death and dying - psych 223

challenges associated with conducting research among those who are dying?

• who wants to spend their final days/weeks/months in research?

  • this is why consent is important

• mental capabilities

  • hallucinations, delusions, ec

• communication may be limited

MAID in Canada - what are the two exceptions

• Alzheimer’s and Huntington’s disease

  • if an individual suffers from depression, they cannot pursue MAID !!

death in infancy and childhood

• 5/1000 newborns do not live until 1st birthday in Canada

  • for children, accidents are most common cause of death

SIDS

• sudden infant death syndrome

• parents often feel guilty

  • leading to many mental health issues - grief, depression, etc.

Developing the meaning of death - kids

• kids do not develop the meaning of death until 5

  • for a long time, they view it as temporary, sleep, etc

  • not afraid of it, rather more curious when someone passes away

• at 9 years old, vast majority of kids realize the universality of death

death in adolescents

• understand the finality and irreversibility of death

  • tend to think it won’t happen to them

death in young adulthood + leading cause of death in young adulthood

• feel as they they are just ready to start living their lives and to accomplish their life goals

  • suicide and accidents

death in middle adulthood + most common causes of death in middle adulthood

• life threatening diseases are the most common cause of death

• tendency to shift from the number of years lived to the number of years remaining ‘

• common causes: cancer and heart disease

death in late adulthood

• less anxiety associated with death and dying

  • perhaps due to prevalence of death among older adults

• some older adults actively seek out death

terminal decline

• impending death is accompanied by rapid declines in cognitive functioning

• occurs a couple weeks before death

components included in the death system

• people

  • e.g. seniors

• places or contexts

  • e.g. car accidents

• objects

  • e.g. weapons

• times

  • e.g. remembrance day

• symbols

  • e.g. skulls

Kastenbaum - culture

1. issue warnings and predictions

2. preventing death

3. caring for the dying

4. disposing of the dead

5. social consolidation after death

6. making sense of death

7. killing

cultural differences in exposure to death

• most societies have philosophical or religious beliefs about death

• rituals that deal with death

• some embrace it while other are terrified to die

• in most societies, death is NOT viewed as the end of existence

functional death

• the absence of heartbeat and breathing

brain death

• all signals of brain activity have ceased

  • arguments that we should use whole brain activity as a sign of death → NOT just the brainstem

  • no activation in the cortex, no higher order thinking → is this a quality we want to preserve?

issues in determining death

• decades ago, determining death was more simple

  • biological functions: breathing, blood pressure, etc

• today, brain death is used

  • monitoring neural electrical activity

advance care planning

• process of patients considering and communicating their preferences for how they want to be cared for as they approach death

  • the vast majority of individuals do not document their wishes. they believe they will survive until the average life expectancy.

living will

• legal document that designated what an individual wants or dosnt’t want in terms of medical treatments if they cannot express their wishes

euthanasia

• painlessly ending the life of an individual who is suffering from a disease that is incurable or severe disabilities

  • important dissection between active and passive euthanasia.

active euthanasia

• administering medicine to assist in death

passive

• taking away life support measures

  • eg. taking away the equipment needed to survive

Dr Kevorkinan

• assisted in ending the lives of MANY terminally ill patients

• convicted of 2nd degree murder and served 8 years in prison

• known as the suiciide machine/doctor of death

• occurred before MAID

hospice

• program committed to making the end of life

  • free from pain, anxiety, depression, etc

• differs from hospitals

palliative care

• reducing pain and suffering in patients

• strongly emphasized in hospice care

children 6-9 years…

• death exists, but happens to some people

children 9+ years

• death is universal and final

Robert Kastenbaum

• even young children experiences are strongly concerned with separation and loss

  • strive to understand death

• best mental health outcome: communicating with children about death and dying

suicide (3)

• completed

• attempted - may or may not end in death

• ideation

• approx 3% of pop attempts suicide - 13% report having suicidal thoughts

• women are more likely to attempt sucide, men are more likely to complete suicide

kubler ross stages of dying

1. denial

2. anger

3. bargaining

4. depression

5. acceptance

issues with kubler ross

• existence of 5 stage sequence has not been demonstrated

• neglects the specific circumstances of the individual facing death