infant death syndrome (SIDS) - External causes are the main cause of death among children under age 15, which account for 42% of all deaths in this group - Cancer (especially leukemia) is the second leading cause of death in youngsters between ages 1 and 15, and its incidence is rising - Leukemia has a much higher rate of survival now than 50 years ago (from virtually 0% to 80% survival rates) Children's Understanding of Death - Up to age 5 or 6, most children think of death as a great sleep; children are curious of death rather than frightened or saddened, partly because they may not understand the permanence of death - Between ages 5 and 9, the idea that death is permanent may develop, although most children do not have a biological understanding of death; the idea that death is universal and inevitable may not develop until age 9 or 10 Death in Young Adulthood - Leading causes of death (in order of frequency): 1) unintentional injury (automobile accident), 2) suicide, 3) cancer, 4) homicide Reactions to Young Adult Death - Health care workers may find it difficult to work with them because they tend to be angry when faced with a terminal illness - Because they are otherwise in good health, young adults may face a long drawn-out process of dying Death in Middle Age - Death becomes more of a reality; middle age is when most fear death the most - Midlife crisis may be triggered by the death of a friend/acquaintance or aging signs of the body Premature Death - Defined as death that occurs before the projected age of 79 - Leading cause is heart attack or stroke - Likelihood of a family member dying before the age of 65 was increased for those who experienced a variety of different adverse childhood events including neglect, abuse, domestic violence in the home, and criminal acts by a family member - Overall, death rates in the middle-aged group have been decreasing/ Death in Old Age - Although death is not easy at any age, it is the easiest with the elderly as they may have thought more about their and death and made the necessary preparations - Typically, the elderly die of degenerative diseases (cancer, stroke, heart failure), or just general physical decline that makes them susceptible to infectious illnesses - Terminal phase of an illness is usually shorter as there are usually more than one biological competitor for death - Psychological distress predicts declines in health and even increased risk for mortality - For men, much of the association between distress and mortality can be accounted for by socio-demographic differences and the presence of chronic diseases; lower education and widowhood was also linked to greater risk of mortality (but not for women) - For women, the link persists even after accounting for socio-demo differences and the presence of chronic diseases; experiencing greater financial distress was also linked (but not for men) - Improving quality of life is a bigger issue now than reducing mortality, as many older people are living poor quality lives (due to chronic disease) - Women tend to outlive men (82 vs 77) What Are the Psychological Issues in Advancing Illness - Advancing illness may need aggressive, highly unpleasant procedures - After many of these, patients may feel despair ("it won't work"), or feel that they are being disassembled bit by bit (after surgically removing organs that are affected) - The sheer number of treatments can lead to exhaustion, discomfort, and depression - In some cases, refusal of treatment may indicate depression/hopelessness, but many cases represent a thoughtful choice (decision to forego aggressive painful therapy) What Is a Good Death? - A good death is defined as "one that is free from avoidable suffering for patients, families, and caregivers in general accordance with the patients' and families' wishes." Institute of Medicine - Six components that enhance the quality of dying: 1) Pain and symptom management 2) Clear decision making 3) Preparation for death 4) Completion 5) Contributing to others 6) Affirmation of the whole person - The Good Death Inventory assesses 10 dimensions associated with quality of death outcomes for patients that include: not being a burden to others; having physical, psychological, and spiritual comfort; good relationships with family and caregivers; and having a sense of control over the future - A study of lung cancer patients found that they focused on themes reflecting their need for a pain free death Is there a Right to Die? - Although assisted suicides and euthanasia is illegal in Canada, the right-to-die movement has been fighting to legalize it - Patients who supported it were not generally more in pain or closer to death, but rather they felt more fatigued, depressed, and felt they were more of a burden to others Moral and Legal Issues - Terminally ill patients most commonly request euthanasia when they are experiencing distress, fatigue, and suffering, and when they fell that they are a burden to their family members - Physicians may feel that it goes against their oat to "do no harm" and 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 few days - They also feel that patients will end up losing their autonomy because the decision of whether euthanasia is necessary will be on the physician; the power to make this decision may lead to patients being killed or coerced into taking aid in dying against their will (as well as causing a profound change in society's attitudes towards illness and disability - As of 2011, euthanasia is only legal in the Netherlands, Belgium, and Luxemburg; physician aid in dying (PAD) is legal in the Netherlands, Switzerland, and in the states of oregon ,Washington, and Montana - Advance directives (aka living wills) can request that extraordinary life sustaining procedures not be used if they are unable to make this decision on their own; there isn't a guarantee that it will be honoured however - Research suggests that many physicians ignore the wishes of their dying patients and needlessly prolong 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 illnesses can threaten the self-concept, as they may be incontinent, they may drool, have distorted facial expressions, or shake uncontrollably, etc - They may face mental regression and inability to concentrate; they may be in intermittent pain; they may suffer from uncontrollable vomiting - Decline in mental functioning is accelerated in the last years before death (this may be due to the tranquilizing effects of painkillers as well) Issues of Social Interaction - Social interactions during the terminal phase of illness are complex and often marked by the patient's gradual or intermittent withdrawal - Patients may find it difficult to see their loved ones see them in their state - 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 - Withdrawal may also be caused by fear of depressing others and becoming an emotional burden - Family may mistakenly believe that the patient wishes to be alone, when it would help for them to support the patient as depression appears to precipitate death Communication Issues - Communication may start to break down when prognosis worsens and therapy becomes more drastic - Death is a taboo subject and so each participant may avoid speaking about it; also they may believe that others do not want to talk about death Kubler-Ross's Five-Stage Theory - Denial: Diagnosis of a terminal illness can come as a shock to a person; denial is a defence mechanism by which people avoid the implications of an illness - May act as if it isn't severe (as if it'll shortly go away or have few long-term implications) - May deny that they even have the illness in extreme cases - Denial is the subconscious blocking out of the full realization of the reality and implications of the disorder - Denial early on in adjustment to life-threatening illness is both normal and useful because it can protect a patient from the full realization of impending death; however, long term denial of one's illness is a defensive pattern from which a patient should be coaxed through therapeutic intervention - Anger: "Why me?" - One of the harder responses for family; they need to realize that the patient isn't usually mad at them, but at fate - The anger will be directed at anyone who is nearby, especially toward people with whom the patient feels no obligation to be polite and well-behaved (family members) - Bargaining: Patient abandons anger and tries to trade good behaviour for good health - Pact with god, in which the patient agrees to engage in good works or at least to abandon selfish ways in exchange for health or more time - A sudden rush of charitable activity or uncharacteristically pleasant behaviour may be a sign - Depression: May be viewed as coming to terms with lack of control - The realization that there is a lack of control (of their eminent death), which may coincide with worsen
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