Death & Dying

Beneficence

"Do good" Challenge: Balancing between beneficence & nonmaleficence

Traditional societies tend to view disease and death as...

"Out of balance", Public events

Nonmaleficence

"do no harm", principle can more accurately be thought of as minimizing harm to as many interested parties as possible (bottom line) Challenge: to please everyone (dying person, loved ones, etc) so usually one person is hurt *very tricky

Identity vs. role confusion

(11-18) "Who am I", death can effect self-formation

Formal operational

(12+) Abstract reasoning, hypothetical reasoning

Autonomy vs. shame

(2-3)

Preoperational

(2-7) Learning language & symbols

Initiative vs. guilt

(3-5) Seek own purpose, looks for approval/confrimation

Industry vs. inferiority

(5-11) Very active. Recognition/encouragement key

Concrete opperational

(7-12) logical abilities to concrete ideas

Sensorimotor

(Birth-2 years) senses & motor abilities

Trust vs. mistrust

(Birth-2) Sense of self, seeking trust & predictability

According to the text, what percentage of Americans affiliated with a religious tradition?

+ 90% of Americans +95% of American teenagers believe in God

List 4 principles/ goals for a "good death" (4)

-To know that death is coming and to understand what can be expected - To be afforded dignity - To have time to say goodbye - To have choice about where death occurs

What is the approximate death rate per 1000 in the United States today?

8.7%

Define Hospice Care:

A program of caring that is oriented toward the needs of dying patients and their families, the focus is on comfort rather than cure

Define Epidemiologic transition

A redistribution of deaths from the young to the old

According to the text, what is the leading cause of death in the United States today?

Heart disease

Institutional Medical Care consists of:

Hospitals Nursing Homes Hospice Programs

Approximately how much has the average life expectancy in the United States increased since 1900?

Increased from 47 to 77 years of age - 30 year increase

Respite Care

Temporary care that gives family members or other caregivers a break

The sociological theory that must resembles the study of the human body is?

The Structural-Functionalist Approach

Justice

The fairness regarding treatment of others and how goods and services are distributed Challenges: Financial situations, Provision, Cultural

Define Thanatology

The scientific study of death and the practices associated with it, including the study of the needs of the terminally ill and their families

What does the statement "Death involves causality" mean?

There are biological reasons for the occurrence of death

What percentage of the gross domestic product of the United states in 2000 was spent o health care?

13% - 1.3 trillion

"Mean World" syndrome

-Lessens sensitivity to real violence & it's victims -increases unwarranted fears of becoming a victim -contributes to aggressive behavior -conveys heightened sense of danger, insecurity, & mistrust - contributes to irrational dread of dying

List the Urgent Clinical Indications for Discussing End-of-Life Care:

1. Imminent Death 2. Talking about wanting to die 3. Inquiries into hospice and palliative care 4. Recently hospitalized for severe progressive illness 5. Severe suffering and poor prognosis

List three specific topics that should be included in end-of-life discussions:

1. Advance Directives (living wills, health care proxy) 2. Palliative Care (pain mgmt., psychological, spiritual) 3. DNR orders *relative emphases on life prolonging *relative emphases on quality of life

Provide three reasons for initiating end-of-life discussions:

1. Choices differ based on information (more info yields more choices) 2. Could receive undesired treatments (CPR) 3. Allows time for healing relationships, completing goals, preparation!

Describe three aspects that comprise cultural sensitivity:

1. Ethnocentrism 2. Stereotyping 3. Judging the worth of other communities

List and describe three agents of socialization:

1. Family 2. School and peers 3. Mass Media 4. Religion

What are three sources of caregiver stress? (3)

1. Feelings of inadequacy (What can I say?) 2. Too many demands 3. Inability to cure a disease or save a life

Describe three ways religion functions in societies:

1. Help form common identity for people 2. Answers to "big questions" about human existence and purpose 3. Foundation for norms and laws of a society 4. Emotional and psychological support

What are three (5) Features and Goals of Hospice Care?

1. Provide relief from pain and suffering 2. Promote an aura of peacefulness and acceptance of dying 3. Treat patient and family as the unit of Care 4. Provide access to comprehensive services 5. Designed for those in the final stages of a terminal illness who agree to forgo medical interventions intended to extend life

What are the five major social institutions delineated by sociologists?

1. The economy 2. The educational system 3. The family 4. The political system 5. Religion

What are three challenges to Hospice Care?

1. The presence of a primary caregiver, whose is available 24/7 2. Adequate funding 3. The six-month rule

Discuss a Mature Concept of Death. What four aspects/ knowledge does a mature concept of death include?

1. Universality 2. Irreversibility 3. Non-functionality 4. Causality Unfolds throughout life span Core concepts enriched Allows for elaboration about the death Values other cultural contexts and expressions, avoids enthocentlrism

Sits of memory

AIDS quilt & the Vietnam veterans memorial are focal points for mouraning

Define Palliative Care

Active total care of patients whose disease is unresponsive for curative treatment

Childhood experiences with death are most likely to...

Become fully aware of the impact only in adulthood

What are the aims of Palliative Care?

Control Pain, Relieve Suffering, Provide Care for physical, psychological, spiritual, and existential needs, help patients achieve a good or peaceful death

Institutional denial

Death avoidance

DRGs

Diagnosis-Related Groups

What are characteristics of the concept of invisible death?

Dying in death are less visible, less part of our common experience - hired professionals, deathbed scenes dominated to delay death, family/friends no longer present, funerals/services shortened/more private

In many traditional societies, death is believed to occur because...

Ecological orientation, heredity, behavioral exercise, socioeconomic, psychosocial, natural, supernatural, and enviornment

Palliative Care

Embodies the idea that the ultimate goal of medicine is healing, rather than curing disease

Managed death

Manage care settings; chronic illness aspect

The Health Care Triangle consists of:

Patients Staff Institutions/Administration

Fidelity

Professional must act to maintain and enhance the trust of the client/patient, done through truth-telling and maintaining confidentiality Challenges: To adhere to fidelity in end-of-life situations (truth-telling & confidentiality)

QALYs

Quality adjusted life years- balance between length of life and quality of life

Autonomy

Respect for the person's rights; self-determination Challenge: If the health providers disagrees, can be difficult to respect a person's decisions, another challenge is to respect a child/nonadult's autonomy, "rational suicide"

In which country was the most influential modern hospice established?

St. Christopher's Hospice in Sydenham, England founded in 1967

Hospital health care focuses primarily on which aspect of the patient's well-being?

Sustaining life rather than consulting patients