Unit 11: Death, Dying, and Grief

Introduction

• Final unit focusing on death, dying, and grief.
• Discusses the concept of a "good death."

Hospice vs. Palliative Care

• Hospice Care:
  • Originated in the 1960s to support dying patients in hospitals.
  • Requires doctor certification of terminal illness with six months or less to live.
  • Covers diseases like dementia, COPD, cancer, etc.
  • Multidisciplinary approach involving family, religion, psychosocial aspects.
  • Focus on care, not cure; available in various settings (home, nursing home, hospital).
• Palliative Care:
  • Broader term; includes chronic illnesses (diabetes, heart disease, dementia).
  • Focuses on comfort while continuing treatment.
  • Emphasizes patient and family-centered care, autonomy, and reducing suffering.

Death and Dying Theories

• Kubler-Ross Model:
  • Stages of grief: Denial, Anger, Bargaining, Depression, Acceptance.
  • Non-linear progression; individuals may experience stages differently.
• Emphasizes the importance of treating patients as they want to be treated.

End-of-Life Ethical Considerations

• Euthanasia Types:
  • Voluntary: Physician-assisted suicide, varies by location (e.g., legal in Canada).
  • Passive: Withholding life-sustaining treatments.
  • Involuntary: Ending life without consent, ethically controversial (e.g., Five Days at Memorial).
• Legal and Ethical Debates:
  • Individual liberty vs. government protection.
  • Autonomy vs. quality of care.
  • Non-maleficence (do no harm) vs. beneficence (do good).

Communication and Symptom Management

• Importance of being present, listening, and using open-ended questions.
• Symptom Management:
  • Focus on pain management, constipation, breathlessness, delirium.
  • "Rule of Double Effect" allows pain management without concern for hastening death.

Grief and Bereavement

• Anticipatory Grief: Mourning a future loss.
• Developmental Tasks in Dying:
  • Tying up loose ends, acceptance, saying goodbyes.
• Grieving vs. Major Depression:
  • Grieving involves specific emotions tied to a loved one.
  • Persistent complex bereavement and complicated grieving defined.

Self-Care for Caregivers

• Compassion fatigue is common among healthcare workers.
• Importance of maintaining boundaries and seeking support.

Conclusion

• Importance of understanding cultural and religious customs in end-of-life care.
• Open for questions and further discussion.