Death, Dying & Grieving Lecture Notes

Page 1: Title Slide

• University of Lethbridge

• Course: KNES 3630: Death, Dying & Grieving

• Instructor: Kelsey Kendellen, PhD

Page 2: Lecture Objectives

• Define death

• Describe the Parkes/Bowlby Attachment Model

• Explore Medical Assistance in Dying (MAID) procedures in Canada

• Discuss Kübler-Ross’s Stages of Dying

Page 3: Defining Death

• Defining the moment when life ceases and death occurs is complex.

• Functional Death: traditionally defined as an absence of heartbeat and breathing.

• Current medical definitions prioritize the measurement of brain function.

Page 4: Brain Death

• Definition: "Death is the permanent cessation of brain function, observable by the absence of consciousness and brainstem reflexes including the ability to breathe independently" (Shemie et al., 2023).

• All electrical activity in the brain ceases.

• Higher brain regions die sooner than lower regions:

  • Higher centers: consciousness and thought.

  • Lower centers: heartbeat and respiration.

Page 5: Death & Dying Across the Lifespan

• Topics:

  • Coping with the death of someone else.

  • Facing one's own death.

  • Euthanasia & MAID.

  • Kübler-Ross’s Stages of Dying.

Page 6: Perspectives on Bereavement

• Bereavement: state of loss.

• Grief: emotional response to loss.

• Mourning: culturally prescribed ways of displaying reactions to death.

Page 7: The Parkes/Bowlby Attachment Model

• Model Stages:

  • Numbness

  • Yearning

  • Disorganization & Despair

  • Reorganization

Page 8: Stage 1: Numbness

• Initial reactions in the first hours/days:

  • Daze, sense of unreality, and emotional emptiness.

  • Painful emotions may intermittently surface.

Page 9: Stage 2: Yearning

• Experience of intense separation anxiety:

  • Hearing voices, seeing the deceased in crowds, or interacting with their belongings.

  • Grief fluctuates in waves, peaking 5 to 14 days after death, accompanied by common feelings of anger and guilt.

Page 10: Stage 3: Disorganization & Despair

• Intense grief begins to lessen but is replaced with despair and apathy.

• The bereaved often experience challenges managing daily life for most of the first year post-loss.

Page 11: Stage 4: Reorganization

• Individuals start to adapt and refocus emotional energy on new attachments:

  • Transition from a spouse to a widow/widower.

  • Increased engagement in new activities and relationships.

Page 12: Model Quality of Distress Over Time

• Introduction of timeline reflecting different stages over months:

  • High intensity of distress observed during early bereavement stages.

Page 13: Grieving Dimensions

• Grief: encompasses numbness, disbelief, anxiety, sadness, and loneliness.

• Influential factors:

  • Circumstances of death.

  • Yearning for the lost person.

  • Experience of separation anxiety.

Page 14: Types of Grief

• Anticipatory Grief: grief before death occurs.

• Complicated Grief: persists 6+ months and can adversely affect health.

• Disenfranchised Grief: loss that cannot be openly mourned.

Page 15: The Grief Work Perspective

• To cope adaptively with death, bereaved individuals must:

  • Confront their loss.

  • Experience and process painful emotions.

  • Psychologically detach from the deceased.

Page 16: Misconceptions in Grief Work

• Common misunderstandings include:

  • The existence of a singular right way to grieve.

  • The idea of working through grief as a linear process.

  • Beliefs about breaking emotional bonds with the deceased.

Page 17: Who Copes and Who Succumbs?

• Factors distinguishing those who cope well with loss:

  • Individual’s personal resources.

  • Nature of the loss.

  • Context of support and associated stressors.

Page 18: Overview of Questions on Death and Dying

• Similar topics as previously discussed:

  • Coping with death.

  • Facing death.

  • Euthanasia & MAID.

  • Stages of dying.

Page 19: Euthanasia & MAID in Canada

• MAID: medical assistance for eligible individuals to end life.

• Legalization in Canada as of June 2016 (Bill C-14).

• Revised in March 2021 (Bill C-7) to remove the requirement for a foreseeable natural death.

Page 20: Types of MAID Permitted

• Two forms:

  • Direct administration by a physician/nurse.

  • Self-administration prescribed by a physician/nurse.

Page 21: Eligibility Criteria for MAID

• Established criteria to qualify for MAID:

  1. Eligible for government-funded health insurance in Canada.

  2. Age 18+ or possess decision-making capacity.

  3. Grievous & irremediable condition.

  4. Voluntary request without external pressure.

  5. Informed consent to receive MAID.

Page 22: Defining Grievous and Irremediable Condition

• Conditions must include:

  • Serious illness, disease or disability.

  • Advanced, irreversible decline with predictable trajectory to death.

  • Unbearable physical or mental suffering that cannot be alleviated.

Page 23: MAID and Mental Illness

• Starting March 17, 2027, individuals suffering from mental illness can qualify for MAID if they meet all criteria:

  • Includes psychiatric but excludes neurocognitive conditions.

  • Progressive timeline from Bill C-7 implications.

Page 24: MAID Procedural Safeguards

• Essential safeguards include:

  • Independent medical assessments (two practitioners).

  • Written requests for MAID.

  • Witnessing requirements for requests.

  • Final consent immediately before MAID.

Page 25: Waiver of Final Consent (Audrey’s Amendment)

• Allows pre-approved MAID individuals to proceed on their chosen date without current capacity.

• Case study: Audrey Parker opted for early MAID to ensure consent before cognitive decline.

Page 26: Assessment Period for MAID

• Assessment begins at the first evaluation of eligibility.

• MAID assessor triggers the assessment period, which must last a minimum of 90 days.

Page 27: Overview of Previous Topics

• Reiterations of important themes:

  • Coping with death.

  • Facing death.

  • Euthanasia & MAID.

  • Stages of dying.

Page 28: Kübler-Ross and Stages of Dying (1969)

• Seminal work focusing on terminally ill patients and their emotional responses.

• Emphasis on quality of life considerations for the dying and their families.

Page 29: Kübler-Ross's 5 Stages of Grief (DABDA)

• Breakdown:

  • Denial

  • Anger

  • Bargaining

  • Depression

  • Acceptance

Page 30: Insights on Emotions and Stages

• Discusses emotional challenges individuals face during the dying process including:

  • Denial and its subsequent emotional states (anger, bargaining).

  • Progression towards acceptance.

Page 31: Cultural Reference: Swifties and Grief

• Exploration of cultural interpretations in media regarding the stages of grief.

Page 32: Stage 1: Denial & Isolation

• Denial as a common mechanism in terminal illness:

  • Temporary reaction leading to feelings of disbelief.

Page 33: Stage 2: Anger

• Anger often manifests towards caregivers:

  • Resentment can lead to complexity in relationships with family and healthcare providers.

Page 34: Stage 3: Bargaining

• Efforts to negotiate one's death typically involve hopes to extend life through various means.

Page 35: Stage 4: Depression

• Various forms of depression may occur in awareness of impending death:

  • Reactions range from quiet reflection to emotional outpouring.

Page 36: Stage 5: Acceptance

• Acceptance characterizes the final stage, showing peace with the process of dying.

Page 37: Critique of Kübler-Ross’s Theory

• Highlights limitations:

  • Non-linear dying process.

  • Oversight of individual personality factors.

  • Lack of attention to the living experience of those who are dying.

Page 38: Models of Dying & Bereavement

• Comparison of Kübler-Ross's stages and the Parkes/Bowlby model highlighting similarities in emotional responses.

• Stages of dying and bereavement are interconnected.