Thanatology

Study of the experiences of dying and bereavement

Definitions

Death

absolute cessation of vital functions

Dying

process of losing these functions

Good death

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

Subjective feeling precipitated by the death of a loved one process by which grief is resolved State of being deprived of someone by death …. Being in a state of mourning

 

Mourning

Bereavement

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
 

Depression
 

Fluid, changing and evolving state Fluctuating state and cognitive and behavioral adjustments are progressively made Time limited fleeting with full resumption o function

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

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