Death Dying And Bereavement Pdf
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Five stages of grief
On Friday, March 18, , doctors removed the feeding tube that had sustained Ms. Terri Schindler Schiavo, a young woman who had suffered brain damage as a result of cardiac arrest in The Schiavo case underlined numerous issues that were important in our national consciousness. First, experts disagreed about whether Schiavo was in a persistent vegetative state, an irreversible condition in which cortical functioning ceases but brainstem functions, such as heartbeat and respiration, remain intact.
Had Schiavo completed an advance directive, or written instructions about her health care, her wishes would have been clearer after she became incapacitated. Terri Schiavo was a young woman, 26 years of age, when she suffered cardiac arrest. Most people would never think of someone in her twenties as needing an advance directive.
Perhaps one positive outcome in this otherwise tragic tale is that it forced the issue of quality of life, and end-of-life decisions, into our awareness, despite our best efforts to avoid thinking about such things! It has been said that one way to tell how uncomfortable a culture is with something is the number of euphemisms for it.
It is no accident that western culture boasts a multitude of euphemisms about death. In this article, we explore the psychology of death, dying, and bereavement, as well as relevant medical, legal, social, and political issues. Clinical death, also known as cardiac death, is defined by lack of heartbeat and respiration.
However, medical advances have resulted in the ability to extend life far beyond what could have been anticipated. Therefore, it has become necessary to define a state in which there is catastrophic, irreversible loss of brain function, including brainstem function.
The determination of brain death is a complex clinical process. Second, clinical tests are performed to ensure that the criteria for brain death are met. However, definitions of brain death differ among countries. According to Elliott , the United States and many other countries have adopted a whole-brain definition of brain death, which involves the cessation of all brain function. However, the United Kingdom has adopted a definition known as brainstem death, in which loss of brainstem function is sufficient to be declared brain dead.
This list has changed dramatically from years ago, when most people died from rapidly progressing infectious diseases rather than chronic conditions. These changes in cause of death have significant implications for our experience of death. By far, most deaths in the United States occur in hospitals or other health care settings such as nursing homes or hospice centers.
However, this statistic varies by demographic variables, as well as by cause of death. For example, in a study of adults aged 65 and older, Mitchell, Teno, Miller, and Mor found that On the other hand, patients with cancer were nearly equally likely to die at home There are two kinds of advance directives. It specifies the treatments the patient wants, and those the patient does not want, under those circumstances. However, a living will only covers those situations that can be anticipated, so most experts also recommend that the patient give durable power of attorney for health care to a trusted person.
A living will and durable power of attorney for health care are the most frequently employed advance directives. However, people sometimes use two additional directives. A medical directive is a questionnaire in which patients report what treatments they would desire under a variety of medical circumstances, and a values history is an open-ended questionnaire in which patients discuss health-related values, and what decisions clients have made on the basis of those values.
Underscoring the need for patients to understand their options for end-of-life care, Congress passed the Patient Self-Determination Act of Decisions regarding end-of-life care are more complex than they might seem, and are influenced by cultural factors. For example, research has indicated that African Americans are less likely than other ethnic groups to complete advance directives. According to Bullock , reasons for this may include religious faith, differing views of suffering e. Palliative care is defined as care that focuses on relief from symptoms, including both relief from physical pain or discomfort and relief from emotional suffering.
It is differentiated from curative care, which focuses on treating the disorder that is causing the symptoms National Hospice and Palliative Care Organization, n. A patient need not have received a terminal diagnosis to receive palliative care, and palliative care can be combined with curative care, either in a hospital or another setting. For example, a patient with cancer may receive both pain management palliative care and chemotherapy curative care.
Hospice care is specific to terminally ill patients, and it often includes palliative care. Hospice care emphasizes a team-oriented approach to dealing with a life-threatening illness or injury including medical care, symptom management, and support for the patient and family.
In , there were approximately 3, hospice programs, serving approximately 1,, patients in the United States alone Schonwetter, As with the use of advance directives, there are large racial differences in utilization of hospice services, with African American and Latino patients being significantly underserved. According to Taxis , focus groups conducted with African Americans indicated a lack of knowledge about the scope of services provided, eligibility requirements, and the costs of such programs.
Finally, participants reported some mistrust of the health care system, which might have hindered their willingness to allow health care workers into their homes. Additionally, surveys conducted between and indicated that a majority of Americans supported the idea of allowing physicians to assist those who wanted to die under those circumstances Allen et al.
The Supreme Court has upheld the right of an individual to refuse life-support treatment or other medical treatment if he or she suffers from an incurable disease. Therefore, under those circumstances, passive euthanasia is legal in the United States.
Active euthanasia including physician-assisted suicide is illegal in 49 states. In Oregon passed the Death With Dignity Act, which states that Oregon residents who are terminally ill may selfadminister a lethal dose of drugs that has been prescribed by a physician for that purpose. The Death With Dignity Act has withstood various legal challenges, including a federal lawsuit, Gonzalez v.
Between and , people opted to end their lives under the guidelines of the Death With Dignity Act Miller et al. More women than men attempt suicide, but men are more likely to complete suicide, probably because they tend to select more lethal means for committing suicide. Men are more likely to commit suicide by a firearm than are women, and women are more likely than men to attempt suicide through poisoning or overdose.
Certainly suicide among children and teens is always a cause for concern, and the rate of adolescent suicide has risen alarmingly in recent years. However, older white males continue to be the group at highest risk for suicide. European Americans in general have the highest rates of suicide among ethnic groups, followed by Native Americans. Contrary to popular myth, it is untrue that if someone talks about suicide, he or she is unlikely to commit suicide.
Most people who commit suicide have talked to others about it in the past. Suicidal ideation or suicide attempts should be taken seriously, regardless of their objective level of lethality NIMH, As we already seen, our society appears to be profoundly uneasy about death and, at times, outright afraid of it. Fear of death is not necessarily a unitary construct; rather, it represents a group of fears, including such things as a fear of the unknown, fear of nonbeing after death, or fear of the dying process itself.
In everyday discussion, people often use the terms bereavement, grief, and mourning interchangeably. However, in the death and dying literature they have meanings that are distinct from one another.
Although there is some variability among authors, the most common definition of bereavement is the state of having lost someone through death. Grief consists of the emotional and psychological reaction to bereavement, and mourning is defined as the way grief is expressed. How people experience grief, and how, or even if, grief becomes resolved, have been the subject of intense theoretical focus.
According to the grief work perspective, working through grief is necessary to resolve it. One must acknowledge the reality of the loss, as well as express and work through the resulting feelings. Otherwise, the individual is at risk for grief-related complications Center for the Advancement of Health, a. On its face, the grief work perspective sounds a bit like common sense. Many of us have been exposed to the idea that we must acknowledge, express, and work through our feelings in order to resolve them.
However, the grief work perspective rests on a number of assumptions, such as the idea that outward expression of distress is necessary to resolve grief, and that failing to express this distress is an indicator of pathology. More research is needed to shed light on the validity of this approach. Bowlby , an attachment theorist, developed a stage theory of grieving that was an extension of his views on attachment and also based in psychoanalytic theory.
As the reality of the loss sets in, the person shifts from an agitated state to a state of lethargy and despair.
Finally, the individual begins to take control of his or her life once more, and loosens the attachment bond to the lost loved one, a phase that Bowlby called detachment. However, as noted above, there is now a great deal of evidence to indicate that bereavement is a very individual process, and does not follow a predictable sequence of stages.
In addition, some controversy exists about the necessity of loosening emotional bonds in order to resolve grief, with some researchers arguing that maintaining a continued relationship with the deceased serves an adaptive function, and others seeing it as maladaptive under particular circumstances.
There also appears to be some cultural variation in the association between continuing bonds and the progression of grief. Lalande and Bonanno found that in China, higher levels of continuing bond early in bereavement were associated with better adjustment, whereas in the United States, higher levels of continuing bond early in bereavement were associated with poorer adjustment later in bereavement.
According to the Dual Process Model, bereaved individuals have to cope with two different types of stressors, loss-oriented and restoration-oriented.
Loss-oriented stressors are related to the loss of the deceased person, whereas restoration-oriented stressors are secondary stressors that are indirectly related to the loss, such as having to be responsible for household finances when the deceased spouse used to handle such things. Dealing with loss-oriented stressors, such as coping with the distress of separation from the lost loved one, is called loss-oriented coping. Dealing with restoration-oriented stressors, such as coping with the shift in identity from wife to widow, is called restoration-oriented coping.
The Dual Process Model posits that a bereaved individual goes through a process of alternating between confrontation and avoidance of these stressors.
When confronting loss-oriented stressors, the individual avoids restoration-oriented stressors, and vice versa. This process is called oscillation. According to Stroebe and colleagues, oscillation is both a short-term process and a long-term one. Oscillation between loss-oriented coping and restoration-oriented coping may occur from one moment to the next, but there also appears to be a long-term shift from more loss-oriented coping early in bereavement to more restoration- oriented coping later in bereavement.
Just as Stroebe et al. Whereas the grief work view emphasizes expression of negative emotions as important to resolution of grief, the social-functional approach examines the possible adverse effects of this expression. For example, prolonged expression of anger or sadness may disrupt social networks, which may in turn prolong or worsen grief. The social-functional approach, then, examines the potential adaptability of reduced experience and expression of negative emotions.
It also examines the role of positive emotions, such as laughter, in assisting with bereavement. Several researchers have found that expression of positive emotion in bereavement is predictive of better adjustment e. Creating meaning involves two independent processes that occur simultaneously.
First, the bereaved individual attempts to make sense of the loss by incorporating it into his or her worldview. Although the meaning-making perspective has intuitive appeal, it is not without its critics.
Death, Dying, and Bereavement
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People cope with the loss of a loved one in many different ways. For some, the experience may lead to personal growth, even though it is a difficult and trying time. There is no right or wrong way to cope with the passing of a loved one. The way a person grieves depends on the personality of that person and the relationship with the person who has died. What is the difference between grief, bereavement and mourning?
Death, Dying, and Bereavement in a Changing World. Alan R. Kemp. Pierce College. Boston Columbus Indianapolis New York San Francisco Upper Saddle.
Death, Dying, and Bereavement
Although commonly referenced in popular culture, studies have not empirically demonstrated the existence of these stages, and the model is considered to be outdated, inaccurate,  and unhelpful in explaining the grieving process. Doka, "not as reflections of how people grieve. In , during the COVID pandemic , Kessler applied the five stages to responses to the virus, saying: "It's not a map but it provides some scaffolding for this unknown world. There's anger: You're making me stay home and taking away my activities. There's bargaining: Okay, if I social distance for two weeks everything will be better, right?
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On Friday, March 18, , doctors removed the feeding tube that had sustained Ms. Terri Schindler Schiavo, a young woman who had suffered brain damage as a result of cardiac arrest in The Schiavo case underlined numerous issues that were important in our national consciousness.
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Death and Dying
Глаза Стратмора сузились. - Странно. Я вчера говорил с. Велел ему сегодня не приходить. Он ничего не сказал о том, что поменялся с тобой дежурством. У Чатрукьяна ком застрял в горле. Он молчал.
- Надо думать. Есть различие, которое мы все время упускаем. Что-то очень простое. - Ой, дорогие мои… - сказала вдруг Соши. Она открыла на экране второе окно и просматривала остальную часть документов Лаборатории вне закона. - В чем дело? - спросил Фонтейн. - Вы что-то нашли.
Привет, это Дэвид. - Он замолчал, не зная, что сказать. Беккер терпеть не мог говорить с автоответчиком: только задумаешься, а тот уже отключился. - Прости, не мог позвонить раньше, - успел сказать. Подумал, не рассказать ли ей. Но решил этого не делать. - Позвони коммандеру.
Сьюзан открыла одно из старых входящих сообщений, и у нее тотчас же перехватило дыхание. ТО: NDAKOTAARA.
Какие-нибудь новости, Сьюзан? - спросил Стратмор и тут же замолчал, увидав Грега Хейла. - Добрый вечер, мистер Хейл. - Он нахмурился, глаза его сузились. - Сегодня суббота.
Приготовиться. Приступайте. - Мы не успеем! - крикнула Соши. - На это уйдет полчаса. К тому времени все уже рухнет.
Он протягивал свою изуродованную руку… пытаясь что-то сообщить. Танкадо хотел спасти наш банк данных, - говорила она. - А мы так и не узнаем, как это сделать. - Захватчики у ворот.