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Sergio flores mptm 621 on death and dying

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  • 1. ON DEATH AND DYINGSergio Flores | December 3, 2011
  • 2. On Death and Dying ELISABETH KÜBLER-ROSS, M.D.ABOUT THE AUTHOR• Born one of triplets in Zurich, Switzerland, Elisabeth was a psychiatrist, humanitarian, physician, and hospice pioneer who wrote “On Death and Dying” in 1969• She authored 24 books published in 34 languages. Considered to have changed the face of medicine and one of the most influential people and important minds of the last century• In 2005 the Elisabeth Kübler-Ross Foundation is formed to further the work and maintain her legacy • Provides educational programs that deepen the understanding of those dying and grieving for the dead • Develop curricula for those involved in the care of the dyingButterflies became her symbol, symbolizing the beautifultransformation that she believed occurred at the time of death.The logo for her Foundation is the butterfly symbol.(http://www.ekrfoundation.org/)
  • 3. On Death and Dying INTERVIEWING THE DYING• At the Hospital where she worked in New York, Kübler-Ross was appalled by the standard treatment of dying patients. Unlike her colleagues, she made it a point to sit with terminally ill patients, listening as they poured out their hearts to her. She began giving lectures featuring dying patients who talked about what they were going through.• Impetus for book was conceived by four theological seminary students researching “crisis in human life”. They considered death as the “biggest crisis people had to face”• In attempting to understand the needs of the dying, she addresses death in terms of change, by studying the terminally ill patient’s attittudes, those of their caregivers, and our cultural attitudes toward death – death as an analogy to changeBOOK QUOTE”If this book serves no other purpose but to sensitize family members of terminally ill patients and hospital personnelto the implicit communications of dying patients, then it has fulfilled its task...help the patient and his family to get „intune‟ to each other‟s needs and come to an acceptance of an unavoidable reality...” Kübler-Ross (2011). (p. 151)
  • 4. On Death and DyingRECURRING CHANGE THEMES DEATH AS CRISIS RESPECT AND DIGNITY• Death is the ultimate change • In control of your destiny• Crisis as a catalyst to change • Manager - Subordinate relationship• Dehumanizing • Doctor - patient relationship• Envy of the living • Equanimity• Job Loss/Retirement – Catastrophic change EMPATHY REAWAKINING AND HOPE • Needs to be understood • Catalyst for renewal • Perceptions of death (change) will • Collective change color our ability to deal with it • Listenting and understanding • Reassurance • Trust • Impact of the messenger
  • 5. On Death and DyingDEATH AS CRISISENVY OF THE LIVING • Society has taught us to view death as a taboo • Feelings or emotions that death invoke in us • Perception toward death, dehumanizes the patient • As a society we rather prolong life than diminish human ANACLITIC DEPRESSION suffering • Patiens who are informed of their imminent death respond with anger, detachment, denial and fear • Losing control of their own destiny • But death, like change, is inevitable • Patients express envy of the living • Avoid death (change) at all costs • Marasmus of the soul • LOE • Catastrophic change • Job Loss • Retirement
  • 6. On Death and DyingCATASTROPHIC CHANGERETIREMENT • Charles Schulz dies weeks after announcing his retirement • Andy Rooney dies a month after his retirement • A study of Shell Oil employees shows that those that retire earlier, die sooner than those who decide to work past their retiring age (http://www.webmd.com/healthy-aging/news/20051020/early-retirement-early-death)"I never dreamed that this would happen to me. I always had the feeling that Iwould stay with the strip until I was in my early eighties, or something likethat. But all of sudden its gone. I did not take it away. This has been takenaway from me.“ – Charles Schulz on The Today Show
  • 7. On Death and DyingEMPATHY AND UNDERSTANDINGLISTENING AND TRUST• Patiens who are informed of their imminent death respond with anger, detachment, denial and fear • Losing control of their own destiny • The act of being merciful, provides relief • Sit, listen, and share• Change is intensely personal (Jeanie Daniel Duck) • The sick person has feelings, the right to be heard• Change is emotional, and evokes real feelings, wounds, our past (Attachment Theory) • Patients suffer more not physically, but emotionally• Communication as a catalyst for reassurance and trust • More than 75% of those interviewed by Kübler-Ross make a full recovery“People have contexts just as organizations do” – Gass, Pascale, and Athos
  • 8. On Death and Dying RESPECT AND DIGNITYEQUANIMITY• Controlling your own destiny • Doctor‟s learn to judge whether or not a person is ready for the news , and the manner in which they will be told of death diagnosis - Hope • Subjective management of individuals • Achieved only by listening and understanding• Address those that need to be heard and understood • “I am alive, don’t forget that. You can hear my voice, I am not dead yet” Do not apply the mushroom principal to change management: “ How to grow mushrooms? Keepem in the dark, and feed them bulls**t”
  • 9. On Death and DyingDABDA MODEL DENIAL ANGER BARGAINING DEPRESSION ACCEPTANCE
  • 10. On Death and DyingDENIAL Resistance is to be expected/accepted Who moved my cheese - Hem and Haw DENIAL This cannot be happening to me How long will this last? Why me?Ultimately, can lead to actual death
  • 11. On Death and DyingANGER Strong emotions about change – stems from desperation Misderected – alienation of a resistor will ANGER often hinder rather than help Cathartic – Grief includes anger Should be respected, and understood“Change is fundemantally about feelings; companies that want their workers tocontribute with their heads and hearts have to accept that emotions are essential tothe new management style” – Jeanie Daniel Duck
  • 12. On Death and DyingBARGAINING I‟ve been good, I can be better What if I don‟t participate? BARGAINING Can I be the exception? I‟ve learned my lesson
  • 13. On Death and DyingDEPRESSION Loss of hope Emotional attachment DEPRESSION Reactive and Preparatory Sadness , regret, fear, and uncertainty
  • 14. On Death and DyingACCEPTANCE Understanding – no more fear Resignation ACCEPTANCE Detachment Enlightment“Look not mournfully into the past. It comes not back again. Wisely improvethe present. It is thine. Go forth to meet the shadowy future, without fear.”- Henry Wadsworth Longfellow (1807 - 1882)
  • 15. On Death and Dying 3-PHASE MODELDABDA MODEL OVERLAYED ON KURT LEWIN‟S MODEL Unfreeze Mobilise Refreeze • Create the case for • Identify and mobilise • Embed new ways of change the resources working in the fabric of • Dissatisfaction with required to effect the organization the status quo change DENIAL AND ANGER BARGAINING ACCEPTANCE (DEPRESSION)“Choosing a model is not an arbitrary choice--it is an ideological one. The assumptions we makeabout change are also assumptions about the nature of reality and people.” – Van de Ven & Poole (Theories and Models of Organizational Change)
  • 16. On Death and Dying DIALETIC CORE PHILOSOPHYCONSTRADICTION IS A NATURAL STATE • Change occurs when opposing powers (contradictory values – competing with each other), gain sufficient power to confront and engage the status quo. (http://gre.academia.edu/MJReid/Papers/252681/A_brief_review_of_Van_de_Ven_and_Pooles_1995_article_Explaining_develo pment_and_change_in_organizations_Academy_of_Management_Review_20_3_) • The DABDA model follows a directly linear representation of this philosophy, but at the micro, rather than macro, level (http://changingminds.org/disciplines/change_management/kubler_ross/kubler_ross.htm)It is inconceivable for our unconscious to imagine an actual ending of our own life here on earth, and if this life of ours has toend, the ending is always attributed to a malicious intervention from the outside by someone else. In simple terms, in ourunconscious mind we can only be killed; it is inconceivable to die of a natural cause or of old age. Therefore death in itself isassociated with a bad act, a frightening happening, something that in itself calls for retribution and punishment.
  • 17. On Death and DyingDABDA & ADKAR KNOWLEDGE REINFORCEMENT BARGAINING ACCEPTANCEGROWTH AWARENESS/DESIRE ABILITY DENIAL /ANGER DEPRESSION ENLIGHTMENT
  • 18. On Death and Dying REAWAKENING AND HOPE THE ROLE OF HOPE IN ACCOMPLISHING CHANGE • Even when the situation is most dire, the possibility of hope can facilitate change ` Positive Focused Flexible Organized Proactive - Characteristics of Resilient Individuals (Conner Partners)Not thinking of dying, but thinking of living Don‟t focus on the negative, focus on the positive
  • 19. On Death and DyingREAWAKENING AND HOPE OLD FRAME OF MIND NEW FRAME OF MIND IMPERSONAL PERSONAL RIGIDITY SENSITIVITY QUANTITY OF LIFE QUALITY OF LIFE ABSOLUTES FLEXIBILITY LAW ETHICS POWER IMPACT CONTENTEDNESS HAPPINESS VICTORY IN CONFLICTS CONFLICT RESOLUTION (Hey & Moore, 1998)
  • 20. On Death and DyingREAWAKENING AND HOPEHow has death changed us asa society?• Peresonally?• Collectively?The impact on our everydaylives and decisions• The collective reality that has changed our lives so drastically
  • 21. On Death and DyingREFERENCES• Change Management Learning Center - Prosci (1996 – 2011). "ADKAR“- a model for change management : Change Management Tutorial Series. Retrieved November 5, 2011, from http://www.change-management.com/• Conner, Daniel (2004). Developing Resilient Teams for Managing Change. Conner Partners website, from http://www.connerpartners.com• Duck, Jeanie Daniel (1998). Managing Change: The Art of Balancing. Harvard Business Review on Change• Goss, Tracy, Pascals, Richard and Athos, Anthony (1998). The Reinvention Roller Coaster: Risking the Present for a Powerful Future. Harvard Business Review on Change• Hey, Kenneth R. and Moore, Peter D. (1998). The Caterpillar Doesn‟t Know: How Personal Change is Creating Organizational Change. New York, NY: The Free Press.• Kubler-Ross, Elisabeth (2011). On Death and Dying. Simon & Schuster, Inc.. Kindle Edition.
  • 22. On Death and DyingIMAGE REFERENCES• http://www.indiesolo.com/files/images/10178_371241.jpg• http://all-silhouettes.com/silhouetteclipart/• http://www.serebiiforums.com/showthread.php?t=551694• http://www.myspace.com/ekrfoundation/photos• http://peanuts.wikia.com/wiki/Charlie_Brown
  • 23. On Death and DyingVIDEO AND AUDIO REFERENCES• http://www.youtube.com/v/aO4xpkH_YMw• http://youtu.be/CYZJXoyrHnw

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