Ch. 12 Death and Loss

Aspects of Death Fears

• Ceasing to be: Fear of losing self-identity.
• Leaving loved ones behind: Concern for those left without support.
• Encountering the unknown: Anxiety about what happens after death.
• Coping with pain: Struggles with the possibility of suffering during dying.
• Memories fading: Fear of being forgotten by others.

Life and Death

• Life and death are interrelated.
• Recognition of death can encourage us to pursue our goals.
• Acceptance of mortality can lead to a deeper sense of meaning and purpose.
• Limited time heightens the urgency to live fully.
• Ancient Greek Saying: "Contemplate death if you would learn how to live."

Suicide Considerations

• Unreported Attempts: Many attempts go unnoticed and untreated.
• Gender Disparities: Women may attempt suicide more, but men have higher death rates.
• Feeling Trapped: Individuals contemplating suicide often feel a sense of entrapment.

Myths about Suicide

• Lack of Warning Signs: Belief that there are no identifiable signs.
• Talk of Suicide: Misconception that those who talk about it won’t act.
• Age Factor: Younger individuals are thought to be more prone to suicide.
• Permanence: The belief that suicidal thoughts are always constant.
• Intent: Misconception that all attempts are aimed at death.

Indicators of Suicidal Thoughts

• Verbal Warnings: Mentioning of suicidal thoughts.
• Lack of Purpose: Absence of meaning can signal danger.
• Previous Threats: Past mentions of suicide can indicate future risk.
• Preoccupation with Death: An ongoing focus on death or dying.
• Prized Possessions: Giving away items can indicate a finality of thoughts.
• Planning: Discussing specific methods of suicide is a critical warning sign.

Behavioral Changes

• Anxiety and Agitation: Increased levels of stress and worry.
• Substance Abuse: Rise in use of drugs or alcohol.
• Isolation: Withdrawal from social circles and loved ones.
• Personality Changes: Sudden, extreme shifts in behavior or mood.
• Finding Closure: A desire to sort out personal affairs.

Types of Suicide

• Rational Suicide: Ending life due to unbearable suffering from terminal illness.
• Assisted Suicide: Provision of means to self-administer death.
• Hastened Death: Accelerating the dying process through medical means.

Advance Directives

• End-of-life Care Decisions: Ensuring self-determination in dying.
• Living Will: Specifies desired medical treatment or refusal.
• Durable Power of Attorney: Designates individuals to make health decisions on one’s behalf.
• Death with Dignity Act: Oregon’s law permitting physician-assisted suicide since 1997.

The Dying Process

• Diminishing Choices: As one dies, fewer choices remain available.
• Coping Choices: Individuals can choose how they respond to dying.

Hospice Care

• Affirming Life: Focused on enhancing the quality of life at end stages.
• Home-Based Services: Care is provided in the patient's home, which is often more personal and less expensive.
• Palliative Care: Aim is to relieve suffering and improve living quality rather than cure illness.
• Family and Patient Unit Care: Support is offered to both patients and their families.

Support in Hospice

• Volunteer Support: Programs to aid helping hands for patients and families.
• Holistic Approach: Treating the whole person - body, mind, and spirit.
• Interdisciplinary Teamwork: Collaboration among various professionals.
• Post-Death Support: Services for those grieving the loss of a loved one.

Kübler-Ross Five Stages of Dying

1. Denial: Refusal to accept reality or facts.
2. Anger: Frustration and helplessness at the situation.
3. Bargaining: Attempting to negotiate for an extended life or a cure.
4. Depression: Deep sadness about the loss; mourning.
5. Acceptance: Coming to terms with the reality of the loss.

Tasks in the Dying Process

• Physical Tasks: Managing pain and other physical symptoms.
• Psychological Tasks: Maintaining autonomy and dignity.
• Social Tasks: Enhancing relationships important to the dying individual.
• Spiritual Tasks: Finding meaning, connectedness, and fostering hope.

Remembering and Grieving

• Continuing Relationships: Individuals remain interconnected even after death.
• Re-membering: Keeping the deceased in daily life decisions and memories.
• Focus on Ongoing Connections: Aim for integration rather than detachment from the deceased.

Grief Work**

• Bereavement Exploration: Understanding and expressing feelings of loss.
• Support Groups: Being part of communities that share similar experiences.

Phases of Grief Work

1. Opening to loss
2. Dispelling grief myths
3. Embracing unique grief processes
4. Exploring feelings
5. Understanding normal reactions to grief

Additional Phases

6. Recognizing mourning needs
7. Self-nurturing practices
8. Reaching out for support
9. Seeking reconciliation with loss
10. Appreciating transformation through grief.

Tasks of Mourning

1. Acceptance: Facing the reality of loss.
2. Work Through Pain: Engaging with grief actively.
3. Adjusting: Navigating life in absence of the deceased.
4. Emotional Relocation: Making peace with the past and moving forward.