Published on

Psych II, Sec B

  • Be the first to comment

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide
  • While each dying person will experience the final stages of living in different ways depending on their illness or injury, there are a few common symptoms that often occur: Changes in Sleep Patterns and Energy Level. You will generally be awake less and your energy level will decrease. Breathing changes . You may experience periods of rapid breathing or even periods where your breathing stops for a few seconds before starting again Hallucinations . It is not uncommon for you to hear voices or see people that aren't there. Changes in Appetite . You will likely lose interest in food and eat much less than normal. Emotional and Personality Changes . You may become withdrawn and depressed, talk less to others and become less interested in the world around you. Depending on your illness, you may even show personality changes. For example, dying people with Alzheimer's Disease (a form of dementia that causes people to slowly lose their memory and self-control), sometimes become angry, have outbursts, swear and yell.
  • The President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research published its definition of death in 1981. Determination of death must be in accordance with accepted medical standards.
  • Ventricular fibrillation and myocardial infarction may follow sudden psychic stress.; e.g. Voodoo death, or death by hex
  • According to law, physicians must sign the death certificate, which attests to the cause of death (diagnosis), and the nature of death (natural, accidental, suicidal, homicidal or unknown causes. Euthanasia is the intentional killing by act or omission of a dependent human being for his or her alleged benefit.
  • Some governments around the world have legalized voluntary euthanasia but generally it remains as a criminal homicide. In the Netherlands and Belgium, where euthanasia has been legalized, it still remains homicide although it is not prosecuted and not punishable if the perpetrator (the doctor) meets certain legal exceptions.
  • Those left to grieve a timely death are usually not surprised or shocked by it, unlike those who grieve an untimely death, such as that of a young person, a person who dies suddenly,or a person whose catastrophic death is associated with violence, an accident, or utter meaninglessness. Death may also be regarded
  • For many years, people with terminal illnesses were an embarrassment for doctors. Someone who could not be cured was evidence of the doctors' fallibility, and as a result the doctors regularly shunned the dying with the excuse that there was nothing more that could be done (and that there was plenty of other demand on the doctors' time). Elizabeth Kübler-Ross was a doctor in Switzerland who railed against this unkindness and spent a lot of time with dying people, both comforting and studying them. She wrote a book, called 'On Death and Dying' which included a cycle of emotional states that is often referred to (but not exclusively called) the Grief Cycle. Stage 1 – Once being told that they are dying, persons initially react with shock. Then they refuse to believe the diagnosis. They may ask for second opinion, and may go from one doctor to another. Stage 2 – they become anry, frustrated and irritable at being ill. They may blame God, family members, friends or themselves. They may displace anger to hospital staff and to their doctors. Stage 3 – attempt to negotiate Stage 4 – patients show clinical signs of depression.; may be reaction to the effects of illness on their lives; may require treatment with antidepressants and ECT. Stage 5 – patients realize that death is inevitable, and they accept the universality of the experience. Kübler-Ross herself never intended for these stages to be a rigid framework that applies to everyone who mourns. In her last book before her death in 2004, she said of the five stages of grief, “They were never meant to help tuck messy emotions into neat packages. They are responses to loss that many people have, but there is not a typical response to loss, as there is no typical loss. Our grieving is as individual as our lives.”
  • The Extended Grief Cycle can be shown as in the chart above, indicating the roller-coaster ride of activity and passivity as the person wriggles and turns in their desperate efforts to avoid the change. The initial state before the cycle is received is stable, at least in terms of the subsequent reaction on hearing the bad news. Compared with the ups and downs to come, even if there is some variation, this is indeed a stable state. And then, into the calm of this relative paradise, a bombshell bursts...
  • The first response to loss, protest, is followed by a longer period of searching behavior. As hope to reestablish the attachment bond diminishes, searching behaviors give way to despair and detachment before bereaved individuals eventually reorganize themselves around the recognition that the lost person will not return. Although the bereaved ultimately learn to accept the reality of the death, they also find psychological and symbolic ways of keeping the memory of the deceased person very much alive. Grief work allows the survivor to redefine his or her relationship to the deceased and to form new but enduring ties.
  • Thanatology

    1. 2. <ul><li>The scientific study of death, dying and bereavement. </li></ul>
    2. 3. <ul><li>The process of losing vital functions </li></ul><ul><li>Signs and Symptoms of Approaching Death </li></ul><ul><ul><li>Changes in Sleep Patterns and Energy Level. </li></ul></ul><ul><ul><li>Breathing changes </li></ul></ul><ul><ul><li>Hallucinations . </li></ul></ul><ul><ul><li>Changes in Appetite </li></ul></ul><ul><ul><li>Emotional and Personality Changes </li></ul></ul>
    3. 4. <ul><li>Absolute cessation of vital functions. </li></ul><ul><li>Death is the last crisis of life </li></ul><ul><li>Death is understood in terms of: </li></ul><ul><ul><li>Permanence : once a thing dies, it stays dead </li></ul></ul><ul><ul><li>Universality : all living things eventually die </li></ul></ul><ul><ul><li>Nonfunctionality : all living functions cease at death </li></ul></ul>
    4. 5. <ul><li>Uniform Determination of Death Act </li></ul><ul><ul><li>Irretrievable cessation of circulation and respiratory functions </li></ul></ul><ul><ul><li>Irretrievable cessation of all functions of the entire brain </li></ul></ul>
    5. 6. <ul><ul><li>the absence of clinical brain function when the proximate cause is known and demonstrably irreversible. </li></ul></ul><ul><ul><li>The three cardinal findings in brain death are coma or unresponsiveness, absence of brainstem reflexes, and apnea. </li></ul></ul>
    6. 7. <ul><li>Coma </li></ul><ul><li>Absence of motor responses </li></ul><ul><li>Absence of pupillary responses to light and pupil at midposition with respect to dilation (4 – 6 mm) </li></ul><ul><li>Absence of gag reflex </li></ul><ul><li>Absence of coughing in response to tracheal suctioning </li></ul><ul><li>Absence of sucking and rooting reflex </li></ul><ul><li>Absence of respiratory drive at a PaCO2 that is 60 mmHg or 20 mmHg above normal baseline values </li></ul><ul><li>Interval b/w 2 eval; </li></ul><ul><ul><li>Term – 2mos = 48 hrs </li></ul></ul><ul><ul><li>>2mo – 1yr = 24 hrs </li></ul></ul><ul><ul><li>>1yr - <18yr = 12 hr </li></ul></ul><ul><ul><li>> 18yrs = optional </li></ul></ul><ul><li>Confirmatory tests: </li></ul><ul><ul><li>term to 2 mos = 2 tests </li></ul></ul><ul><ul><li>>2mos – 1yr = 1 test </li></ul></ul><ul><ul><li>>1yr - <18yr = optional </li></ul></ul><ul><ul><li>> 18 yrs = optional </li></ul></ul>
    7. 8. <ul><li>Sudden death in certain persons that are not otherwise at risk triggered by emotional factors. </li></ul><ul><li>HPA and Autonomic Nervous System dysfunction because of emotional stress. </li></ul>
    8. 9. <ul><li>Death certificate </li></ul><ul><ul><li>Cause and nature of death </li></ul></ul><ul><ul><li>Autopsy; psychological autopsy </li></ul></ul><ul><li>Euthanasia - one person helps another end his or her life </li></ul><ul><ul><li>The administration of a high dose of a medication that causes the person to become unconscious very quickly and then shuts down organs and brain functioning </li></ul></ul><ul><ul><li>The shutting off of machines that are sustaining life, such as a breathing machine, feeding tube, etc. </li></ul></ul>
    9. 10. Places in the World Where Euthanasia or Assisted Suicide are Legal : Netherlands (Green), Belgium (Red), Oregon and Washington (Yellow)
    10. 11. <ul><li>Factors: </li></ul><ul><li>Timely or untimely </li></ul><ul><li>Intentional, unintentional or subintentional </li></ul>
    11. 12. <ul><li>STAGE 1 – SHOCK AND DENIAL </li></ul><ul><li>STAGE 2 – ANGER </li></ul><ul><li>STAGE 3 – BARGAINING </li></ul><ul><li>STAGE 4 – DEPRESSION </li></ul><ul><li>STAGE 5 - ACCEPTANCE </li></ul>
    12. 14. <ul><li>Children: </li></ul><ul><ul><li>Under 5 years old – animistic </li></ul></ul><ul><ul><li>5 – 10 years old </li></ul></ul><ul><ul><li>9 or 10 </li></ul></ul><ul><li>Adolescent – fear of loss of control , being imperfect, being different </li></ul><ul><li>Adult </li></ul>
    13. 15. <ul><li>Bereavement – state of mourning </li></ul><ul><li>Grief – subjective feeling precipitated by death of a loved one </li></ul><ul><li>Mourning – the process by which grief is resolved; societal expression of post-bereavement behavior and practices </li></ul>
    14. 16. <ul><li>Protest </li></ul><ul><li>Searching </li></ul><ul><li>Despair and Detachment </li></ul><ul><li>Reorganization </li></ul>
    15. 17. <ul><li>within 6 months to 1 year </li></ul><ul><li>The most lasting manifestation of grief, especially after spousal bereavement, is loneliness </li></ul><ul><li>most grief does not fully resolve or permanently disappear; rather, grief becomes circumscribed and submerged only to reemerge in response to certain triggers. </li></ul>
    16. 18. <ul><li>grief reactions are brought on by the slow dying process of a loved one through injury, illness, or high-risk activity. </li></ul><ul><li>may soften the blow of the eventual death, it can also lead to premature separation and withdrawal, while not necessarily mitigating later bereavement </li></ul>
    17. 19. <ul><li>When the trigger for an acute grief reaction is a special occasion, such as a holiday or birthday. </li></ul>
    18. 20. <ul><li>Chronic Grief – most common </li></ul><ul><li>Hypertrophic Grief - sudden and unexpected death </li></ul><ul><li>Delayed Grief - marked by prolonged denial </li></ul>
    19. 21. <ul><li>Disruption of biological rhythms </li></ul><ul><li>Impaired immune functioning: </li></ul><ul><ul><li>Decreased lymphocyte proliferation </li></ul></ul><ul><ul><li>Impaired functioning of natural killer cells. </li></ul></ul>
    20. 22. <ul><li>The goal of grief therapy is to identify and solve problems the mourner may have in separating from the person who died. </li></ul><ul><li>the mourner talks about the deceased and tries to recognize whether he or she is experiencing an expected amount of emotion about the death. </li></ul>
    21. 23. <ul><li>6 tasks may be used to help a mourner work through grief: </li></ul><ul><ul><li>Develop the ability to experience, express, and adjust to painful grief-related changes. </li></ul></ul><ul><ul><li>Find effective ways to cope with painful changes. </li></ul></ul><ul><ul><li>Establish a continuing relationship with the person who died. </li></ul></ul><ul><ul><li>Stay healthy and keep functioning. </li></ul></ul><ul><ul><li>Re-establish relationships and understand that others may have difficulty empathizing with the grief they experience. </li></ul></ul><ul><ul><li>Develop a healthy image of oneself and the world. </li></ul></ul>