death is a disguise for the real fear - castration anxiety
death anxiety comes from a fear of losing value,love Security, and by being less than a whole person.
Ernest Becker's Theory of Death Anxiety
Thought humans were terrified of their own morality, sought to deny death anxiety by keeping it unconscious.
denial of death gives motivation to human behavior.
Existential Theory of Death Anxiety
Awareness of out morality is the basic source of anxiety
Society's function is to pretend that life will never end - connects us to something bigger than ourselves and gives us meaning.
Terror Management Theory of Death Anxiety
control death anxiety by socially sanctioned evasions and fantasies - ie movies
strong self esteem is used as a protection from death anxiety
Edge Theory of Death Anxiety
Distinguishes between the everyday low level of death anxiety and the arousal felt when facing death.
Kubler Ross' 5 Stages of Dying
Evidence that Death Anxiety Exists
reluctance to complete a living will
hesitancy to sign an organ donor card
engage in high risk behaviors - think invincible
Level of Death anxiety in normal population
low to moderate
Who has higher death anxiety?
people with psychiatric disorders
Mature Concept of Death - when it occurs and (4) stages
occurs around age 10
Understanding of Death at Early Childhood
Misconceptions on how people die- believe they can come back to life
1/3 of children think that death is unlikely and half thought they wouldn't die/
Understanding of Death at School Age
are able to name intentional and unintentional ways that people die.
show beginning of logical thought
peer interactions provide the meaning of life
Understanding of Death in Adolescence
Demonstrate mature concept of death EXCEPT for when it come to them. They are invincible or death is romanticized. Children who have experienced death have a better understanding.
Fear of Death - Ernest Becker
Denial of death motivates human behavior - need a way to maneuver in a threatening world. Keep our thoughts of death and death anxiety unconscious.
Importance of religion in explaining life and how humans cope
Patients that were secure in their faith experience less distress and pain
Psychological Aspects of benign Human that make it difficult for those left to grieve
Awareness mortality - we can reflect on ourselves
Awareness of the future - desire to predict and control it, greater stress response
When a loved one dies you have to rewrite your future without them and remove your identity from the other person.
Adam and Eve Myth about Death
fell from grace, became mortal - blaming the ancestors
Eros took shelter in cave of death, was careless and fell asleep and his arrows fell out of his quiver and got mixed up with the arrows of death which is why now sometimes old people fall in love and young people die.
Varies across countries and states. 84 countries have currently outlawed it. Is very suceptible to local circumstances.
Supreme Court Ruling 2008
Lethal injection was not cruel and unusual punishment, and therefore remains legal.
Can't use death penalty for Certain people / situations
Death Penalty cannot be used on...
someone whose only crime was raping an adult woman
mentally retarded people because it is considered cruel and unusual punishment with them
adolescents because of lack of maturity and vulnerability to negative influences.
Top 12 Ways People Die
Heart Attack - What Happens
Heart is not getting enough oxygen because there is not enough hemoglobin in the blood because the arteries have hardened.
plaque breaks off from lining of artery and causes blockage of blood to the tissues causing them to die.
Heart Attack Symptoms
Chest Discomfort - uncomfortable pressure, lasts more than a few minutes or goes away and comes back
Pain or discomfort in arms (usually searing pain down left arm), back neck jaw or stomach. Shortness of breath, nausea, cold sweat
Women experience more back pain and nausea
Stroke - What Happens
Decrease in blood flow to artery supplying the brain. Deficit has to last more that 24 hours - otherwise it is TIA
Arteries fail to deliver enough blood and tissues are suffocated (ischemic) OR arteries hemorrhage due to hypertension.
facial weakness, arm weakness, speech difficulty
Cancer - What Happens
Cancerous cells don't work on behalf of the organ, they reproduce blindly, damage the organ, metastasize and move on to another organ.
Cells are ugly, deformed, have unlimited capacity to grow.
Other: Change in bowel or bladder habits, sores that don't heal, white patches in mouth or tongue, lump, indigestion, cough
Traditional Death Criteria
Lack of respiration, no pulse, no heartbeat, no reponse to stimuli
Harvard Death Criteria
unresponsive, no movements or breath, no reflexes, flat EEG no circulation to brain, brain death
Difference between old and New Death Criteria
Importance of Social Networks
Sought out more by woman than men. Study show that those with social networks were 50% less likely to die during study period. - reduce stress and lift spirits.
8 ways to cope with stress
seeking social support
planful problem solving
Issues in Care giving
not enough help for caregivers - leads to resentment of those not helping
have to keep the integrity of the person being cared for - can sometimes be difficult especially with bathroom habits are involved.
Treatment to relieve rather than cure symptoms caused by a serious illness
clear communication, emotional support, help guiding the medical system and difficult medical choices.
for the terminally ill with 6 months or less to live
low tech - heavy on human touch. most of the care is done out of the home, Hospice volunteers come by.
Very focused on pain management and comfortability.
How Many people are served by hospice each year - why not more?
1.3 million - more aren't because you have to be referred by a physician and you have to have 6 months left to live. Difficult to get the referral, and much easier if you have Medicare.
How is Hospice paid for? what is Paid for?
Hospice is paid for my Medicare - Medicare benefits replace standard medical care. Most all of at home care (including equipment needed) is converted, but there might be fees incurred for hospital stays.
Changes in Dying Process
Medical advances prolong death. Have sedation to reduce the awareness of death and often times, people die alone.
4 Trajectories of dying
Certain death at a known time
Certain Death at an unknown time
Uncertain Death but will be determined.
Uncertain death, unknown time - no idea of the cause or time of death. true for most youth
No emergency measures are taken, quietly fading away - visits from family decrease, staff expects little and there is little reaction when death does come.
expected quick trajectory
Patient is not expected to survive, thee is a time urgency and organized treatment with rapidly shifting expectations. Staff and family interactions.
unexpected quick trajectory
person is in good health - paramedics make all the difference - errors can happen is untrained people try to help.
Hidden Standards of Hospital Care
Quite, uneventful death - no fuss if possible.
few people around so the staff can do their work, physician doesn't get involved with family. Attention is focused on the body and care giving, not on psychosocial aspects.
Recommended Hospital Standards
Patient oriented - remission of symptoms, relieve pain and fulfill the patient's wishes
Patient has opp to visit w/ family - children ok, flexible visiting, privacy with loved one when they are alive and dead.
staff forms relationship w/ patient.
Importance of Pain Relief
Pain is a stressful experience
pain reduces amount of attention that can be given to other things
pain can intensify other symptoms
fear and anticipation of pain can be demoralizing
pan contributes to death anxiety.
Experiences of Dying People
Overestimate their odds of surviving.
there is a transition with death- part of human experience.
experience restricted activity - damage to body image, disempowerment, time anxiety
What dying people want at the end of their lives
Want end of their loves to be like any other day. Want certain people with them and want to be free of pain and at peace.
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