Chapter 15 Intro to Human Development

What are the three pathways to death?

occurs quickly

occurs after steady decline

long and erratic process

How do deaths typically occur in affluent countries today?

slowly bc of medicine

How did death typically occur in the nineteenth century?

quickly, horrid, wild

When and how did doctors’ talking about death totally change?

1960s revolution: schools discuss death, Dr.s blunt about diagnoses, planning death

How do different cultures treat death?

West: honesty, need for planning

Hmong: ignore that the person is dying until death is imminent, then shower with affection

What did Kübler-Ross find during the 1960s when she interviewed dying patients about their feelings?

they were relieved to talk about their diagnosis, they know they’re dying but Drs won’t say it

What characterizes each of the five stages in Kübler-Ross’s stage theory of dying?

denial, anger, bargaining, depression, acceptance

Identify and explain three reasons why we can’t take this famous theory as the final word about death.

1. dying people dont want to discuss their full situation

2. they don’t want to know the full truth

3. not everyone passes through stages

T or F: Kübler-Ross’s theory inadvertently encourages its own kind of insensitivity to terminally ill people.

true

What is the more realistic view of facing death?

a ‘complicated cluster of emotions’ rather than stages

people experience death differently

What is middle knowledge and why is it important?

terminally ill person knows they’re dying, but hasn’t fully grasped it

What overall qualities are involved in having “a good death”?

no physical or mental distress, no pain, close to loved ones, sense of spirituality

What is persistent complex bereavement-related disorder and why is it considered controversial?

chronic grief, mourning past 6 months to a year

reclassifies mourning as a pathological state & some deaths are traumatic

How might the COVID-19 pandemic be related to chronic grief?

unexpected death in hospital, isolated

Describe the various feelings that caregivers may have about losing a child.

guilt (couldn’t protect), anger (robbed of life), chronic grief

Describe some research findings on how parents can cope with their lives after a child’s death.

discuss what’s happening to the child with them during final weeks (if old enough to understand death)

turning childs death into a redemption sequence

What is wrong with the traditional hospital approach to dying?

What role does the dying trajectory play?

estimate of a patient’s pathway of death

hospitals can misestimate a dying trajectory and neglect patients accidentally

Deaths don’t occur according to a .

programmed timetable

What is one agonizing ethical choice health-care workers often face?

when do you stop fighting/putting off death

What is a palliative care service?

hospital or home based end-of-life care service, focus on comfort & pain control

What does a palliative care service offer?

can still get cure-oriented treatments, but as illness becomes more terminal, focus shifts to symptom managment

What is the underlying philosophy of the home hospice movement?

death is a natural process and should happen in a natural painfree way

Who are death doulas?

use calming techniques and coach people through death

How do hospice workers feel about their job? What do they see as their role?

the most meaningful job in the world

Who qualifies for hospice care? In the United States, who pays for hospice care?

physician must certify person is within 6 months of death

T or F: The U.S. hospice movement is dwindling.

false

What is the home hospice experience like for caregivers?

fear of addiction to painkillers, overdose

What are some barriers to hospice care?

people don‘t want to accept reality of death

doctors avoid end-of life-discussions

lack of family involvement & support

What unique concerns may ethnic minority individuals have about hospice?

a disregard or cultural death-traditions or religious beliefs

What are advance directives and why are they important?

document with life prolonging treatment instructions for if patient becomes too ill to communicate

What does a living will address?

mentally competent people leave instructions for life-prolonging procedures if they’re incapacitated

How does a living will compare to a durable power of attorney for health care and a DNR order or DNH order?

Durable Power of Attorney: designate specific person to make end of life desicions

DNR: sick person mentally impaired, usually initiated by Dr

DNH: specific to nursing homes, mentally impaired resident is NOT hospitalized

Why might there be resistance to filling out an advance directive?

people don’t want to face death

How can culture affect a person’s desire fill out an advanced directive?

Blacks and Hispanics trust futures to families and rely on their faith

What are some issues with these documents?

subject to misinterpretation, jealously over who is chosen to carry out wishes

What is the most useful advance directive?

durable power of attorney

What is the difference between passive euthanasia and active euthanasia?

passive: eliminating anything external keeping patient alive or comatose

active: actively helping a person die

In what countries is active euthanasia legal?

Netherlands, Belgium, Luxembourg, Columbia, Canada, Spain

Where within and outside of the United States is physician-assisted death legal?

Switzerland, Germany, Australia, California, Colorado, the District of Columbia, Hawaii, Montana, Maine, New Jersey, Oregon, Vermont, and Washington State

What is physician-assisted death?

active euthanasia, Dr. persribes fatal medication to terminally ill patient

Why is there considerable resistance to making active euthanasia and physician-assisted death legal?

killing is ‘playing God’

could cause inappropriate killing

What is age-based rationing of care?

expensive life-sustaining technology should NOT be used on old-old people

What are the arguments for age-based rationing of care? Do you agree?

death is near and inevitable, care is expensive

Across the lifespan, what outweighs everything else?

attatchment