Full Test Bank Ch.12 Coping with Death Dying and Bereavement

CHAPTER 12

COPING WITH DEATH, DYING, AND BEREAVEMENT

CHAPTER SUMMARY

Chapter 12 is divided into two main sections. The first section covers topics related to death and dying. In modern technologically advanced societies, we take it for granted that we will live long lives and indeed a large proportion of deaths occur in very old age. The dying trajectory, which is the speed of decline in functioning that precedes death, is more gradual in advanced societies because medical treatment can extend life even when there is illness. A gradual dying trajectory allows time for dealing with personal issues. Modern life-sustaining treatments (LSTs) such as mechanical ventilation and artificial nutrition and hydration can prolong life. In fact, a controversial issue (both in medicine and religion) is whether there is a moral imperative to use LSTs; are LSTs to be considered ordinary care or extraordinary care?

Advance directives are documents in which individuals make known how they want their property distributed (a will), express their preference not to have medical treatments that would artificially prolong their lives (living will), and designate who will make health-care decisions if they are not able to do so themselves (durable power of attorney for health-care).

Older adults as a group are closest to death, but they express less anxiety about it compared to middle-aged adults, possibly because loved ones are able to function independently. Also, many older adults feel they have had time to carry out their life plans. However, death anxiety can vary within the older group. It tends to be lower in older men than older women, and lower in older adults with strong religious beliefs than in those with no religious beliefs, and lower in older adults who live independently in the community as opposed to those residing in nursing homes. However, older adults, especially those in the old-old (over 80) age group, do worry about how they will die, where they will die, and whether their dying process will be a burden for their families.

Death has been and to a large extent still is a taboo topic, but Elizabeth Kübler-Ross led the way to opening discussions about death and humanizing it. After interviewing 200 terminally ill patients, she proposed five stages of death and dying: denial, anger, bargaining, depression, and acceptance. Although critics claim not everyone goes through every stage and that the stages do not always occur in order, these stages have been important in understanding not only the process of dying but also understanding how people deal with loss.

Although most people have expressed a preference for dying at home, most Americans who die do so in hospitals and other medical facilities or in nursing homes. However, hospice is a movement whereby terminally ill patients are given palliative treatment as well as spiritual, psychological, and societal support. Their families also have access to the support of hospice workers. Euthanasia (a term that means gentle or easy death) has been and continues to be a controversial topic. Active euthanasia is taking action to end a patient’s life, whereas passive euthanasia is withholding action that would sustain it. Assisted suicide is providing the patient the means to end his or her life but not actually administering it. Physician assisted suicide (PAS) is legal in some countries such as the Netherlands, Belgium, and Switzerland, but with strict guidelines. In the United States, PAS is legal in the states of Oregon and Washington, but only under carefully circumscribed conditions. However, there have been attempts at the federal level to invalidate PAS legislation passed at the state level. At present, PAS is not legal in other states.

The second section of the chapter, bereavement and loss, focuses on the reactions people have to the death of a loved one. Bereavement refers to the situation and long-term process of adjusting to the death of a loved one. Grief refers to the emotional response to bereavement. Mourning refers to culturally patterned ways of behaving and rituals that follow a death. Most of us feel grief when we lose a loved one. However, the general attitude in the United States is that death is more acceptable when a person is older rather than younger. Such an attitude can influence the allocation of health resources and life-prolonging techniques.

Many married older adults lose a spouse to death and thus become widowed. There is considerable variation in widowed adults’ expression of their feelings and in the length of their grieving process. However, feelings of distress often taper off after a 12-month period, life takes on some normalcy, and the widowed individual comes to some acceptance of the loss. In comparisons between widows and widowers, more widowers remarry and they often marry women younger than themselves. There are many more older widows than there are older widowers. While widows are at a greater economic disadvantage than widowers, they often have a more extensive social network of others in the same situation. We know more about loss of a spouse than we do loss of siblings, adult children, or friends, all of which also entail a period of bereavement.

SUGGESTED WEBSITES

Living Wills and Related Legal Documents

For up-to-date information, it is best to search the internet with terms such as living will or durable power of attorney for health care. Information can vary across states, but legal opinions are given and links are provided to sites where advance directive documents can be downloaded.

Hospice Care

http://www.hospicefoundation.org

This is the website for the Hospice Foundation of America (HFA), which focuses on end-of-life care resources for professionals, patients, and families. There is a description of the concept of hospice and the history of the hospice movement. There are links to a description and discussion of grief and coping with loss as well as end-of-life ethics. In addition, there is a list of publications and materials related to these topics as well as answers to frequently asked questions. There is also a hospice directory that helps people locate a hospice in their geographic area in the United States or Canada.

Hospice and Palliative Care

www.caringinfo.org

This website is maintained by Caring Connections, a program of the National Hospice and Palliative Care Organization (www.nhpco.org), which is a national consumer and community engagement initiative to improve care at the end of life. There are links to information and answers to questions on planning ahead (advance care, advance directives, etc.), grieving a loss, caring for someone, and living with an illness.

Association for Death Education and Counseling

www.adec.org

This is the website for an interdisciplinary North American organization on thanatology. The site offers links to a list of registered certified professionals who work in the field of death and dying. Also, there is a registry to educational offerings.

End-of-Life Choices

www.compassionandchoices.org

This is the website of a nonprofit organization that aims to improve care and expand end-of-life choices and planning for mentally competent adults. This organization is now handling membership services of the former Hemlock Society (the original right-to-die organization founded in the U.S. in 1980 but which ceased to exist as of 2005).

MULTIPLE-CHOICE QUESTIONS

Select the best answer from the options provided.

1. The dying trajectory __________________.

a. is always sudden once an illness is diagnosed

b. is often gradual in technologically advanced societies

c. only refers to death that results from an accident

d. always takes place in an acute care hospital setting

2. A document that states how individuals want their property distributed to heirs upon their death is called a(n)______________.

a. living will

b. durable power of attorney

c. will

d. intestate instrument

3. The legal document that people can use to specify the circumstances under which they do not wish to be kept alive with the use of artificial life-prolonging technology if death is determined to be inevitable is called the ________________.

a. will

b. durable power of attorney for health-care

c. right to die agreement

d. living will

4. A living will is a document signed by a patient’s relatives when the patient is in a coma or otherwise is not mentally competent to execute a will.

a. True

b. False

5. The Patient Self-Determination Act (PSDA) requires that ______________.

a. all older adults have a written will that specifies how their property is to be distributed upon their death

b. only patients themselves are allowed to make the decisions about their own health care

c. health-care facilities that receive government funds must provide patients with information on advance directives

d. older adults’ family members are not allowed to play any part in their care even in the case of critical illness

6. The durable power of attorney in health-care matters is a document older adults can use to _______________.

a. name an attorney who has agreed to take care of their medical bills

b. designate a trusted relative or friend to make health-care decisions if they have a serious incapacity that prevents them from doing so themselves

c. make decisions about how their property should be distributed to family and friends if they are in poor health

d. request that their lives be prolonged even if there is no doubt that they will remain in a vegetative state

7. The will, living will, and durable power of attorney for health-care matters ______.

a. are documents that plan ahead for a time when a person is unable to make decisions

b. are only valid in some states in the U.S.

c. can be completed by relatives when the individual is unable to do so himself or herself

d. All of the above

8. Which of the following individuals is most likely to express anxiety about death?

a. A 26-year-old man.

b. An 85-year-old man

c. A 21-year-old woman

d. A 40-year-old woman

9. Research suggests that older adults with strong religious beliefs have ___________ compared to older adults without strong religious beliefs.

a. a greater degree of anxiety about death

b. a lesser degree of anxiety about death

c. an equal degree of anxiety about death

10. In older adults, strong religious beliefs are ______ to fear and anxiety about death.

a. positively related

b. inversely related

c. unrelated

11. Which of the following was NOT one of Kübler-Ross’s stages of dying?

a. Anger

b. Bargaining

c. Retribution

d. Denial

12. Now we know that all patients do not go through Kübler-Ross’s stages in the same order and not every patient goes through every stage.

a. True

b. False

13. Hospice care focuses on ___________________.

a. making use of life-sustaining technologies

b. keeping up the patient’s hope that a cure will be discovered

c. paying complete attention to the patient’s needs and ignoring the patient’s family

d. controlling the patient’s symptoms and relieving pain

14. The hospice concept ____________________.

a. stresses the need of patients to die in very sterilized hospital settings

b. includes the provision of a supportive, pain-free atmosphere for dying patients and their families

c. refers to a recent experimental technique of lowering the body temperature of a person at the moment of death to halt deterioration prior to burial

d. includes the use of heroic (extreme) measures to prolong a dying person's life

15. Not resuscitating (reviving) a patient who has gone into cardiac arrest is best seen as an example of ______________.

a. passive euthanasia

b. mercy killing

c. assisted suicide

d. homicide

16. Physician assisted suicide (PAS) is now legal in every state in the United States.

a. True

b. False

17. Providing a patient with the means (for example, medications) to end his or her own life is a form of ___________________.

a. active euthanasia

b. passive euthanasia

c. assisted suicide

d. homicide

18. __________ is the long-term process of adjusting to the death of someone to whom a person feels close.

a. Bereavement

b. Mourning

c. Grief

d. Denial

19. Burial rituals and practices such as wearing black for an extended period of time are examples of _________________.

a. bereavement

b. denial

c. grief

d. mourning

20. Members of American society view the death of an older adult as _________ than the death of a child or young person.

a. more acceptable

b. equally acceptable

c. less acceptable

21. Davidson conducted a study the United Kingdom, asking widows (women) and widowers (men) ages 65+ what they thought about remarriage. Which of the following describes most accurately what was found?

a. More men than women were hesitant to consider remarriage.

b. More women than men were hesitant to consider remarriage.

c. The women and men were equally hesitant to consider remarriage.

d. The women and men were equally reluctant to give up their freedom by remarrying.

22. Which statement is most accurate when comparing older widows (women who have lost their husbands) and older widowers (men who have lost their wives)?

a. Widows are better off economically than widowers are.

b. Widows are more likely to remarry than widowers are.

c. Widows are less vulnerable to depression than widowers are.

d. Widows have a smaller social network than widowers do.

23. Loss of a spouse through divorce that occurs in older adulthood _______.

a. is more common today than it was 10 years ago

b. is so rare that no statistics are available

c. is never associated with bereavement

d. is a positive factor for older women’s financial status

SHORT ANSWER QUESTIONS

1. What is meant by a “dying trajectory.” Give an example of a sudden dying trajectory and of a slow dying trajectory.

2. What is a living will and when can it be useful?

3. What is a durable power of attorney for health-care matters and when would it be needed?

4. Which age group (young, middle-aged, or older adults) has the highest level of death anxiety? Give at least one possible reason why this might be so.

5. Name Kübler-Ross’s five stages of death and dying.

6. Compare the care a patient would receive in a hospice compared to the care likely to be received in an acute care hospital.

7. Describe what is meant by “active euthanasia,” “passive euthanasia,” and “assisted suicide.”

8. What is meant by bereavement and how long does it last when individuals lose a spouse?

9. Compare how widows and widowers cope with the loss of a spouse.