HPR 240 - Role of Death & Bereavement Final

MOURNING BEHAVIORS - USA

19th Century- For most of the 19th century the mood was gloomy. Mourning was not only shown at funerals but also extended into everyday life for certain time periods, usually up to a year. 20th century- the funeral director was widely used and there was a shift in the gloomy feeling of a funeral to more of a rite of passage. The term "death denying society" was coined during this century. 21st century- Today funerals are sometimes termed "Celebration of Life" showing the dramatic shift that funerals are now accepted as part of the dying process.

CEMETERY- NOT-FOR-PROFIT

A city or a church usually owns the not-for-profit cemeteries.

AMERICAN PRACTICE - FUNERAL EXPENSES

Average cost of a funeral in 2008 was $6,200 which includes the casket but not the vault. This means that funeral service is a competitive industry. The average profit of a funeral home is 6.17% in 2008.

ISLAM RITUALS

Burial is without necessary delay, usually within hours. Burial is simple. Members of the same gender wash the body. Muslims are mourned at their mosques, not at funeral homes. Flowers are planted instead of cutting flowers since they believe that every living plant utters the name of God. Widow must stay in seclusion for 4 months and 10 days before she is allowed to remarry.

HINDU RITUALS

Cremation is the preferred method of body disposition. The use of a funeral pyre is common. (But not in the U.S) Guru- the religious teacher. Next to the Hindu wedding, the Hindu funeral is the most important ceremony. The funeral rites are very costly.

The Puritan Funeral (Early to mid 1800's)

Death was feared. Participated in a social gathering after the funeral. The funeral was their way of accepting God's will. There was no extended mourning period.

JEWISH CUSTOMS

Focus more on the bereaved than on the body. Bury within 24 hours if possible. No embalming. No viewing. Orthodox use all wood caskets. A burial society (hevra'qaddisha') washed the body. Shiva is a 7-day mourning period following the death. Quaddish is a doxology reaffirming the mourner's faith in God despite the fact of death. Yahrzeit is the yearly commemoration of the person's death.

CEMETERY - FOR PROFIT

Funeral homes or corporations usually run them.

CHRISTIANITY RITUALS

Funeral is primarily a worship service that reflects the themes of victory and loss. A eulogy is common. The church does not dictate preparation of the body. Memorial Service- a service without the body present. Viewing of the body is common. The funeral is usually held 2 to 4 days after the death. A meal is usually shared after the funeral.

BUDDHISM RITUALS

Funerals rites include Japanese, Korean, Chinese, and Thai Buddhist customs. (This would be similar to Protestant funeral- Lutheran, Baptist, Methodist; each have their own "twist" but most is the same.) The temple is called the wat. The family often witnesses the body being placed into the cremation chamber after the funeral. Sorrow and lamentation are not emphasized during the funeral. The funeral is a social event. Typically there is entertainment.

CREMATION

In 2007, 34.7% of deaths in the U.S. involved cremation. After cremation the cremated remains (often termed cremains) may be buried in a cemetery, placed into a niche in a columbarium, scattered, or simply kept by the family. Cremation is not necessarily the least expensive form of final disposition. There are many options available with cremation.

AMERICAN PRACTICE OF FUNERAL SERVICE - EDUCATION & LICENSE

Licensure of funeral directors and embalmers is mandatory in every state except Colorado. Most licenses are obtained by completing high school, mortuary school, and an internship, which is 1 to 3 years in length. 38 states mandate continuing education averaging 8 hours a year. There are 20,915 funeral homes in the U.S today. (www.nfda.org) 2002 was the first year ever that more women enrolled in mortuary school than men. There are currently 56 accredited mortuary schools in the country (including Arapahoe Community College). The median salary for licensed personnel in 2008 was $47,996. (www.bls.gov) Funeral service is an 11.95 billion dollar a year industry. 87% of funeral homes are privately owned.

The Contemporary American Funeral: Meeting the Needs of the Bereaved

Mourners were encouraged to feel and experience the reality of death and the attempt to adapt to their life after the death. Paul Irion needs of the bereaved: 1. Reality 2. Expression of Grief 3. Social Support 4. Meaningful context for the death. He states the funeral should meet these significant personal values: 1. Religious 2. Social 3. Psychological Grief is an emotion. o Grief is the other side of the coin of love. o One must love someone in order to grieve his or her death. o Lindemann suggests that the body be viewed for the purpose of bringing finality in the mind of the griever. o Many would argue that viewing is not necessary and not appropriate in every situation. o Funerals can provide a social support based upon the saying that grief shared is grief diminished. o The funeral is an unofficial support group. o Funerals provide an atmosphere of openness and honesty. o Funerals provide theological or philosophical perspective to the survivors. o The funeral should be planned to give meaning to whichever value context is significant for the bereaved.

PRE-NEED FUNERALS

Prearranging is making funeral plans in advance of need. Prefunding is legally committing money for those plans. Preneed refers to both of the above terms. There are many pros and cons for a person to prefund their funeral. This is a personal decision and is primarily used by the elderly trying to get assistance from Medicare. A funeral plan is not considered an asset; therefore it is a way to "hide" monies for the elderly.

AFTERCARE

Since 80 percent of the funeral business is repeat business from serving the same family, it makes sense to take care of those families after the service. After-care services vary from funeral home to funeral home and can be simple or elaborate.

AMERICAN PRACTICE- FUNERAL DIRECTOR

The funeral director, known previously as the undertaker, actually "undertook" to perform the details of the funeral for the bereaved families. The funeral director is whom the public turns to in crisis. The funeral director determines the needs of the family and responds to them.

EARTH BURIAL

The most widely used method. Used approximately 65.3% of the time. Entombment is a form of above ground burial. Entombment takes place in a mausoleum.

CEMETERY- GOVERNMENT

There are 130 national cemeteries in 39 States (and Puerto Rico). (www.cem.va.gov)

AMERICAN PRACTICE - PRICING SYSTEMS

Today, as regulated by the FTC, the only acceptable method of pricing in a funeral home is itemization. Itemization allows the family to select and be charged for only what they want for the funeral.

EUTHANASIA

good death. Derived from the Greek, euthanasia, at first glance, appears to refer to the simple act of bringing relief to terminally patients by alleviating their pain. It has also been used to describe refraining from such "heroic" measures as sustaining a heartbeat after the possibility of conscious life has been exhausted.

SUICIDAL CRISIS - HELP

1. Recognize clues to suicide. a. ask: "Are you considering suicide?" b. ask: How will you do it? c. ask: Is your weapon ready? d. evaluate: The more prepared and planned the individual, the more acute the crisis. 2. Trust your own judgment. — act! 3. Tell others; you can betray this confidence. (Don't promise.) 4. Stay with. 5. Listen. Encourage them to talk. Don't give false assurances. Listen & sympathize. 5. Urge professional help 6. Be supportive. Show the person you care. Help make the person feel worthwhile and wanted.

DRAMATURGICAL PERSPECTIVE

the perspective, which looks at the action of the individual to explain suicide. Uses reconstructive drama to understand the suicide; a psychological autopsy. Dramaturgical perspective emphasizes action, looking at the individual from outsiders interpreting his behavior. Examines meanings derived from interaction, which are not necessarily all verbal. Outsiders look at the actions of the person to determine cause.

CORPSE - PREPARING

Cleaning, Decorating, and Clothing the Body a. Many cultures prescribe that the family prepare the body; others (US) have a Professional do the work. b. Generally the body is washed and deodorized ritually. (Hopi Indians do not wash.) c. Some give the corpse liquor (preservative), water (to keep away thirst) or food. d. Some dress the body in white and cover with various things; bark, leaves, blanket. e. Symbolic clothing; wedding outfit, best clothes, the clothes they died in. f. Navajo reverse the moccasins (so the spirit can return).

Biomedical Issues

Definition: Issues concerned with molecular biology to the extent that social, psychological, and behavioral dimension of illness is disregarded.

EMBALMING

the replacement of normal body fluids with preserving chemicals. Embalming is done: So the family can see their loved one, one more time. So the body can be transported long distances The number 1 reason, not listed in the book, is for disinfection. A dead human body is not sanitary the embalming process will help kill the decomposing bacteria in the body.

SOCIAL INTEGRATION

the strength of an individual's ties to society. Social integration varies with social factors, such as economy, stability of the family, etc.

RITUAL

the symbolic affirmation of values by means of culturally standardized utterances and actions.

SUICIDE

the voluntary act of taking one's life. "An irrational act that is a permanent solution to what is often a temporary problem." or any death resulting either from a deliberate act of self-destruction or from inaction when it is known that inaction would have fatal consequences. In the United States, it is a felony to aid or solicit another to commit suicide.

SUICIDE - METHODS OF COMMITTING

1. Firearms 2. drug overdose 3. cutting, stabbing 4. jumping from high places 5. toxic gas inhalation 6. hanging 7. drowning

BURIAL RITES

1. Give meaning and sanction to the separation of the dead person from the living. 2. Help effect the transition of the soul to another, worldly realm. 3. Assist in the incorporation of the spirit into its new existence.

SUICIDE - SOCIAL FACTORS INVOLVED

1. Physician-assisted suicide is on the ballot and banned by the Supreme Court. 2. Jack Kevorkian practices it none-the-less. 3. At last count, 1 person commits suicide every 16 minutes. 4. Every reported suicide represents only 10-15% of people committing suicide. 5. Average age of suicide: 43 (homicide: 34) 6. Females attempt suicide more but men are more successful at it. 7. Men use firearms, women use drugs. 8. More Native Americans commit suicide than whites, but less African Americans do than whites. 9. Highest rates are on Monday and Tuesday. Lowest are on Saturday. Where the moon is has nothing to do with it. 10. Age: rare in childhood, rises in adolescence and early adulthood, declines and then peaks in 75-84 years of age. 11. Suicide rate for males rises during adolescence and peaks in older adult years. 12. Rate for females increases from young until 45 or 50, and then diminishes. 13. Terminality: mentally healthy patients with a terminal disease have no higher suicide rates than the general population. 14. Exception is AIDS. AIDS male patients are 36 times more likely to commit suicide than men without AIDS. (Elisabeth Kubler-Ross suggests they want to avoid enduring feelings of despair, isolation and discrimination with ravaging deterioration.) 15. Marital status (social integration): lower for married than for never married and is highest for widowed, divorced, separated. Parents commit suicide less than non-parents. 16. Socioeconomic: suicide rates highest at both extremes of socioeconomic. MD, DDS and AAL more likely, teachers and clergy less likely to commit suicide. (Less/more social integration?) 17. Race: suicide rate is lower for blacks than whites. Native Americans have a higher than national average rate of suicide, varying from reservation to reservation. 18. Race-related methods: Native Americans have more alcohol-related and violent method (guns and hanging) suicides than the American population as a whole. 19. Location: More suicides in heterogeneous urban areas than in homogeneous rural areas. 20. Seasonal: nostalgic times (Christmas, season of renewal spring) have more than others, with the fewest in the summer. More often on a weekend (Saturday) with Monday the peak (end of the weekend.) 21. Faith: Jewish has the highest rate, followed by Protestants and then Catholics.

Irion, Paul - Needs of the bereaved

1. Reality 2. Expression of Grief 3. Social Support 4. Meaningful context for the death. He states the funeral should meet these significant personal values: 1. Religious 2. Social 3. Psychological

ADOLESCENT SUICIDAL BEHAVIOR

1. Suicide rates for adolescents has soared 250% since the 50's and 60's. The numbers may reflect the increased willingness to report a death of suicide. Since 1980, though, level has declined (perhaps less mind-altering drugs, perhaps increased attention to at risk kids.) a. Every 90" in the US one teenager commits suicide; every 9 minutes they attempt. b. Reason: influence of death themes in rock music: Are the lyrics of heavy metal destructive, or do they provide an outlet for confronting death-as-bogeyman? 2. Causes of death in adolescence: accidents, homicides, and suicides. Accidents and homicides may be disguised suicides sometimes. Drug OD's, fatal auto accidents and self-destructive deaths (anorexia, bulimia, and alcoholism) may be uncounted teen suicides. 3. Geographically: Nevada is first in youth suicides, New Mexico is second. 4. Risk factors for adolescent suicide: a. depression b. social problems. c. family disorganization and problems d. life stress e. poor problem-solving skills 5. Warning signs: a. self-mutilation b. change in habits c. truancy d. behavior that implies preparation for death (giving away stuff) e. poor school performance f. withdrawal from and less involvement with school activities g. More problems with peers, no confidence 6. Girls try more often, boys succeed more often. Due to the method; boys use more violent means (shooting, hanging) while girls tend to be less violent, although violence in girls is increasing. 6. Adolescents have a. frustration with tasks of adolescence b. high impulsivity c. limited alternatives for problem solving and skills d. live for the moment perspective e. few good role models f. vulnerability to suggestion (cluster suicides)

CHILDHOOD SUICIDAL BEHAVIOR

1. The reporting of suicides (and attempts) in childhood is inconsistent, confused and covered by concealment and denial. Adults think childhood is happy and carefree. 2. Nonexistent under 5, rare in 5-14 3. Adults prefer to believe that children do not commit suicide and thus would be disinclined to report a child's death as suicide, even in the face of facts. US Division of Vital Statistics is to not even report deaths of children under age 8 as suicides, regardless of what may have been entered on a given death certificate — "other and unknown and unspecified causes" are the classifications used for these deaths. 4. Child suicides are easily mistaken for accidents, and causes of death involve an element of chance. (traffic accidents — running into traffic? falls — jumping? guns or drowning.) Since most do not leave a note, it's difficult to tell. (Notes are the chief category of evidence that coroners use to verify suicide.) 5. The disintegration of the family increases the risk of suicide in children. Children with family members who committed suicide have higher risk, regardless of closeness with victim. 6. In junior high, the risks increase. 20% have seriously thought about suicide, and a slightly higher percentage have personally known someone who has committed suicide. Up to 50% of junior high accidents are unreported suicides. Most kids have thought about suicide and more have known someone who has committed suicide.

SUICIDE - SIGNS

1. Verbal Cues a. outright statements b. other verbal statements 2. Behavioral cues a. Changes in behavior (giving away possessions, getting house in order, loss of appetite, inability to concentrate, insomnia) (Example: wearing black) b. changes in emotions (crying, or sudden euphoria) c. social withdrawal: from organizations, from accomplishing schoolwork, etc.

SUICIDE - HIGH RISK FACTORS

1. lethal weapon ready (gun, cache of drugs, rope, etc.) 2. history or prior suicide attempts 3. Detailed suicide plan 4. feelings of hopelessness & helplessness 5. problems at school, work, relationships, finances 6. severe personal loss (health problems, bereavement) 7. Alcohol or drug abuse

CORONER/MEDICAL EXAMINER

A coroner is a public official whose duty is to make inquiry of unexplained deaths or deaths from unnatural causes. The coroner assigns a cause of death and signs the death certificate. In some rural areas the coroner is the local funeral director. The coroner is NOT usually the person performing the autopsies; the pathologist does this. A pathologist is a medical doctor and has approximately 12 years of schooling and interning. The difference between a medical examiner and a coroner is a medical examiner is a physician, and again is not necessarily the pathologist.

ACTIVE EUTHANASIA

A direct action that causes death in accordance with the stated or implied wishes of the terminal patient. The Hemlock Society in the United States and EXIT in Great Britain are advocates for the legalization of active euthanasia.

LIVING WILL

A living will states that a person does not want medical intervention if the technology available to keep him or her alive will not offer an acceptable quality of life. The difference between the living will and Do Not Resuscitate is a living will is when you are on life support and chose to be disconnected and Do Not Resuscitate is when you're on life support and start to crash nothing will be done to save you. Perhaps the most important thing when making a living will (or other medical decision documents) is to TELL YOUR FRIENDS/FAMILY what you want done.

SELF DELIVERANCE

A positive action taken to provide a permanent solution to long term pain and suffering for the individual and his or her loved ones faced with a terminal condition." A more politically correct term for when the terminally ill takes his own life. Interestingly, active euthanasia advocates reject the legitimacy of suicide (self-deliverance) for those afflicted with depression or other psychological pain.

INSURANCE - TERM LIFE

A type of insurance policy covering the insured for a fixed period of time. Premiums are usually lower for a greater amount of coverage than with other types of insurance.

INSURANCE - VARIABLE LIFE

A type of insurance policy that does not allow for the premium or minimum coverage on one's life to change but allows one to switch the savings from among money makers or various forms of stock.

INSURANCE - UNIVERSAL LIFE

A type of insurance policy that is flexible and allows one to raise or reduce premiums and the amount of coverage on one's life.

INSURANCE - WHOLE LIFE

A type of insurance policy with which, for a set annual premium, one receives life insurance coverage and, at the same time, invests one's money.

EXTRAORDINARY MEASURES

All medicines, treatments and operations that cannot be obtained without excessive expense, pain or other inconveniences (i.e., exotic, innovative, experimental) or that, if used, would not offer a reasonable hope of death.

LIVING WILL

An advance directive in the form of a document that states that one does not want medical intervention if the treatment does not offer a reasonable quality of life or hope for recovery. This is a request for passive euthanasia.

DURKHEIM/SOCIOLOGICAL PERSPECTIVE

Different types of society produce different strengths of ties and thus types of suicides. Egoistic suicide: the individual is inadequately integrated into society because their status places them into a special category, which makes connecting to society in the usual way difficult. (Example, hermaphrodites, movie stars, "brains", "nerds".) Anomic suicide: results from lack of regulation of the individual when the norms governing existence no longer control that individual, such as when the individual feels let down by social institutions. (Example: suicide after stock market crash, loss of job, divorce.) Altruistic suicide: the individual is over integrated into society (with an exaggerated concern for society) and is willing to die for the group. Example: Kamikazi pilots, terrorists. Fatalistic suicide: too much control by society may lead to feelings of oppression under extremely strict rules. One despairs in a society where they feel there is little opportunity for satisfaction or individual fulfillment. Example: totalitarian states, slavery.

CEMETERY - PURITAN

Early pioneer burials were in unorganized, isolated places. Churchyard burials were the first organized cemeteries.

MERCY KILLING

Ending the life of a terminal patient in accordance with the person's stated or implied wishes. Mercy killing involves other people's behavior that may or may not be sanctioned by the patient.

THE VICTORIAN FUNERAL (1850-1920)

Focus on Aesthetics The funeral process was "beautified." An attempt was made to hide the unpleasant side of death. National Funeral Directors Association was founded in 1882. Before 1850 a coffin (6 sided in shape) was used, by 1927 a casket (rectangular in shape) was used. Embalming was a widely used as a result of the Civil War. It allowed the dead to be returned to their families. Bereavement Practices were affected by: 1. Change from coffin to casket. 2. Restorative Art of the Embalmer. 3. Movement of the funeral from the family home to the funeral home.

INTERNET FUNERAL SERVICES

Funeral service on the Internet not only allows the customer to purchase merchandise but it also gives funeral homes another avenue of advertising.

DEATH RITUAL-RITE OF PASSAGE

Human beings construct rituals as one means of acknowledging and adapting to change. In many cultures and religion, being dead is another status change. Often the dead are expected to cure illness, reward good deeds, and assure a good harvest. All rites of passage have 3 sub-rites: 1. Rite of separation- those whose identity is undergoing change will be perceived by the group as different or "other." 2. Rites of transition- a funeral ceremony would be a rite of transition. 3. Rite of reincorporation- the community incorporates in a new way those who have taken on a new identity. Example: after-funeral meals. Funeral rites in many societies are critical because they ensure that the dead make the transition to the next stage of life or non-life (Buddhist).

Body - use of in medical research & training

Human cadavers have been used for training medical students in the U.S. since the 1800's. • The family giving the body to science has to trust the medical school to act ethically and use the body for student learning; yet when a donor signs a contract it allows the school to use their body for any LEGAL purpose. • Cadavers are also used by the Department of Transportation to measure the effectiveness of various crash protective devices in automobile collisions. • The book talks about practice procedures done in emergency rooms, which may lead to unethical attitudes among interns and residents. Human beings and human remains must be treated with dignity and respect. Many of you have chosen the field of mortuary science because of your respect not only for the living, but also the dead.

CEMETERY- CITY GARDEN

In early 19th century, cemeteries were changed into small family gardens to hide the reality of the death. Then followed the small city run cemetery.

Organ Transplantation

Israel and Denmark do not generally accept the use of animal organs in transplantation (called Xenotransplantation). • The Japanese take it a step further and resist even human organ transplantation as it is believed that the spirit of the dead would or could cause wrath if violated by their organs being removed. • Some ethical issues involved in organ transplantation are entitlement criteria for acceptance to waiting lists such as: 1. Age 2. Ownership of cadaver organs 3. Criteria for allocation of scarce organs 4. Surgery on health people as live donors of organs 5. Purchase of organs from the poor to serve the rich 6. Abortion for viable replacement tissue

KILLING A PERSON

Killing involves intervening in an ongoing physiological process that would otherwise have been adequate to support life.

LETTING A PERSON DIE

Letting a person die involves NOT intervening to aid physiological processes that have become inadequate to support life.

AUTOPSY

The purpose of an autopsy is to determine the cause of death. An autopsy can be performed at a hospital or at a coroner's office. A complete autopsy refers to examination of the head, chest, and abdomen of the body. An autopsy can provide information for medical research. Autopsies are not as common today as they were in the 1940's, perhaps because technology has given us new ways to learn about disease.

Bioethics

The right of patients to refuse or discontinue treatment is now an acknowledged aspect of American medicine. • Bioethicists have no legal or medical authority; they are called on for their philosophical and legal expertise to help with difficult situations about medical treatment and end-of-life care. They meet privately with the patient, family and medical staff before they make recommendations. • One can earn a degree in bioethics up to the level of Ph.D.

CEMETERY- RURAL

The rural cemetery simplified the cemetery movement by landscaping a garden in a suburban setting.

DEATH CERTIFICATE

Purposes of a death certificate: 1. To provide a permanent record 2. To collect insurance and other death benefits 3. To provide cause of death data 4. To provide mortality statistics

RATIONAL SUICIDE

Suicide in which the individual is presumably not insane, when the decision is reached in an unimpaired, undeceived fashion, and in which the choice is not a bad thing for that individual to do. a. Person has a realistic assessment of the situation. b. Person's mental processes are unimpaired by psychological illness or emotional stress. c. The person has a motive that would be understandable to a majority of uninvolved community members. d. Decision is deliberated and reiterated over a period of time. e. If at all possible, the decision-making process should involve the suicidal person's significant others.

SLIPPERY-SLOPE-TO-AUSCHWITZ ARGUMENT

The belief that if a society wishes to extend to any of its members the right to active euthanasia, none of its members is protected from being killed. They refer to when Hitler sent his "undesirable" German citizens for euthanasia. These people included the unproductive, defective, morally and mentally unfit, Jews, homosexuals and handicapped. Society moves toward a disregard for human life in predictable steps: a. Passive euthanasia for terminally ill and chronically ill patients b. Active euthanasia: ordinary and customary procedures are withdrawn (food and water) c. Voluntary euthanasia: self-deliverance accepted d. Passive euthanasia allowed for non-terminal patients such as quadriplegics e. Physician assisted suicide (self-deliverance) and active euthanasia, believing that people deserve the same consideration as beloved animals. f. Auschwitz, society requires euthanasia the unwilling, incompetent, undesirable.

CULTURAL LAG

The dilemma caused when some parts of culture change more slowly than others. When technology moves faster than a society can incorporate it into its values, a cultural lag results; the culture is unprepared for the societal decisions created by the technological wonders.

SANCTITY OF LIFE

The perspective that all natural life has intrinsic meaning and should be appreciated as a divine gift. As a consequence, human beings have the obligation to enhance the quality of life, as it may exist. In studies, African-American's and religious persons tend to hold this view.

QUALITY OF LIFE

The perspective that when life no longer has quality, death is preferable to life. In studies, whites tend to hold this view.

EXISTENTIALIST PERSPECTIVE

The perspective which acknowledges that we all must face death, and that one must assume responsibility for his or her own actions and must be responsible for moral choices and actions. Emphasizes the anticipation of inevitable death on everyday life, thus, life and death are linked. The individual chooses life or death. Death is as reasonable choice as life. (Death is not the enemy in the other perspectives.) Existentialists study the internal experiences directly through examination of failed suicides to understand their motivations.

SUICIDE - SOCIOLOGICAL PERSPECTIVE

The perspective, which sees suicidal actions as the result of social factors. i.e.; the motivation for suicide comes from collective values upon which society rests. Suicide is larger than just the act; the meaning arises out of what people feel about it as well as what values society as a whole holds. Sociological perspective is based on the concept of social integration, concluding that social pressures that decrease social integration appear to correlate with higher suicides.

ORDINARY MEASURES

The withholding of treatment, which hastens death. Includes removal of medical technology and withholding medical intervention.

PASSIVE EUTHANASIA

The withholding of treatment, which hastens death. Includes removal of medical technology and withholding medical intervention. Food and water will prolong the life of a patient. When to withdraw nutrition and water can be an ethical question, and is considered passive euthanasia.

DURABLE POWER OF ATTORNEY

This document allows a person to designate another individual to make medical decisions for them if they are not capable. It usually allows the person acting on behalf of the patient to: 1. To use or withhold life support or other medical care. 2. To check the person in or out of a facility. 3. To make decisions not covered in a living will.

CEMETERY- LAWN PARK

This type of cemetery was created to not use monuments and in some places even headstones. Its purpose was to create a landscape, not a monument. (As a side note, the lawn cemeteries are much less expensive to maintain)

SUICIDE - ELDERLY

Throughout the world as well as in the US, a much greater % of elderly commit suicide than any other age. App 15% of general pop is >65yo, but they commit up to 30% of all known suicides. a. Higher in men — Hypothesis is that men may not be as adaptable to retirement as women. — Since women are used to financial difficulties throughout life, the shock of retirement income is greater for men. — Men living alone are more isolated than women living alone are. — Widowerhood is more likely to create suicide than is widowhood, perhaps because losing a wife disrupts social and emotional functioning more for a man than for a woman. — Highest rate of suicide in the US is white male over age 85. b. Older persons who practice their faith frequently have lower rates of depression, alcoholism and hopelessness; and suicide. c. Suicide rate in elderly rose 8.5% from 1980 to 1992, while it had previously been decreasing: maybe medical technology extends lives without quality, or decreases savings. Perhaps also the society places value on youth, health & beauty, increasing elders' feelings of worthlessness. There is also a growing acceptance of suicide in society. d. Suicide in elderly may be more prevalent than statistics suggests: — intentional overdoses of meds may be unrecognized or unreported — they may commit chronic or passive suicide where they lose the will to live and simply stop caring for themselves. — they may cease taking meds, take increased health risks or delay treatment for medical conditions — they may slowly stop eating and drinking until they become sick and die

PAD - PHYSICIAN-ASSISTED SUICIDE

When a physician either directly (by administering a deadly dose of medication) or indirectly (by knowingly prescribing a deadly dose of medication) assists the patient in taking their own life in accordance with their wishes.

MANIFEST FUNCTION

When the consequence of the activity is as it was intended. (Going to a funeral to pay respects and show that you care)

MOURNING BEHAVIORS - GENDER DIFFERENCES

Women are expected to express more emotion than men do. a. Women cry and self mutilate (internalize grief) more than men, who direct their anger away from self. b. May be easier to socialize women's aggression into crying than men's. c. Maybe women are more affected by loss than men because of natural mothering emotions. d. Women are used to symbolize the loss that all experience. e. We really don't know why.

National Organ Transplantation Act of 1984

authorized the creation of a national organ and transplantation network, which lead to the United Network for Organ Sharing (UNOS), a nonprofit organization and a system of regulations governing the distribution of organs from donors.

CORPSES

burned, buried (with or without animal or human sacrifice), preserved by smoking, embalming, pickling or whiskey poured down the throat; eaten raw, cooked or rotten; ritually left exposed or abandoned, dismembered, placed in various poses at burial such as squatting, fetal position, hands in various positions.

LATENT FUNCTION

consequences that contribute to social adjustment but were "by-products" of the manifest function. (The gathering at the funeral becomes a reunion)

RITE OF TRANSITION

a funeral ceremony would be a rite of transition.

UNOS - United Network for Organ Sharing

a nonprofit organization and a system of regulations governing the distribution of organs from donors.

SUICIDE GESTURE

a suicide attempt that is not successful, and is motivated by a need for aid and support from others. Obviously, un- "successful"

SUICIDE - COMPLETED

a suicide in fact, motivated by resignation. Death occurs; but was it perhaps a suicide gesture gone awry?

SUICIDE - ATTITUDES: HISTORY/WESTERN CULTURE

a. Some societies required it of wives and slaves. (Hindu: Sati) b. In Ancient Rome, suicide was socially accepted until slaves began the practice, causing financial loss. Then it was declared a crime. c. Modern Judaism regards suicide as sin, but honors "heroic" suicides to avoid rape or captivity. d. Roman Catholic Church has long denied Catholic ritual and burial to suicides. (changing in certain areas) e. The Japanese "Kamikaze" was regarded as a "great death." f. Chinese regard suicide as honorable, esp. for defeated generals or deposed rulers. g. Suicide is not condemned in the Bible, though suicide of Judas is recorded. h. Christian attitudes changed with St. Augustine whose writings became the basis for church doctrine against suicide. i. Today, thinking is still mixed. j. Attempted suicide a felony in nine states. (Only!) (Not Colorado.) Western culture a. Is morally against suicide. b. Society's norms decree that families feel shame. c. Suicidal individuals are considered crazy, ill or stressed. d. In the US, one is legally, morally and ethically bound to try to prevent a suicide. 3. Attitudes range from total acceptance to total rejection.

SUICIDE - DANGER SIGNS IN ELDERLY

a. Threat of suicide rare in elderly; they simply kill themselves. b. When suicidal intentions exist, completion is higher than at other ages. (rarely impulsive, strong death wish and careful selection.) c. Suicide is lower in married older people who are in touch with children and relatives, and have no history of suicide or attempt in their family. d. The suicidal elderly is more depressed. e. Suicidal desire may occur in senescence or out of a whole lifetime of feeling unimportant. f. Suicide is rarely an impulsive act without notice; as a rule, it is an act that can be anticipated. 75% of suicidal elders visit doctors before suicide. (only 6% of doctors asked about depression, suicide.) g. Lack of communication contributes to elderly suicide: — living alone reduces opportunities to discuss intentions with another caring person — a low-income, transient urban area makes elders socially invisible — depression reduces communication — since most suicides are male, perhaps the group at greatest risk is the least likely to seek help.

PATIENT SELF-DETERMINATION ACT

allows one to rightfully refuse medical treatment.

MEMORIAL SERVICE

although a type of funeral ceremony without the body present, the memorial is an alternative to the traditional funeral. Primarily because a family can have a memorial service on their own, without assistance from the funeral home, but would be unlikely to ever have a casketed service without the help of a funeral director.

SUICIDE CLUSTER

an excessive number of suicides occurring in close time and location. Seems to be a phenomenon of youth due to imitation and identification.

IMMEDIATE DISPOSITION

cremation or burial take place without ceremony as soon as possible.

CPR - CARDIOPULMONARY RESUSCITATION

follows sanctity of life view. In other words, try to save the person's life.

Ethical Behavior

refers to a conscious reflection on moral beliefs and seems typically to be applied to specific cases in a setting as opposed to the nature of the setting itself.

ANOMIC SUICIDE

results from lack of regulation of the individual when the norms governing existence no longer control that individual, such as when the individual feels let down by social institutions. (Example: suicide after stock market crash, loss of job, divorce.)

BODY DONATION

the body is given to a medical school usually. The family usually receives the cremated remains in the mail 1 or 2 years later after the school is "done" with the body.

RITE OF REINCORPORATION

the community incorporates in a new way those who have taken on a new identity. Example: after-funeral meals.

FUNCTION

the extent to which a given activity promotes or interferes with the maintenance of a system

EGOISTIC SUICIDE

the individual is inadequately integrated into society because their status places them into a special category, which makes connecting to society in the usual way difficult. (Example, hermaphrodites, movie stars, "brains", "nerds".)

ALTRUISTIC SUICIDE

the individual is over integrated into society (with an exaggerated concern for society) and is willing to die for the group. Example: Kamikazi pilots, terrorists.

RITE OF SEPARATION

those whose identity is undergoing change will be perceived by the group as different or "other."

FATALISTIC SUICIDE

too much control by society may lead to feelings of oppression under extremely strict rules. One despairs in a society where they feel there is little opportunity for satisfaction or individual fulfillment. Example: totalitarian states, slavery.

DNR - DO NOT RESUSCITATE

would follow a quality of life view. In other words, let the person die. DNR is a formal written order and a person must have this in their chart for this directive to be followed.