Death and Dying 1-5 PDF

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Dr. Hinerman, Notes used for midterm...

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- Text-based appraoch to truth (critisism) - common and sound way to get at what the text means - authorial intent - reading the book/text & having a specific interpretation, - intent is sometimes hidden - biographical criticion - pointing out characters atonement - personal life - Reader response critisism - taking a text and reading it in specific way - your take - share different takes/outlooks - post-modern era → knowledge/meaning is unstable, experience will arise meaning - experience of reading the book - Karl Rahner, SJ (Society of Jesus) - special focus: education - “no one in hell” - Vatican II - doesn’t write about suffering - Liberation Theologians - different take than Karl Rahrner - unless you served someone who’s suffering, you won’t see God - those who are suffering are with God - God aligns & affiliates those who are poor - nothing like that in his biography, how would he know? - Psychosocial: how do I feel about you? How do I feel about myself? - Why are people dying? - Lack of medical care - malnutrition - acute infectious illnesses: caused death very quickly - relationship between medicine & religion - looked to religion to “fix” things - presence may displace social (if out of place, may think you’re bringing death) - people who are different from us migh disrupt 1910 vs. 2010 - life expectancy: 47, 77 - infant mortality rate: 14< (50%), >1% - 85% at home (0% dying in hospitals), 85% instutitional care facility - 92% wouldn’t want to die in care facility - professional care have replaced family members - active vs. passive level of family involvement - conversations of death & dying were apart of everyday life - most common cause of death: slow chronic diseases - death displaced from home to care institues Life-extending technologies - cardiac difibulation, - mechanical ventalation (intibation)

- artificial nutrition & hydration (nose or stomach) - organ transplantation (rejection of recipient is biggest problem) - get sick & die vs. get sick & sick lingers (until death) - Goal of care: palliative care (reduce suffering) - not just physical, but emotional suffering as well - some ppl don’t believe in palliative care (giving up hope) - community base palliative care - takes time to have things in order: makes things easier for the patient & their family - hospice: 6 month prognosis, stop 95% of treatment (palliative care not like this) - don’t need to be dying to recieve palliative care Epidemiologic Transition - quality vs. quantity - sometimes, you can have both (through palliative care) - euphemisms: death is the most euphemized word in english Mass Media - we don’t have any idea of deaths & what to do during times of diagnosis like cancer (chronic illnesses) bc it’s not really reported on - many people don’t know palliative care (the word & meaning) - nature programs suggest death is a natural (circle of life) - entertaining death: - cartoons: irreversible death (characters come back to life) - mean world syndrome: the way in which death is being reported to us - less insensitivity - aggressive behavior - conveys a certain height of danger, insecurity, etc., - “managed death” → most common word/phrase when ‘death’ searched up in medical journal - invisible death → we don’t have a lot of contact with death - tamed death (technological imperative) → if theres a medical intervention that can sustain life, that’s the ethical choice - institutional denial → denial of death within the institution (don’t support the care givers grief. Assumed that they should just get through it, but it eventually leads to burn out) - cultural lag → diminished quality of life during treatment - if patient dies under hospice, it’s under hospice and not the hospitals care - hospice is known as “no more hope,” but hospice is supposed to provide hope & be attentive to the patients needs Survey of Californians, Paliative care survey: No bankrupt, no burden to family, at peace, no pain Mature Concept of Death - Universality - Irreversibility - not like in cartoons, we don’t come back to life - Nonfunctionality - we can’t assign our own doings/consequences to those who have died - Causality

- there’s a biological cause for why we die - Unfolds throughout life span - Core concepts enriched (and redirected) by questions, doubts, exceptions, conditions - “Either/or” logic replaced by more sophisticated “fuzzy” concept - Allows for elaboration about the meaning of death - Values other cultural contexts & expressions - Avoids ethnocentrism Noncorporeal Continuity - notion that human beings survive in some form after death of the physical body - what happens to the personality after death? Does the self or soul continue to exist? What is the nature of the afterlife? Stages of Psychosocial Behavior - 5 stages → one stage happens the other - when death occurs to a child at one of the stages, disrupts psychosocial development (stages will take longer than normally would) 1. Trust vs. Mistrust (Birth - 2) - during infancy, kids are developing a sense of self, seeking trust & predictability. Death can cause unpredictability in their environment - routine is disrupted: if there’s a death/misplace, child can sense it - child might take longer to trust that “world is safe” 2. Autonomy vs. Shame (2-3) - death of a parent can cause regression to earlier behaviors like clinging, crying and being more demanding - death can lead to regressive behavior in child if loss is prevalent & on going 3. Initiative vs. Guilt (3-5) - pre-school/kindergarten years, seek own purpose and direction. Looks for approval -- kids look to adults/parents for confirmation as to their actions as they place themsleves in society - death: child feels guilt for the loss. Child will take on the emotional feeling but will forget about it from time to time (child will be playing, grief, play, grief) - grief/feelings show up when a child is playing 4. Industry vs. Inferiority (5-11) - very active. A lot of comparison making is going on. Recognition and encouragement are keys during this stage. Death of a family member can greatly hinder this 5. Identity vs. Role Confusion (11-18) - during adolescents, the main issue is “Who Am I?” Death at this stage can affect one’s identity and self-formation - death can be difficult, understanding death is real and can happen to any of us Cognitive Transformation (Piaget) - Piaget focused on Cognitive Transformations that occur during childhood. He distinguishes 4 different periods of intellectual (cognitive) development 1. Sensorimotor (birth-2) - focus on senses and motor abilities. Object permanence is being refined - death: person doesn’t come back (parent leaves room, they simply vanish) 2. Preoperational (2-7) - learning to use language and symbols. Exploration is key here. Securing and

identifying one’s place in the world - “What makes things die?” - Magical omnipotence (death is reversible) 3. Concrete Operational (7-12) - applies logical abilities to concrete ideas. See sports games! Arithmethical thinking - grasps death’s irreversibility 4. Formal Operational (12+) - abstract reasoning, hypothetical reasoning, interest in synthesizing - acquiring a mature understanding of death is part of a development - death → makes concentrating a lot harder, child can exemplify symptoms like ADHD Nonmaterial Aspects of Culture - knowledge, beliefs, values, norms, signs & symbols Agents of Socialization - family, schools & peers, mass media, religion Teachable Moments - childhood experiences can have great impact on the way you decide to grieve later in life (ex: story of raccoon & death of best friend’s brother) Ethnocerntrism - making judegments about others based solely on one’s own cultural assumptions and biases Cultural Sensitivity - avoid stereotyping - beware of judging the worth of other communites - understand that culture is not defined simply by ethnicity - known that there may be more differences within than between cultural groups Fundamental Medical Ethical Principles - autonomy (if you don’t have capacity, you can’t exercise autonomy) - beneficence - justice - nonmaleficence - trust Why initiate end-of-life discussions? - Choices differ based on the information (more information yields more choices) - Could receive undesired treatments (CPR?) - Allows time for healing relationships, completing goals, wills → allows for preperation - Clarification (gives more freedom and more choices to patient)

Feb 17, 2020 Learning About Death 4 ways to fix a belief

a. b. c.

d.

authority - from a young age, we believe things based off of those who have authority over us (ex: parents beliefs) taste - preference, but only works with certain kinds of beliefs (not all) tenacity - partciuclar perspective. Continue to have that perspective despite other beliefs/opinions (oblique stubborness) community of inquiry

February 24, 2020 - More death anxiety then or now? - Causes of Death - supernatural - psychosocial - *Atonement - became part of Christian landscape - effort to try to deflect God’s wrath - preists would walk around town trying to atone the sins of the town ppl - God is all knowing, God knew decisions we would make - whether we’d go to Heaven/Hell - Anselm - “An infinite God, a perfect God, could not tolerate sin/impurity” - In order for God to remain God’s purity, God has to say NO - God has to reject the sin, reject the person that did the sin - God gives opportunity for forgiveness - Jesus avoids the conversation of what happens before/after you die? - Plato - Jesus borrowed metaphysics of Plato - largely responsible for the concept/purpose of “soul” - realm of forms (sea), our lives (island) - before we decay, we exist in the realm of forms, existing as a soul - soul becomes attached to a body (stepping onto the island) - when you finish walking across the island and go back into the sea, become a soul once again - baby & those on death bed: full of knowledge - Death & Dying in Wester Culture - Danse macabre (Dance of Death) - when the music stops, death calls - Burial Customs - graveyards - charnel houses - bones - catacombs next to the saints - helped curve spread of the plague - simple gravemarkers - effigies

- hanging a picture - can be interpreted as playful or violent (context is important) - some that you were respecting a loved one by engaing in an effifgie - some cultures thought it was disrespectful - rural cemeteries - ornate monuments Danse Macabre/Dance of Death - influenced by mass plague deaths - reflected inevitability and impartiality of death - emphasized uncertainties of human mortality Native American Traditions - Diversity in beliefs & customs - Death is viewed as a natural event - Death songs as final act of earthly life - reverence for bones of ancestral decay - Ohlone: - ensured progresses of deceased to supernatural realm - adorn the corpse - personal posessions burned with corpse → didn’t want person to come back & look for it - name of deceased not mentioned for 6 mo-1 year → not to be mentioned, saying goodbye - Cherokee: Multi-Soul Concept - soul of conscious life leaves body at death - 2nd soul, located in liver, takes about a week to die - 3rd soul, located in heart, takes about a month to die - 4th soul, located in bones, takes about a year to die - Cocopa: - wail in ecstasy of violent grief behavior - posessions burned with the body for use in afterlife - Hopi: - funeral rituals private & attended by few people - wish to avoid the dead completely - mourners couldn’t express grief, needed to show strength African Traditions - LoDagaa of Northern Ghana: Mourning Practices: - funeral ceremonies span from six months to several years - mourning companion - mourning restraints based on relationship to deceased: leather, fabric, string Mexico Traditions - El Dia de los Muertos - communion between living and dead - fiesta-like atmosphere in cemetery - special foods (e.g., bread in shape of human bones)

- sugar-candy skulls and coffins - graves cleaned and decorated Chinese Traditions Japanese Traditions - O-bon festival reveres the soul of the dead - light used to guide spirits - funeral prayers help emancipate the spirit - dead given special name to indicate their status Celtic Traditions - death on battlefield considered glorius - fallen heroes The Health Care Triangle - between patient, staff, institutions/administration Institutinonal Medical Care Hospitals vs. Nursing Homes QUALY: Quality Adjusted Life Years 2000 GNP 13% 2010 GNP 26% - paying hospitals for services they weren’t paid for

In Class Study Guide What are the central factors that influence our factors towards death? - changes in life expectancy - causes of death (acute, chronic illnesses, etc.,) - geographical ability (on the move all the time, hard to attend funerals/care for ppl) - death no longer happens in the home, but in an institution - life extending technology What are some ways our personal attitudes towards death are expressed? - language we use to talk about death (avoiding the word “death”) “Mean world Syndrome” - grief has been privatized - begins to desensitize because there’s so many events that have happened already like it (school shooting) - we push death outside of our normal sphere, but we don’t talk about it so it creates an irrational fear of dying Mature Concept of Death - universal, irreversible, renders us non-functional & biological costs

Non-material aspects of Culture - knowledge, values, beliefs - viewpoints that we’re socialized into Primary Agents of Socialization - family, religion, school you attend/people you befriend, etc.,...