Developments in End of Life Care John Sheridan End of Life Care Clinical Educator.
THE END OF LIFE
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Transcript of THE END OF LIFE
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THE END OF LIFE
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The Quest for “Healthy Dying”The Quest for “Healthy Dying”
Thanatology: The Study of Death and Dying
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Living WillLiving Will
A legal document that states an individual’s wishes regarding medical care in case the person becomes incapacitated and unable to participate in decisions about his or her medical care.
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The Right-to-Die MovementThe Right-to-Die Movement
Physician-Assisted Suicide Trend: basing decisions less on legalistic
interpretations regarding specific treatments and more on balancing benefits on a case-by-case basis
Euthanasia: Mercy killing
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Three concepts: (NIMH)1. Suicide ideas
2. Suicide attempts
3. Completed suicide
Who Commits Suicide and Why?Females attempt more suicides, but males complete most.
SuicideSuicide
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Provides comfort and care but with the knowledge that the recipients are nearing the end of their life’s journey--that they’re dying
The Hospice MovementThe Hospice Movement
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The Dying ProcessThe Dying Process
Defining Death
Brain Death occurs when the brain receives insufficient oxygen to function.
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A Life Review
Elderly person takes stock of his life, reflecting and reminiscing about it
Confronting One’s Own Confronting One’s Own DeathDeath
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Death drop Near-Death Experiences
– Dying individuals feel themselves leave their bodies and watch as spectators, the resuscitation efforts. Then they pass through a tunnel and enter a spiritual realm.
Changes Before DeathChanges Before Death
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Other views:– (Siegel) Arousal of nervous system and
disorganization of brain– (Alkon) Anoxia induces such mental states– (Kastenbaum) Some heart-attack victims: no
recollection of experience
Near-Death ExperiencesNear-Death Experiences
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Christian: Book of Revelation
Jewish: Speculation about afterlife is pointless
Buddhists: Detailed account
Religious BeliefsReligious Beliefs
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(Elisabeth Kubler-Ross)
1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance
Stages of DyingStages of Dying
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It is the nature of the disease that determines pain, mobility and length of terminal period.
Other factors:– Gender, ethnic group, personality,
developmental level and death environment
Kastenbaum’s Trajectories Kastenbaum’s Trajectories of Deathof Death
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National Mortality Followback Survey: 1993
Data on 23,000 records of death in 1993. All states except South Dakota
Causes of DeathCauses of Death
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Grief, Bereavement, and Grief, Bereavement, and MourningMourning
Adjusting to the Death of a Loved One Bereavement: state in which a person has
been deprived of a relative or friend by death
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Grief: keen mental anguish and sorrow over the death of a loved one
Mourning: socially established manner of displaying signs of sorrow over death
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Support groups to help people through grief work
Culture and Grief Work– Cultural variability in expressing grief
Expressing Anguished FeelingsExpressing Anguished Feelings
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Survivor vulnerable to physical and mental illness and death
Adjusting to Violent and Premature Death– Most severe grief reaction
Consequences of GriefConsequences of Grief
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Stages of bereavement for healthy adults who have lost a parent
1. Going back to the origins
2. Reevaluation phase
3. Assuming leadership
Adjusting to the Death of a Adjusting to the Death of a ParentParent
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1. Shock, numbness, denial, disbelief
2. Pining, yearning, and depression
3. Emancipation from loved one and adjustment to new circumstances
4. Identity reconstruction
Phases in the Bereavement Phases in the Bereavement ProcessProcess
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People handle grief differently Widows and Widowers
– Death rate for widowers higher– Difficulty expressing emotion
Individual VariationsIndividual Variations
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Three types (Lopata)1. Better educated, middle class, strongly identifying with role of wife
2. Women who led multidimensional lives; husband only one part of total set of relations
3. Lower-or working-class women in sex-segregated worlds immersed in kin, neighboring or friendship relationships with other women
Types of WidowsTypes of Widows
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Loss by Miscarriage– Sometimes receive no recognition of loss– Support Groups
Loss by Murder or Violence Bereavement process can go on indefinitely
Death of a ChildDeath of a Child