Death, Grief and Caring
Death, Grief and Caring SOCI 3804
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Chapter 6 Endof Life Issues and Decisions Choices that are so difficult Caregiver Making a will Obtaining life insurance Completing advance directives about medical treatment Settling one s estate Things to think about now before you have to make definitive plans This is when you will Your funeral plans will be due March 28th Your paper will be typed single spaced to include no less than three pages long Your decisions about your Funeral service Body disposal If per chance you develop a lifethreatening illness treatment decision DNR hospice home care caregiver Principles of Medical Ethics Informed Consent Withdrawing or withholding medical treatment Euthanasia Physicianassisted Morals about these issues It is about autonomy your choices Impact on welfare of the individual On others Society s interest in regard to scarce resources ethics Nonmaleficence or doing no harm Informed Consent to Treatment Implies a contract whereby each party agrees to perform certain acts Patients have a right to be fully informed about a proposed plan of treatment to thus decidechoose their path of treatment Process Patient must be competent Consent must be given freely Patient must have adequate understand of proposed treatment and the risks Patient Must make sure all of their questions are answered both the positives and the negatives Descriptions must be clear terms used spelled out what is a tumor size mass growth etc 1977 research revealed that many physicians would give general explanation of the medical situation while eliciting the patient s cooperation Keeping patients confidences than truth telling for its own sake Prognosis the expected course of the disease Teams of medical professionals Can be problematic Every health care professional can have their own opinion Too many Chiefs and not enough Indians Family members may not share Quality of communication DNRs and CMOs must be spelled out CPR choices Cooperation between patient and physician in seeking the common goal of optimal and appropriate health care To choose death Kevorkian Hemlock Society Right to Die The Rule of Double Effect a harmful effect of treatment even if it results in death is permissible if the harm is not intended and occurs as a side effect of a beneficial action chemo Choosing death Palliative care does not hasten death Sedation or nonsedation Imminently dying patients are imminently dying patients A peaceful comfortable death should be the preeminent treatment goal when someone is dying Euthanasia Illegal Page 228 Nutrition and Hydration Seriously Ill Newborns page 231 Advance Directives page 231 and page 232 AND 233 Five Wishes created by Aging with Dignity on page 235 Wills and Elements of Wills Statement on page 242 leave a legacy Chapter 8 my RMES Funeral should 0 Reflect the person Alexander the Great s page 289 A Rite of Passage from the womb to the tomb The setting up with someone or wake is a vigil The Egyptian thought was to prepare for the afterlife with quotstuffquot The quotsecond line jazz in New Orleans Elements of funeral rituals on page 291 Funeral serve four functions Acknowledge and commemorate the death Provide a setting for disposition Assists in reorienting the bereaved Demonstrates reciprocal economic and social obligations Funeral are another milestone in one s life obits Announcement to community Structure for acknowledgement Vehicle to detail method of death Recognition of bereaved Allows for mutual support Funerals in the United States 0 A business 0 Professionals Planning Burial services such as embalming cremation Aid in bereavement page 300 humor Protect Aftercare New Directions of funerals 0 Additional choices of Video biographies Wearing jewelry made from cremated remains Designing their own casket Funeral directors are now event planners Decorate your own vault Shared eulogies Life centered funerals Doityourself funerals or family directed Data on page 304 Green funerals page 305 biodegradable coffinrecyclable Ecopod Eternal Reef Space Burials Cryonic Cyberfunerals funeral casting New and Rediscovered Memorial Choices Web memorials equipped with Digital flowers Cremation jewelry locket style pendants that hold a small bit of cremated remains worn around the neck or displayed in special holders Memorial Tshirts given at the wake Memorial walls Roadside memorials now outlawed in Georgia Spontaneous shrines Selecting funeral services Purchasing funeral services is not like shopping for a car we don t tend to shop around sadly Funeral charges on page 311 Comparing all this should be done long before death to be completely quotsoberquot while choosing Embalming is mandatory if burial is after xx days We don t have refrigerated caskets Body disposition Dead bodies need a tomb cultural Cremation Unembalmed adult body buried 6 ft deep in ordinary soil without a coffin normally takes 10 12 years to decompose A child takes V2 time If in a coffin it takes much longer to decompose Other culture s rituals on page 319 Donation to medical science Burial Arlington National Cemetery Gene Autrey Oaxaca Mexico on page 321 Cemetery plots Cremation Memorialization Grave markers Taj Mahal Image makers Wives memorialize Making meaningful choices pictures on 327 328 Chapter 9 Survivors Understanding the Experience of Loss Grief is weaved all through life Death Loss of a baseball team Graduating from high school Getting a promotion Changing jobs Leaving town of youth A break of a relationship Bereavement grief and mourning Bereavement is defined as the objective event of loss 0 Grief is the reaction to that loss Mental or cognitive distress in grief may manifest as disbelief confusion anxiety tension pain a pervasive sense of disorganization and depression Emotions of grief Sadness Longing Loneliness Sorrow Selfpity Anguish Guilt Anger Relief Outrage Inability to control events Physical signs of grief Sighing Shortness of breath Tightness of the throat Feeling of emptiness in the abdomen Muscle weakness Chills Tremors Nervous system hyperactivity Insomnia Changes in appetite Wandering about quotsearchingquot Models of Grief Working through grief Beginnings as far back as Freud in 1917 Grief work Letting go Attachment theory on page 337 The grief work model incorporates several important points about mourning a loss grief as an adaptive response to loss reaity of the loss must be confronted and accepted acknowedges that grieving is an active process that occurs over time Duration of grief Depends upon the success with which a person does the grief work namely emancipation from the bondage to the deceased readjustment to the environment in which the deceased is missing and the formation of new relationships 0 The griefwork model incorporates several important points about mourning a loss first it describes grief as an adaptive response to loss What does grieving do for us It affects emotional physical psychological spiritual as well as cultural Some cultures create quotcontinuing bonds keeping a special place not changing a child s room a place setting at the table keeping a piece of clothing such as a sweater furniture etc 0 Household shrines gardens Narratives Journalling Writing letters to loss Doing videos of pictures Scrapbooking Quilts of clothing Duel Process Model of Grieving Understanding that grief is a dynamic process which involves movements Oscillation or alternation Actively confronting the loss Avoidance of the loss Distraction TwoTrack Model of Bereavement Rubin s loss process includes Functioning and quotcontinuing the relationship with the quotlossquot Functioning focuses on recovery growth continuing difficulties adaption etc Continuing the relationship relates to memorialization emotional distance memories etc His four major points or stages of bereavement process are on page 343 The Task of Mourning Worden s four tasks of mourning Accept Process the pain Adjust to a world without Find an enduring connection And embark on a new life 0 Rando s six R s on page 344 and 345 There is no standard way of coping with loss Colin Murray Parkes sees three main influences on a person s course of grieving Urge to look back cry and search The urge to look forward explore discover The social and cultural pressures The experience of brief frightening overwhelming even quotcrazy making the mental versus emotional lots of different the course of grief Duration of Grief and Complications Grief has no absolute ending point Various influences hamper satisfactory adjustment page 351 When grief is suppressed and emotional engagement with the loss is absent or diminished or when grief is so boundless that it becomes totally overwhelming Rondo suggests two things page 351 The Mortality of Bereavement Can you die from a broken heart Yes Oppenheimer said you can Stroebe said you can Particularly sudden death Can bereavement make you sick Variables Influencing Grief How you see the world perceptions of reality and judgment Personality types Cultural context and social roles how does your culture norms direct grieving gender differences in grieving Perceived relationship with the deceased quotan outsider or others consider quotclosequot Values and beliefs Coping patterns and gender stereotypes 0 Men don t cry 0 Many effective ways of expressing and adapting to loss for both genders Intuitive Instrumental Linear types of thinking and communicating processing Systemic mode spider s web Mode of death influences one s grieving Anticipated death Sudden death Suicide Homicide Myrtis Disaster More than one loss and bereavement burnout Chapter 2 Learning About Death The Influence of Sociocultural Forces Death as a concept Death is a concept that we learn about learn attitudes towards Children do not understand the finality of death until about age 710 pg 48 The never return Death experiences differ person to person previous held knowledge beliefs and attitudes are constantly being reexamined The concept Not a single unidimensional concept but rather several relatively distinct subconcepts Universality Irreversibility Nonfuctionality cessation of all physiological func ons Causality there are always reason Personal mortality I will die notjust everyone else Concept of Death Ever evolving knowledge as one progresses through life stages Development of the Understanding of Death Development occurs in stages as does the psychosocial person Nagy and Anthony Age 35 death is less than alive Age 59 final but as avoidable and lacking inevitability Age9 result ofa biological process that is final inevitable universal and personal Erikson and Piaget s work Each stage requires moving from a crisis to development of a skill gaining mastery over various issues and into developing a sense of identify Erikson was it as connectiveness and independence significantly dependent upon environment and relationship with others Piaget Focus on cognitive transformation Everything is filtered through our frame of reference the world is safe fearful etc Assimilation and accommodation is the rule for the day for children As children look at death they do it through their frame of reference thus as the child goes through assimilating information into their world as well as accommodating to other s demands Piaget Sensorimotor Preoperational Concrete operational and Formal operational Each stage is sequential but each child is unique in their rate of development Enkson Age birth to one year trust Age two to three autonomy greater independence Age four to five initiative who am I what kind of personal am I seeking direction affirmation Beginning of moral self concerned about body wholeness Always should be given accurate information about death Response and Reaction for children 34 5 Be honest but not unnecessary graphic details Common expressions of grief for this age group is sadness regression play reenactment and magical thinking This applies to pets neighbors as well as relatives play mates Some common questions from this age group What makes things die Fantasy reasoning etd The middle age child Age 6 to 10 or so industry I am what I learn busy busy busy being in control Grace Crist children in this age range had a difficult time navigating what had happened because they weren t old enough to fully grasp the big picture they need details as apposed to the earlier age group who needs facts but not details but not on overload Need to feel some sense of control Death concept for middle age Grieving reactions School and learning problems Phobias Anger Hypochondriasis If a parent dies during this time frame the child feel rejection looses a source of recognition Adolescence and death concept Age 1114 early adolescence shift from parental dependency to peer attachments Age 1517middle adolescenceindividual selfimage experimentation and striving for competency mastery and control Age 18 21late adolescence an increased selfacceptancy intimacy and concern for others future oriented Adolescence Erikson sees this time as identify versus role confusion Piaget sees this as a time for the use of formal operations a person fundamental way of seeing the world is firmly established Death is seen as reconcile that identify with ultimate disintegration and not being Sociocultural Influences Socialization regarding death Agents on a ad hoc basis disorganized and impromptu Family School Peers Tactical socialization informally teaching people about death and dying an active effort to change other people s perceptions and behaviors about some aspect of their social world family First source of death education This education continue through out life Every family approaches it differently Many messages about death are unspoken unconscrous Parental attitudes and the attitudes of other family members shape the values and behaviors not only of the child but also of the adult that the child will become and they influence how that adult conveys attitudes toward death to his or her own children School Mass Media and literature School provides a social venue for approaching the subject of death casually Mass Media a powerful socializing influence uses death to sell its stories Children s Literature often describing death near death experiences or the threat of death Little Red Riding Hood The Three Little Pigs Rockabye Baby Religion Lots of traditions How to put on a grand southern funeral Family traditions Wakes Foods Dress Places experiences with death Bandura theorists who approach human development from a lifespan perspective treat the environment not as a situational entity but as a varied succession of life events that differ in their power to affect the direction lives take Social Structure A structural view of society helps us appreciate the institutionalized family economy educational political religion occupational bases of attitudes and behaviors toward death Cultural expectations about death reflect a social reality consistent with a technological oriented and bureaucratic society Page 79 Symbolic Interactionism Emphasizes the freedom of individuals to construct their own reality as well as to potentially reconstruct that which has been inherited It seeks to explain human action and behavior as the result of the meanings which human beings attach to action and things Page 79 and 80 Chapter 11 Death In the Lives of Adults The three stages of adulthood all 0 View death differently in their stage of life as well as life threatening illness but some experience Parental Bereavement children are suppose to outlive their parents Parents protect and shield children 0 Coping with Parental Bereavement as a Couple Adam Welsh s parents Linda and Hector Parental bereavement Each pa rent grieves differently can cause issues different needs different expression Different interpretations individual isolation This requires open and honest communication A definite roller coaster pattern still exists Need to reframe each other s behavior in a positive way Childbearing losses Mother Tammy Stillbirths Neonatal deaths Miscarriage spontaneous abortion Induced abortion artificial or therapeutic Infertility Sterility Sudden Infant death Syndrone SIDS Chapter 4 Death Systems Mortality and Society We like to categorize death issues Death system the interpersonal and sociophysical and symbolic network through which an individual s relationship to mortality is mediated by his or her society This includes People funeral directors life insurance people weapon designers guns pepper spray etc Death systems continued Places churches funeral homes memorial gardens Times memorial days anniversaries Objects obits hearses tombstones electric chairs Symbols funeral music black garments languages certain flowers carnations These systems death look on page 134 s list Disasters The scales of disasters Chinese government disposing of 60000 bodies little ceremony families unable to identify bodies traditional Chinese reverence denied Disaster is generally defined as a life threatening even that affects many people usually for a relatively brief period of time acts of God floods earthquakes tornadoes airplane crashes terrorist acts Disasters Industrial accidents BP spill Fires Explosions Dixie Crystals Sugar Refinery just outside of Augusta So what do we do to try to reduce those disasters we have construction requirement for earthquakes destruction disasters Airlines Pan Am 288 doors on cabins etc Tornado drills shelters Hurricanes evacuation routes watches New Orleans had bluffs as barriers they were just in the wrong place 2004 tsunami and several since warnings not always heeded the Gulf Coast is common for this Coping with the Aftermath of Disaster think of 911 Existential crisis Profound sense of emptiness and despair State of shock Uncertain of the whereabouts of loved ones Uncertain about the future Can go on for months years Communities share all of the above Steps after disaster Christ Church in Australia Rescue and treatment The repair and maintenance of basic serVIces The recovery and management of bodies Immediate needs of survivors food shelter caring for medical needs emotional needs missing persons alleviating the anxieties of surviviors Post disaster Priorities must be instituted Normalizing the situation Minimizing recovery time Reducing distress Restoring functions lights water traffic Mobilizing resources red tapeFEMA Think about the flooding last year in Douglas Cobb Paulding Counties Hurricane Katrina Levees broke built wrong Flooded leaving 1500 dead many more homeless with thousands wo means to evacuate Roots long predating Katrina Government officials fought for Power Poor disproportionately at greater risk What was done was almost accidentally Homicide and Capital Homicide the killing of one human being by another criminal and non criminal Criminal murder vs manslaughter the killing is intentional deliberate premeditated is murder where as manslaughter accidental is not premeditate or killing done without malice and is unplanned heat of passion etc Look at chart on page 141 Capital Punishment Sparky Jackson State Prison in H house Death penalty is legal in Georgia Most murderers who received the death sentence were interracial murders We don t impose capital punishment on juvenile in Georgia some states do Deterrence is the basis of capital punishment we kill to stop killing we will not impose capital punishment on someone who is sick we get them well then do it We stop suicide in prison get therapy and then impose it Risk did they really do it Project Innocence Defining Death Biological No sociological Catatonic mimicking death Five step method Define death Criteria and procedure Apply criteria coroner not necessarily a doctor Pronounced death Certification of death Conventional signs of death It is more than just the absence of a heartbeat and breathing What about lifesupport equipment Braindead brainstem functions Clinical Death cessation of function but can be reversed Cellular death The irreversible of the characteristics of living now define living Death is about loss Irreversible loss of flow of vital fluids Most common biological evidence Physiological defined Irreversible loss of the Soul from the body cultural 12 ounce loss lots of issues discussed KNOWING what is human being is page 150 Irreversible loss of the capacity for bodily integration loss of the power to preserve and sustain to regulate its own functioning internal regulation through complex homeostatic feedback mechanisms the brain is a powerful agent Ethics the Florida daughter Irreversible Loss of the Capacity for Consciousness or Social Interaction significant life being alive implies capacity for conscious interaction with one s environment Uniform Determination of Death Act The Commission for the Study of Ethical Problems in Medicine The Act death is an absolute and single phenomenon p age 155 37 years in a state of persistent vegetative state Whole brain still differences variability in practice differences that might have implications for determination of death and initiation of transplant procedures Organ transplantation and donation How when and where Uniform Anatomical Gift Act 1968 revised in 1987 7 provisions on page 157 The transfer of living tissues or cells from a donor to a recipient with the intention of maintaining the functional integrity of the transplanted tissue in the recipient Most common is kidneys skin heart eye Donations made by completing a simple form that describes under what conditions and what can be Human trafficking and body parts Gatekeepers and UNOS voluntary Carry your donor card Body parts donor issues page 160 Cadaver trade the exhibit The Bodies at Fern bank Medical ethics Japan s foopah mistrust world wide Japan s cultural view of the body and the need to keep it intact to go to the next world The cultural traditions regarding the body influences organ donation and transplantation Death Certificates Doctor must sign Funeral directors routinely acquire and process Must be filed with the state Probate Court usually Cause of death on the death certificate is the official statement