Chapter 15 [PSY]

the study of death and dying

imagine that you were born in the seventeenth or eighteenth century. which of the following statements about your dying pathway would not be true.
a. you would probably have died quickly of an infectious disease
b. you would have died in a hospital
c. you would have seen death all around you from a young age
d. you would probably have died at a relatively young age

if you follow the typical 21st century pattern as you approach death, you can expect to decline (quickly/slowly and erratically) due to (an accident/an age-related chronic disease)
slowly and erratically; an age-related chronic disease

margaret says that, today, we live in a death-denying society. ella says, “no, that’s not true. today we are more accepting of death than ever.” first, make ella’s case and then margaret’s, referring to the information in this section
ella’s case: today, we openly discuss dying with seriously ill patients and try to get everyone to document their wishes for a dignified death. we also routinely offer death education classes and make active efforts to think about how to take good care of the terminally ill.
margaret’s case: we still are disconnected from- and frightened about- the physical reality of death. our euphemisms for death, life “passing away,” clearly show that we still live in a death-denying culture.

kubler-ross’s stage theory of dying
the landmark theory, developed by psychiatrist elisabeth kubler-ross, that people who are terminally ill progress through five stages in confronting their death: denial, anger, bargaining, depression, and acceptance.

terminally ill people (do/do not) want to discuss their situation
usually do not (contrary to kubler-ross’s theory)

almost every culture or person or family feels it’s best to spell out the truth (true/false)

middle knowledge
the idea that terminally ill people can know that they are dying yet at the same time not completely grasp or come to terms emotionally with that fact

people (do/do not) pass through distinctive stages in adjusting to death
do not

what are the four factors that signify a “good death”?
1) we want to minimize our physical distress, to be as free as possible from debilitating pain
2) we want to maximize our psychological security, reduce fear and anxiety and feel in control of how we die
3) we want to enhance our relationships and be as close as possible emotionally to the people we care about most
4) we want to foster our spirituality and have the sense that there was integrity and purpose to our lives

sara is arguing that kubler-ross’s conceptions about dying are “fatally flawed.” pick out the argument she should not use to make her case:
a. people who are dying do not necessarily want to talk about that fact
b. people do not go through “stages” in adjusting to impending death
c. people who are dying simply accept that fact

if your uncle has recently been diagnosed with advanced lung cancer, he should feel (many different emotions/only depressed/only angry), but in general, he should have (hope/a lot of anger).
many different emotions; hope

you are a psychologist who works with the terminally ill and their families. all other things being equal, which client is likely to find it easiest to cope with impending death: a 16-year-old, a 30-year-old, an 80-year-old woman, a parent of a dying 8-year-old child?
an 80-year-old woman

as a hospital administrator, outline some steps you might take to help patients have a good death by reducing their fear and increasing their feelings of having control over how they die.
provide counselors on call 24/7 so that terminally ill people on the units can express their ears and concerns. at entry to the hospital, ask seriously ill patients “what exactly do you want in terms of care?” and make sure that their preferences- with regard to family visits, pain control, and everything else- are fulfilled by the staff

dying trajectory
the fact that hospital personnel make projections about the particular pathway to death that a seriously ill patient will take and organize their care according to that assumption

palliative care
any intervention designed not to cure illness but to promote dignified dying

end-of-life care instruction
courses in medical and nursing schools devoted to teaching health-care workers how to provide the best palliative care to the dying

palliative-care service
a service or unit in a hospital that is devoted to end-of-life care

hospice movement
a movement, which became widespread in recent decades, focused on providing palliative care to dying patients outside of hospitals and especially on giving families the support they need to care for the terminally ill at home

in a sentence, describe to a friend the basic message of the classic research describing the various dying trajectories discussed on page 465 and 466.
although medical personnel set up predictions about how patients are likely to die, death doesn’t always go according to schedule- so these prognostications are often wrong!

based on this section, which statement most accurately reflects doctors’ reactions to the terminally ill?
a. doctors are insensitive to dying patients’ needs
b. doctors feel terribly upset when a patient is dying, but may feel forced to use modern technologies to “prolong” death

sara is arguing that we have made tremendous strides in improving end-of-life care in medical settings such as hospitals. martha says no- we have a long way to go. first, make sara’s case and, then, make martha’s, citing the evidence discussed in this section.
sara’s case: we now routinely provide death education courses to health professionals and, increasingly, have established hospital-based palliative-care services.
martha’s case: we need far more education in end-of-life care. most people, even in the developed world, don’t have access to palliative services. moreover, traditional medicine is cure-oriented, making it difficult to shift to palliative care.

which patient are you most likely to find enrolled in a US hospice program?
a. an old-old man who lives alone
b. a man with end-stage lung cancer living with his wife and daughters
c. an ethnic minority, first-generation immigrant who has had a stroke

melanie is arguing that there’s no way she will die in a hospital. she want to end her life at home, surrounded by her husband and children. using the information in this section, convince melanie that there may be a downside to spending her final days at home.
would you feel comfortable about burdening your family 24/7 with the job of nursing you for months or having them manage the health crises that would occur? how would you feel having loved ones se you naked and incontinent- would you want that to be their last memory of you? wouldn’t it be better to be in a setting where trained professionals could manage your physical pain?

your grandmother is dying. her main priorities are likely to be
a. feeling close to you and your parents
b. dying at home

advance directive
any written document spelling out instructions with regard to life-prolonging treatment if individuals become irretrievably ill and cannot communicate their wishes

living will
a type of advance directive in which people spell out their wishes for life-sustaining treatment in case they become permanently incapacitated and unable to communicate

durable power of attorney for health care
a type of advance directive in which people designate a specific surrogate to make health-care decisions if they become incapacitated and are unable to make their wishes known

do no resuscitate (DNR) order
a type of advance directive filled out by surrogates (usually a doctor in consultation with family members) for impaired individuals, specifying that if they go into cardiac arrest, efforts should not made to revive them

do not hospitalize (DNH) order
a type of advance directive put into the charts of impaired nursing home residents, specifying that in a medical crisis they should not be transferred to a hospital for emergency care

passive euthanasia
withholding potentially life-saving interventions that might keep a terminally ill permanently comatose patient alive

active euthanasia
a deliberate health care intervention that helps a patient die

physician-assisted suicide
a type of active euthanasia in which a physician prescribes a lethal medication to a terminally ill person who wants to die

age-based rationing of care
the controversial idea that society should not use expensive life-sustaining technologies on people in they old-old years

callahan’s 2 arguments in favor of age-based rationing of care
1) after a person has lived out a natural lifespan, medical care should no longer be oriented to resisting death
2) the existence of medical technologies capable of extending the lives of elderly persons who have lived out a natural lifespan creates no presumption that the technologies must be used for that purpose

your mother asks you whether she should fill out an advance directive. given what you know from this chapter, what should your answer be?
a. go for it! the best thing to do is to fill out a living will so you can be sure your preferences will be fulfilled
b. go for it! but you need to regularly discuss your preferences with each of us and complete a durable power of attorney
c. avoid advance directives like the plague because your preferences will never be fulfilled

latoya and jamal are arguing about legalizing physician-assisted suicide. jamal is furious that this practice is not legal and feels that “people should have the right to die.” latoya is terribly worried about formally institutionalizing this practice. using the points in this section, first make jamal’s case, and then support latoya’s argument.
jamal’s case: we are free to make decisions about how to live our lives, so it doesn’t make logical sense that we can’t decide when our lives should end. plus, it’s cruel to torture fatally ill people, forcing them to suffer fruitless, unwanted pain when we can easily provide a merciful death.

latoya’s argument: i’m worried that greedy relatives might pressure ill people into deciding to die “for the good of the family” (that is, to save the family money). i believe that legalizing physician-assisted suicide leaves the door open to society deciding to kill people when we think the quality of their life is not good. furthermore, only god can take a life!