Thanatology Study of the experiences of dying and bereavement
Definitions
Death
Dying
process of losing these functions
Good death
absolute cessation of vital functions
Free from avoidable distress and suffering
Bad death
Needless suffering, dishonoring of patient/family wishes or values
Uniform Determination of Death Act (1981)
Irretrievable cessation of circulatory and respiratory functions
Irretrievable cessation of all brain functions, including the brain stem
Interval between 2 evaluations according to age
Term to 2 months – 48 hours
> 2 months to 1 year – 24 hours
> 1 year to < 18 year – 12 hours
Legal Aspects of Death
physicians must sign death certificate
Attest cause of death
Attribute death to natural, accidental, suicidal, homicidal or unknown
Unattended cases – medical examiner, coroner or pathologist must examine and perform an autopsy
Psychological autopsy in some cases
Stages of Death and Dying (Elisabeth Kubler Ross, MD –1969)
Stage 1 – Shock and Denial
Stage 2 – Anger – Why me?
Stage 3 – Bargaining
Stage 4 – Depression
Stage 5 – Acceptance
Near Death Experience
Strikingly similar Descriptions
Out of body experience Viewing one’s body Overhearing conversations Feeling of peace and quiet Hearing a distant noise Entering a dark tunnel Leaving the body behind Returning to life to complete unfinished business
Described as peaceful/loving Feels real Provoke sweeping lifestyle changes Experience of “visions” ( unio mystica )
Life Cycle Considerations about Death/Dying
Children Pre-
school
Death seen as temporary absence, incomplete and reversible (departure/sleep) Maybe unable to relate treatment to illness
School
– age
Recognize death as a final reality Active fantasies of violence/aggression (6-12 yrs)
II.
Adolescents
Understand death is inevitable/final but may not accept that their own death is possible Concerns about body image or loss of body functions – great resistance to treatment Alternating emotions of despair, rage, grief, terror, are common Potential for withdrawal/isolation great
III.
Adults
Common fears
Separation from loved ones Becoming a burden Losing control What will happen to dependents Pain Being unable to complete life tasks Dying Being dead Fears of others Fate of body The afterlife
Sense of integrity vs. despair (Erik Erikson)
Management Highly individual caretakers need to need to deal with death honestly; tolerate wide range or affects, connect with patients and resolve issues as they arise Major themes confront all health providers caring for dying patient
Grief, Mourning and Bereavement
Grief
Mourning
Subjective feeling precipitated by the death of a loved one process by which grief is resolved
Bereavement
State of being deprived of someone by death …. Being in a state of mourning
Normal Bereavement Reactions Protest Searching behavior Despair and detachment Reorganize self
Duration of Grief Few weeks to months to years Lasting manifestation is loneliness Protracted grief occurs intermittently Bittersweet memories may last a lifetime
Complicated Bereavement Chronic grief Hypertrophic grief Delayed grief Traumatic bereavement
Grief
Fluid, changing and evolving state Fluctuating state and cognitive and behavioral adjustments are progressively made Time limited fleeting with full resumption o function
Depression
Pervasive Recognizable cluster of debilitating symptoms accompanied by a protracted, enduring low mood Persistent and associated with mark social/occupational dysfunction
Grief Therahy
Normal grief – seldom need psychiatric help Seriously suicidal – psychiatric intervention ex. Sleeping medications, antidepressants, anxiolytics Counseling sessions – depressive disorder, pathological mourning Grief theraphy – one on one or group