Death & Dying

• Five-Stage Theory of Dying

  • Denial
  • Anger
  • Bargaining
  • Depression
  • Acceptance
• Denial


  This is a mistake, it's not happening to me
• Anger


  Why me, why is this happening? Who's to blame?
• Bargaining


  If I could only have a little more time...
• Depression


  I don't want to see anybody, why bother...
• Acceptance


  Now I'm gonna start planning for my death, peace, accepting what's to come
• Fear and Anxiety


  • Fear of the Unknown
  • Fear for Significant Others
  • Fear of the Dying Process
• Fear of the Unknown


  What happens after I die?
• Fear for Significant Others

  Women report higher levels of fear
• Fear of the Dying Process


  Is it gonna be painful?
• Forecasters overestimate the negativity and underestimate the positivity of dying
• Near-death patients with cancer were more positive and less negative (than the simulated blog posts of non-patients)
• Patients' blog posts became more positive as death neared
• Last words of death-row inmates were more positive and less negative (than the simulated last words of non-inmates)
• Factors that influence the experience of death & dying

  • Cultural Factors
  • Trajectories & nature of death
  • Individual differences
  • Social network & support
  • Medical system
• Cultural Factors


  How we think about death & dying comes from society
• Sudden death


  Eg) heart attack, stroke, accident, murder, suicide. Straight forward, short, no plan/preparation
• Terminal illness


  Eg) cancer. Steep decline leading to death. No time measure. Difficult for individual and family, but there is time to plan remaining days
• Organ failure


  Eg) COPD, chronic heart failure. Series of crises & recoveries
• Time frailty


  Eg) Alzheimer's. Slow, gradual decline. Can take decades
• Individual differences


  • Age
  • Personality
  • Coping strategies
  • Stressors
  • Previous experiences
• Social network & support


  The amount of support, size of network. Do the people supporting have experience of caring for someone who's dying? Are they comfortable? Do they know what to do/say?
• Medical system


  Curative/disease focus vs. palliative/hospice care focus
• Doctors may have been trained (in the past) to see death as a defeat, as they are supposed to be able to fix problems and be competent
• Palliative/hospice care


  Addresses the needs of people with life-limiting conditions to improve quality of life for them and their families. Patient & family identify unique end-of-life goals. Assess how symptoms, treatment, issues are hindering reaching goals. Interventions to assist in reaching end-of-life goals. Focus on quality of life & closure
• Anorexia‐cachexia syndrome


  A common syndrome observed at end of life. The individual loses appetite (anorexia) and muscle mass (cachexia)
• Anxiety, depression, confusion, and dementia are also common psychological symptoms that people experience in their final days and hours
• Tamed death


  Death was viewed as familiar and simple, a transition to eternal life. Death and dying were events that involved the entire community, supported by specific prayers and practices that "tamed" the unknown
• Invisible death


  The preference that the dying retreat from the family and spend their final days confined in a hospital setting
• Social death


  The process through which the dying become treated as non‐persons by family or health care workers as they are left to spend their final months or years in the hospital or nursing home
• Idea of "Death with dignity"


  Proposed that the period of dying should not subject the individual to extreme physical dependency or loss of control of bodily functions
• Good death


  Patients' opportunity in which they can have autonomy in making decisions about the type, site, and duration of care they receive at the end of life
• Legitimization of biography


  A process when you reach the point of thinking about your own life's ending, you may wish to take steps to leave a legacy that will continue to define you after you are gone
• Awareness of finitude


  People first start to think about their own mortality when they reach the point of finitude, when they pass the age when other people close to them died
• Curative/Disease Focus vs. Palliative/Hospice Care Focus

  • Diagnosis
  • Treatment
  • Cure
  • Extending Life
  • Futile care?
  • Patient & family identify unique end-of-life goals
  • Assess how symptoms, treatment, issues are hindering reaching goals
  • Interventions to assist in reaching end-of-life goals
  • Focus on quality of life & closure
• Palliative care


  Addresses the needs of people with life-limiting conditions to improve quality of life for them and their families. Goal is to help live life to fullest with time they have remaining. Allows family to get a break & deals with end-of-life
• Palliative care's benefits compared to standard care

  Manage pain and other distressing symptoms. Helps patients live as actively as possible. Uses a team approach to address the needs of patients and their families. Offers a support system to help the family cope during the patient's illness and in their own bereavement. Integrates the psychological and spiritual aspects of patient care. Will enhance quality of life and may also positively influence the course of illness
• Western attitudes towards death have undergone major shifts throughout history. Contemporary Canadian attitudes regard death in a sensationalistic way, but the predominant tendency is to institutionalize death and make it "invisible"
• The death with dignity movement has attempted to promote the idea that the individual should have control over the conditions of death
• The work of Kübler‐Ross was important in shaping contemporary approaches to care of the dying