Science Liver Cancer & AIDS Practice Questions

Lifespan DevelopmentModule # 11: Death and Dying
Module Learning Outcomes
Explore the experiences and emotions related to death and dying
11.1: Describe the leading causes and types of deaths
11.2: Examine emotions related to death and dying
11.3: Examine care and practices related to death
Most Common Causes of Death
Learning Outcomes: Most Common Causes of
Death
11.1: Describe the leading causes and types of deaths
11.1.1: Examine the leading causes of death in the United States
and worldwide
11.1.2: Explain physiological death
11.1.3: Describe social and psychological death
The Most Common Causes of Death
• In 1900, the most common causes of death were
infectious diseases while chronic disease were the
most common causes of death in the United States
in 2016
• Many of the top causes of death are linked at least
in part to lifestyle choices and are preventable or
avoidable if the proper actions are taken
• The top 10 deadliest disease worldwide in 2015
include heart disease, stroke, lower respiratory
infections, COPD, trachea, bronchus, and lung
cancers, diabetes, Alzheimer’s or other dementia,
dehydration, tuberculosis, and cirrhosis
• The major causes of death vary significantly
among age groups with unintentional injuries a
leading cause of death for the widest variety of
ages
The Process of Dying
• A person’s physiological, social, and psychological death can
occur at different times
• Physiological death occurs when the vital organs no longer function
and may take 72 or fewer hours
• Digestive and respiratory systems begin to shut down
• Circulation slows and mottling may occur
• Agonal breathing, the gasping, labored breaths caused by an
abnormal pattern of brainstem reflex may occur
• Someone is brain dead when there is no longer brain activity,
referred to as clinically dead
• A vegetative state occurs when the cerebral cortex no longer
registers electrical activity but the brain stem continues to be
active
The Process of Dying, continued
• Social death begins earlier than physiological death and occurs when
others begin to withdraw from someone who is terminally ill or has a
terminal illness diagnosis
• Doctors as well as family members and friends may spend less time
with patients after their prognosis becomes poor and
• People in nursing homes may live as socially dead for years with no
one visiting or calling
• Psychological death occurs when the dying person begins to accept
death and withdraw from others and regress into the self
• This can take before physiological death and may even bring it
closer as people give up their will to live
• Interventions based on the idea of self-empowerment for terminally
ill individuals has been associated with a perceived ability to
manage and control things resulting in better mental health
Practice Question 1
Which top cause of death was most prevalent across multiple
age groups in the United States according to 2016 statistics?
A. Heart disease
B. Congenital anomalies
C. Malignant Neoplasms
D. Unintentional injury
Practice Question 2
Which aspect of death is characterized by the failure of vital
organs, often resulting in difficulty with eating and breathing?
A. Physiological
B. Social
C. Psychological
D. Behavioral
Emotions Related to Death
Learning Outcomes: Emotions Related to Death
11.2: Examine emotions related to death and dying
11.2.1: Explain common perceptions and attitudes toward death
11.2.2: Explain attitudes towards death from different ages
throughout the lifespan
11.2.3: Explain bereavement and types of grief
11.2.4: Explain Kübler-Ross’ stages of loss
11.2.5: List and describe the stages of grief based on various
models
Attitudes about Death
• Bereavement is the outward expressions of grief and mourning and
funeral rites are expressions of loss reflecting personal and cultural
beliefs
• Culture does not provide set rules for how death is viewed and
experienced
• Regardless of variations in conceptions and attitudes toward
death, ceremonies provide survivors a sense of closure after a loss
• In most cultures, after the last offices have been performed and
before the onset of decay, relations or friends arrange for ritual
disposition of the body
• There are various methods of destroying human remains,
depending on religious or spiritual beliefs and practical necessity
Bereavement and Grief
• Grief is the psychological, physical, and emotional experience and
reaction to loss
• Grief reactions vary depending on whether a loss was anticipated or
unexpected and whether it occurred suddenly or after a long illness
• Struggling with the question of responsibility and what if is particularly
felt by those who lose a loved one to suicide
• Bereavement describes the state of being following the death of
someone
• Anticipatory grief occurs when a death is expected and survivors have
time to prepare to some extent before the loss
• Complicated grief involves a distinct set of maladaptive or selfdefeating thoughts, emotions, and behaviors that occur as a negative
response to a loss
• Disenfranchised grief may be experienced by those who have to hide
the circumstances of their loss or whose grief goes unrecognized
Bereavement and Grief, continued
• It has been said that intense grief lasts about
two years or less but grief is throughout life
• Layers of grief include an initial denial
marked by shock and disbelief and anger
towards those who could not save the
person’s life or that life did not turn out as
expected
• Grief and mixed emotions go hand in hand
with normal contradictions arising throughout
our grieving
• We are often asked to grieve privately,
quickly, and to medicate our suffering
• The fading affect bias suggests that negative
events tend to lose their emotional intensity
at a faster rate than pleasant events
Stages of Loss
• Kübler-Ross described five stages of loss experienced by someone
facing the news of their impending death that provide a framework
(not a linear progression) for understanding the psychological
experience of an impending death
• Denial is often the first reaction to overwhelming, unimaginable news
and protects us by allowing the news to enter slowly
• Anger provides us with protection by energizing us to fight against
something and providing structure to an unknown situation
• Bargaining involves trying to think of what could be done to turn the
situation around
• Depression involves feeling the full weight of loss and an important
part of the process of dying
• Acceptance involves learning how to carry on and incorporate this
aspect of the life span into daily existence
Other Models on Grief
• Worden’s model of grief explained it through four different tasks the
individual must complete
• Accepting the loss has occurred
• Working through and experiencing the pain associated with grief
• Adjusting to the changes the loss created in the environment
• Moving past the loss on an emotional level
• Parkes broke down grief into four stages: shock, yearning, despair, and
recovery
• Strobe and Shut suggested individuals cope with grief through an
ongoing process:
• Loss-oriented: grief work, intrusion on grief, denying changes toward
restoration, and breaking of bonds or ties
• Restoration-oriented: attending to life changes, distracting oneself
from grief, doing new things, establishing new roles and relationships
Other Models on Grief, continued
• Theories that have been developed help
explain and understand how the grief
process has shifted over time
• Healthy grieving includes the following
strategies:
• Talk about the death to help surviving
individuals understand what happened
and remember the deceased positively
• Accept the multitude of feelings
• Take care of yourself and your family can
help with moving through each day
effectively
• Reach out and help others dealing with the
loss
• Remember and celebrate the lives of your
loved ones
Class Activity: A Good Death?
• How would you define a “good death”?
• What criteria are important for determining a good death for
the person dying, family or loved ones, and any healthcare
professionals?
• How does grief change based on whether a death is
considered “good”?
Facing Death
Learning Outcomes: Facing Death
11.3: Examine care and practices related to death
11.3.1: Explain the philosophy and practice of palliative care
11.3.2: Describe hospice care
11.3.3: Summarize Dame Cicely Saunders’ writings about total
pain of the dying
11.3.4: Differentiate attitudes toward hospice care based on race
and ethnicity
11.3.5: Describe euthanasia, passive-euthanasia, and physicianassisted suicide
Palliative Care and Hospice
• Palliative care is an interdisciplinary approach to specialized medical and
nursing care for people with life-limiting illnesses
• The goal is to improve the quality of life for both the person and family
through relief of symptoms, pain, physical stress, and mental stress
• Palliative care is provided by a multi-disciplinary team who work with the
primary care physician and other hospital or hospice staff to provide
additional support to the patient
• It is appropriate at any state in a serious illness and not limited to end-oflife
• Hospice care involves palliation without curative intent and is typically
used by people without further options or who have decided not to
pursue further options
• The biggest difference between hospice and palliative care is the type of
illness people have, where they are in their illness especially related to
prognosis, and their goals/wishes regarding curative treatment
Palliative Care and Hospice, continued
• Hospice care involves caring for dying patients by helping them to
be as free from pain as possible, providing them with assistance to
complete legal documents, providing social support, and helping
family members cope
• The focus is on five topics: communication, collaboration,
compassionate caring, comfort, and cultural (spiritual) care
• The patient is allowed to go through the dying process without
invasive treatments
• Dame Cicely Saunders emphasized focusing on the patient rather
than the disease and introduced the notion of “total pain”
• Saunders’ focus on the broad effects of death on dying individuals
and their families has provided the foundation for modern day
hospice care
Hospice Care in Practice
• Early hospices were independently operated and dedicated to
giving patients as much control over their own death process as
possible
• Although hospice care has become more widespread, new
programs are subjected to more rigorous insurance guidelines that
dictate the types and amounts of medications used, length of stay,
and types of patients eligible for hospice
• The majority of hospice patients are cancer patients who do not
enter hospice until the last few weeks prior to death with the
average length of stay less than 30 days and many patients in
hospice for less than a week
• Hospice care focused on alleviating physical pain and providing
spiritual guidance
• Not all racial and ethnic groups feel the same way about hospice
Euthanasia and Physician-Assisted Suicide
• Euthanasia refers to helping a person fulfill their wish to die and can
happen through voluntary euthanasia or physician-assisted suicide
• Voluntary euthanasia can be passive or active
• Passive euthanasia involves no longer feeding someone or giving
them food
• Active euthanasia is when there is an administration of a lethal dose
of medication to someone who wishes to die
• A dying individual may ask a friend or family member to administer a
lethal dose of medication, often leaving lasting impact
• Physician-Assisted Suicide occurs when a physician prescribes the
means by which a person can end his or her own life
Euthanasia and Physician-Assisted Suicide,
continued
• Physician-Assisted Suicide is mandated by a set of laws and
backed by legal authority
• Currently it is legal in the District of Columbia and several states
including Oregon, Hawaii, Vermont, and Washington
• The Netherlands, Switzerland, and Belgium have also made it
legal
• The laws that govern physician-assisted suicide vary between
states
• In 2000, the U.S. Supreme Court upheld the right of states to
determine their laws on physician-assisted suicide and holds the
position that the moral and ethical debate continues
Practice Question 3
Which type of euthanasia involves withholding food, water, or
necessary medication from an individual who wishes to die?
A. Active euthanasia
B. Physician-assisted suicide
C. Passive euthanasia
D. Physician-assisted euthanasia
Class Activity: Working with the Terminally Ill
• Imagine that you are training others to work with people who
are terminally ill or in grief.
• Advise your group about how to work most effectively with those
populations.
• Identify at least two ways to effectively address the needs of the
terminally ill physically, emotionally, and psychologically.
• Identify at least two ways to effectively address the emotional
and psychological needs of grieving family members or
caregivers.
• Share your ideas in a group and discuss how they are similar and
different.
Quick Review
• What are the leading causes of death in the United States and
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worldwide?
What is meant by physiological death?
What are social and psychological death?
What are some common perceptions and attitudes toward
death?
How are attitudes towards death similar and different from
different ages throughout the lifespan?
What are bereavement and types of grief?
What are Kübler-Ross’ stages of loss?
Quick Review, continued
• What are included in the stages of grief based on various
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models?
What is the philosophy and practice of palliative care?
How is hospice care delivered?
What is included in Dame Cicely Saunders’ writings about total
pain of the dying?
What is similar and different in attitudes toward hospice care
based on race and ethnicity?
What are euthanasia, passive-euthanasia, and physician-assisted
suicide?