Psy210 Death and Dying


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Human Development. Goes over grieving process, hospice, funeral cost, dealing with your own death, etc.

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  • Right to Die Debate
  • Psy210 Death and Dying

    1. 1. Death and DyingSarah Hammett, Ruth Dennison,and Roman Liskevich
    2. 2. Death “No one wants to die. Even people who want to goto heaven don’t want to die to get there. And yetdeath is the destination we all share. No one hasever escaped it. And that is as it should be, becauseDeath is very likely the single invention of Life. It isLifes change agent. It clears out the out the old tomake way for the new”. Steve Jobs
    3. 3. Death and Dying As medicine progressed there were newer guidelines forbeing termed dead. Not having a heartbeat and respiration didn’t qualify someone forbeing dead. New technology allowed a person to have his his/her heart andcirculatory system to be sustained on a ventilator and feeding tubes togive nutrients to the individual. Sometimes people who were plugged up to these machines neverregained consciousness, so we had to find a new term for being dead.
    4. 4. What is Death In the first edition of the Encyclopedia Britannica, death wasdefined as “the separation of the soul and the body.” The latest definition of death is three times as long and themore we learn about death the harder it gets to defining it About three centuries ago it was fairly simple to determineif someone was dead. If someone was thought to have died the family would have called thepriest to come and make sure. The priest would come and do some simple tests like put a mirrorright by their mouth see if it clouded up by breathing If the family needed further proof he would put feather on the nose tosee if it moved. O things were so simple back in the day.
    5. 5. Brain Death Doctors started to use terms like “persistent vegetativestate”, and “irreversible coma” to describe people who hadbeen in some kind of traumatic injury were they had braindamage that was irreversible. Medicine could now keep people alive when their own braincouldn’t, but a persons consciousness , his personality wasgone forever Brain death or the irreversible end of all brain activity due tototal necrosis of the the cerebral neurons following loss ofbrain oxygenation.
    6. 6. Cause of Brain Death Technically everybody dies of brain death, a young personmight suffer a gunshot to the brain or an older person mightsuffer a stroke and doesnt get oxygen to the brain,eventually we all die of brain death. The brain can be without oxygen for six minutes after theheart stops, severe brain damage occurs after 6 minuteswithout oxygen. There is a difference between brain damage leading to deathand brain damage leading to a comma.
    7. 7. Coma VS Brain Death Being brain dead and being in a coma is not the same thing. Patients who suffer brain death are not in a coma. Patients in a coma may or may not progress to brain death Patients in a coma may come out of it and wake up butpatients who are brain dead will never wake up again. A patient can only be either in a vegetative state or braindead, theres no such thing as almost brain dead, its yes orno.
    8. 8. Determining Brain Dead The patient must pass all of these tests to be determined brain dead There are several tests done to determine if a patient is brain dead.1. The patient has no response to command2. The patient is flaccid, with areflexic extremities3. The pupils are nonreactive4. Patient has no oculocephalic reflex5. The patient has corneal reflex6. The patient has no response to supra orbital stimulation7. The patient has no oculovestibular reflex8. The patient has no gag reflex9. The patient has no spontaneous respiration.
    9. 9. Dying Brain
    10. 10. Assistant living Assistant living is for senior who are in some need of helpwith some daily assistance. Assistant living differs from nursing homes in that patients inassistant living can do most thing themselves, and they don’tneed intensive care. The benefit of assistant living is the trained staff that canhelp patients who cant do something because of a illness. The national average for assistant living is $3,300 a monthand in Huntsville its $1,900.
    11. 11. Nursing Home Nursing homes are for patients who don’t need to be in ahospital but cant be at home. Nursing homes are not only for the elderly but for anyonewho requires 24 hour care. The cost in the of nursing home care has risen 4 percent inthe last year with a private room being $84,000 a year or$229 a day. The average cost in Huntsville is $179 per day.
    12. 12. Death and Burial A person can have a will made out telling how he/she wantsto be buried. Most people in the US want to be buried in a casket but thereare many(mostly in the Pacific and Asia) who prefer to becremated. Religious and cultural beliefs also play a role in how aperson want to be buried(or cremated).
    13. 13. Funeral Home The price of a funeral can cost depends on how much youwant to spend. The basic service for a funeral with staff is $1495 Embalming costs another $595 and cosmetics are another$295 The casket costs anywhere from $900 to over $10,000! The burial costs another $1000 Cremation is a lot cheaper and cost only $1,345.
    14. 14. Funeral Home The price of a funeral can cost depends on how much youwant to spend. The basic service for a funeral with staff is $1495 Embalming costs another $595 and cosmetics are another$295 The casket costs anywhere from $900 to over $10,000! The burial costs another $1000 Cremation is a lot cheaper and cost only $1,345.
    15. 15. Hospice care is end-of-life care by medical professionals and volunteers who givemedical, psychological and spiritual support. The goal is to help those dying havepeace, comfort and dignity. The caregivers try to control pain and other symptomsso a person can remain as alert and comfortable as possible. This type of care iscalled palliative care Hospice programs also provide services to a patients family.Hospice patients are usually expected to live 6 months or less. Hospice care cantake placeAt homeAt a hospice centerIn a hospitalIn a skilled nursing facilitySource Cited: National Cancer InstituteHospice Care:“Hospice is covered by Medicare nationwide and Medicaid is covered in Alabama. Mostinsurance providers also cover the cost of hospice care. Medicare covers the full scope ofmedical and support services provided by hospice. There is little to no expense to thepatient.” -Hospice of North Alabama
    16. 16. Hospice of North Alabama (aging and terminally ill patients)Hospice Family Care(terminally ill patients and families)CommercialHospice Care options in Huntsville Area(patients must be referred by a doctor) :
    17. 17. Patients have the right to choose where they get their hospice services, and whatservices they use. Most hospice centers offer patients the following services:Case Manager (nurse): Periodically visits the patient to check patients physical,emotional, and spiritual health. The case manager then decided what can be donefor the patient to make them as comfortable as possible.Hospice Aide: Visits patient at scheduled times. Assists in bathing/grooming,recording vitals. Aide regularly reports the patients status to the Case Manager.Social Worker: Coordinates patients resources.Chaplains: Provides pastoral care, often gives patient their last rites.Volunteers: Provide care when family members are unable to, providescompanionship for patient. Generally helps the family when needed (groceryshopping, errands, etc) so that the family may spend their time with the patient.Source: Hospice of North AlabamaWhat Hospice Does
    18. 18. Advance DirectivesWhat are AdvanceDirectives?Legal documents thatexpress an individualsdesires regarding their end-of-life care.Living Wills express what procedures an individual does ordoes not want to extend their life. This includes; dialysisand breathing machines, if an individual wants to beresuscitated if heart or lungs stop, whether a feeding tubecan be used on an individual, and whether the individualwould like to donate organs or tissues upon death.
    19. 19. Advanced Directives in Alabama(Source: you wish to revoke theAdvanced Directives you havethree options:Destroy the legal document.Write a formal revocation withyour signature and date.Orally express your desire torevoke the order to anindividual over the age of 19.This individual must then writeand sign confirmation that theyheard you revoke yourdirectives.Under Alabama law AdvanceDirectives that prohibit the useof feeding tubes, and life-sustaining treatments forpatients that are pregnant willbe ignored.Under Alabama law,separate documents areneeded to preventambulance and emergencyroom personnel fromproviding CPR.
    20. 20. Expected Lifespan:4865737981466167727640526476881001900 1940 1960 1990 2013Source: shift from family care to professional care hasminimized our exposure to the painful circumstancessurrounding the death of a loved one. Even thoughthe news exposes us to stories of death, becausethere is often no personal connection we are allowedto have distance from death. Because of this, we arenot as death-obsessed or as fearful of death asprevious generations.Source: SantrockTHEN (Early1900sTODAYOne out of twochildren diedbefore age 10. Byadulthood,children had lostone parent (onaverage).Death mostlyoccurs amongstaging adults.Most people diedat home, cared forby family.80% of deathsoccur in hospitalsor careinstitutions.
    21. 21. Leading Causes of Death:19001. Pneumonia2. Tuberculosis20131. Heart Disease2. CancerSource: cdc.gov19371. Heart Disease2. Pneumonia18501. Tuberculosis2. Cholera
    22. 22. Death in a Digital AgeGoogle recently introduced its “InactiveAccount Manager”, which allows usersto determine whether they want toopen accounts to loved ones, or havethe information deleted after theirpassing (this is determined by aselected amount of inactivity).Online profiles (i.e. facebook) often become makeshift memorials after someone dies,with the bereaved writing on their wall or tagging them in images to pay theirrespects. Some sites even offer a service that sends an email to a loved one of yourchoosing after you die. One such site, is designed to send lovedones important account numbers, passwords, and short messages after your passing.It regularly prompts you to enter a password via email, and when you miss severalreminders, it determines that you are either dead or disabled. Many funeral homesnow offer “streaming” services so loved ones that are deployed, or unable to travelcan view the funeral.
    23. 23. Also known as “Stages of Loss” because it appliesto both accepting your own death as well asgrieving the loss of a loved one.Cyclical. Even though aperson may go through thestages several times beforefinally reaching trueacceptance. There is no settime frame to the stages ofgrief, they can last years.Many people who havegone through the stagessay that it comes in“waves”.Image: ShutterstockText:Santrock, J.W. (2007). ATopical Approach to Life-Span
    24. 24. Stage 1: Denial and IsolationPerson denies that they are goingto die. “No. This couldnthappen to me.” Commonreaction to terminal illness. Isonly temporary, and is usually“cured” when a person isconfronted with evidence oftheir illness; doctor bills, failinghealth, etc.This is a natural coping mechanismthat gives an individual time toprocess the idea of theirimminent death.This period is marked by:Avoidance, Confusion,Fear, Numbness, andBlame.Source: Santrock &
    25. 25. Stage 2: AngerHappens when they are forced to facethe fact that they are dying, anddenial is no longer possible. Itbecomes harder for medical staff,loved ones, and otherprofessionals to care for the dyingperson as their anger will becomedisplaced onto those around them.Dying persons may becomeincreasingly resentful and jealousof others in good health.This stage is marked by:Frustration, Anxiety,Irritation,Embarrassment, andShame.Source: Santrock & Kubler-Ross,
    26. 26. Stage 3: BargainingThe hope that deathcan be postponed.Some will try tobargain-most oftenwith a higher power-to delay their death.This stage is oftenmarked by: Reachingout to others, Desireto tell their story,Struggle to findmeaning.Source:Santrock
    27. 27. Stage 4: DepressionThe dying person accepts that theyare going to die. They becomesilent, and may refuse visitors.They spend much of the timecrying, and grieving their owndeath. This behavior should not bediscouraged, as it is necessary forthe dying person to preparethemselves. This is a defensemechanism, in which the dyingperson is distancing themselvesfrom loved ones in order to savethem from the pain of theireventual death. “Cheering themup” can lead to them feeling guiltor shame, which may only furtherthe depression.This stage is marked by:Lack of energy,Helplessness.Text: SantrockImage:
    28. 28. Stage 5: AcceptanceThe dying personbecomes at peacewith their death.However, they maystill want to be leftalone. Feelings andpain may be absentby this stage.This stage is marked by:Exploring options(“bucket lists”),Finalizing plans, andMaking amends.Source: SantrockImage:
    29. 29. Kubler-Ross Stages of DyingRobot Chickens Stages of LossCons of the 5 Stages:-Not enough researchsupport.-Ignores individualcircumstances.Pros:-Helps individuals copewith dying.
    30. 30. Perceived Control and DenialPerceived Control:Coping mechanism.When led to believethat they are incontrol of their fate,aging or dying adultsmay become happierand more active.“I have cancer, cancerdoes not have me.”Denial is also an effective coping tool.It can be adaptive (eases the initialshock) or maladaptive (preventsindividual from truly facing theirdeath). Denial can not be classifiedas good or bad, but judged on acase by case basis.
    31. 31. Ben has been told that hehas a cancerous tumorthat can be removed by asimple operation. Benrefuses the operation,saying that “the tumor issmall, so its not worththe risks of surgery”.You Decide: Maladaptive or Adaptive?Bobby has been given sixmonths to live. Hebegins to make plans tocomplete his bucketlist. He even spendsmost of his savings on atrip that will take placeafter his “expirationdate”.
    32. 32. To ReviewIn this clip:Perceived Control (shaving head, instead ofwaiting for hair to fall out from chemo, using itas a dating strategy, etc.)5 Stages.
    33. 33. 4/4/13Communicating with a Dying PersonPsychologists believe it’s best for the terminally illpatient to know that they are dying. Advantages:1.Close their lives in accord with their own ideas,getting closure and saying their good-byes2. Complete plans or projects, make arrangementsfor survivors and participate in funeral and burialdecisions3. Reminisce and converse with important peoplein their life4. Understand what is happening within their bodyand what the medical staff is doingSource: Essential of Life-Span Development
    34. 34. 4/4/13How should I talk with a loved one who is dying?Love: Communicate love through verbal and non-verbalexpressionsIdentity: Focus on the relationship between the living andthe dyingSpirituality: Statements of religious faith and experiencesEveryday Talk: Sharing the mundaneSource: How Should I Talk with a Loved One Who is Dying?
    35. 35. What is Grief?"Grief is a natural response to loss. It’s theemotional suffering you feel when something orsomeone you love is taken away. The moresignificant the loss, the more intense the grief willbe. You may associate grief with the death of aloved one—which is often the cause of the mostintense type of grief—but any loss can cause grief.“Grief is also described as "The emotionalnumbness, disbelief, separation anxiety, despair,sadness, and loneliness that accompany the loss ofsomeone we love."
    36. 36. Prolonged GriefType of grief that involves enduring despair and is stillunresolved over an extended period of time.Negative Consequences of prolonged griefPhysical health: Fatigue, sleeping problems, loss ofappetite, and painMental health: loss of motivation and anxietysymptomsDisenfranchised Griefan individuals grief over a deceased person that is asocially ambiguous loss that cant be openly mournedor supported.
    37. 37. Widowhood Effectthe increased probability ofdeath among grieving mateswithin weeks or months of theirspouses passing.“
    38. 38. 4/4/13Steps for Coping with Grief and LossGet Support1. Turn to Family & Friends2. Join a Support Group3. Go to a Grief Counselor4. Draw Comfort from your FaithSource: Help Guide
    39. 39. 4/4/13Steps for Coping with Grief and Loss Cont.Take Care of Yourself1. Face Your Feelings2. Express Your Feelings (Journaling)3. Look after your Physical Health4. Don’t let anyone tell you how to feel5. Plan ahead for “Grief Triggers”Source: Help Guide
    40. 40. 4/4/13
    41. 41. Right to Die DebateDoes a person have the right to choose to die? To commit suicide?Euthanasia: Doctor-Assisted Suicide“The laws of the Netherlands and Belgium defineeuthanasia as ‘the act, undertaken by a third party, whichintentionally ends the life of a person at his or her request,and in both countries euthanasia can only be effected by adoctor’.”Two Criteria for Euthanasia in Belgium & Netherlands:1.After getting a second opinion, patient has to be capableof letting their wishes clearly known repeatedly over aperiod of time2. Patient must be suffering from "unbearable physical orpsychological pain“Source: The International
    42. 42. 4/4/13Marc and Eddy VerbessemDeaf from BirthGoing Blind“Nothing to Live For”Loss of IndependenceSomething to think aboutSource: Google Image
    43. 43. 4/4/13Dr. Ezekiel J. Emanuel, an oncologist and former WhiteHouse adviser, wrote in The Atlantic that providing assistedsuicide to those not suffering unbearable physical pain is aslippery slope: “Once legalized, physician-assisted suicideand euthanasia would become routine. Over time doctorswould become comfortable giving injections to end lifeand…comfort would make us want to extend the option toothers who, in society’s view, are suffering and leadingpurposeless lives.” He continues to say, “Physician-assisted suicide and euthanasia should not be performedsimply because a patient is depressed, tired of life, worriedabout being a burden, or worried about being dependent.All these may be signs that not every effort has yet beenmade.”Source: The International
    44. 44. 4/4/13Oregon Death with Dignity Act (1997)1stU.S. State to Pass Death with Dignity LawProponents: Argued that mentally competent, terminally ill adults havethe right to request their physicians aid in hastening their dying.Opponents: Violates religious teachings on the sanctity of life and leadsto a "slippery slope" toward euthanasia.*Washington and Montana now also allow physician-assisted suicide.Source: U.S. Supreme Court Upholds Oregons Right-to-Die Law USA,8599,2075644,00.html
    45. 45. 4/4/13Dr. Jack KevorkianA.K.A. Doctor DeathSaid he assisted in over 130 deathsHis work spurred the debate on ethics of euthanasia in U.S.Served 8 years for Second-Degree MurderSources:Google Images Story,8599,2075644,00.html
    46. 46. 4/4/13Cultural Differences in DeathMost Cultures: Death is not viewed as theend of existence – though the biologicalbody has died, the spirit is believed to liveon (Hedayat, 2006).Grief, whether in response to the death of a loved one, to the loss of atreasured possession, or to a significant life change, is a universaloccurrence that crosses all ages and cultures.South America: Hispanics are family oriented, end of life care given by familymembers and strong support systemAnticipatory Grief: feelings of loss before loved one has died.Ireland: Irish Wake with music and dancing, pre-planning funeralsHawaii:Ancient Burial Method, Buried in a Cave or Sand Dunes or Burial at SeaModern Method, In Casket in Ground, mourners wear brightly-colored garmentsas black is not worn at funerals.Sources: Death in Cultures Around the World
    47. 47. 4/4/13Israel: Rend or Tear Clothing at news of death or at the funeral, sometimesrabbi will give family a torn ribbon to wear to signify the loss.Shiva: Seven day mourning period, turn mirrors backwards or cover, sit andreminisce.India: Most are Buddhist. Monks chant verses to them while they are dying andwhile the person is being ready for funeral fire (cremation). Monks attendfuneral with family and are given food and candles by the family.United States: Death Avoiders and Death Deniers. Funeral homes preparebody. Visitation, Funeral, GravesideSources: Death in Cultures Around the World and Buddha.net
    48. 48. Remains of the Day
    49. 49. The Death and Dying GroupRecommends (for further interest)Ben Breedlove: My Story“The Last Lecture”Elizabeth Kubler-Ross on DyingJoan Didion, “The Year ofMagical Thinking”