Objectives: At the end of this lesson, you will be able to
- Compare the leading causes of death in the United States with those of developing countries.
- Compare physiological, social, and psychic death.
- List and describe the stages of loss based on various models including that of Kubler-Ross.
- Explain the philosophy and practice of palliative care.
- Describe hospice care.
- Differentiate attitudes toward hospice care based on race and ethnicity.
- Summarize Dame Cicely Saunders’ writings about total pain of the dying.
- Compare euthanasia, passive-euthanasia, and physician-assisted suicide.
- Characterize bereavement and grief.
- Express your own ideas about death and dying.
“Everything has to die,” he told her during a telephone conversation.
“I want you to know how much I have enjoyed being with you, having you as my friend, and confidant and what a good father you have been to me. Thank you so much.” she told him.
“You are entirely welcome.” he replied.
He had known for years that smoking will eventually kill him. But he never expected that lung cancer would take his life so quickly or be so painful. A diagnosis in late summer was followed with radiation and chemotherapy during which time there were moments of hope interspersed with discussions about where his wife might want to live after his death and whether or not he would have a blood count adequate to let him precede with his next treatment. Hope and despair exist side by side. After a few months, depression and quiet sadness preoccupied him although he was always willing to relieve others by reporting that he ‘felt a little better’ if they asked. He returned home in January after one of his many hospital stays and soon grew worse. Back in the hospital, he was told of possible treatment options to delay his death. He asked his family members what they wanted him to do and then announced that he wanted to go home. He was ready to die. He returned home. Sitting in his favorite chair and being fed his favorite food gave way to lying in the hospital bed in his room and rejecting all food. Eyes closed and no longer talking, he surprised everyone by joining in and singing “Happy birthday” to his wife, son, and daughter-in-law who all had birthdays close together. A pearl necklace he had purchased 2 months earlier in case he died before his wife’s birthday was retrieved and she told him how proud she would be as she wore it. He kissed her once and then again as she said goodbye. He died a few days later (Author’s notes).
A dying process that allows an individual to make choices about treatment, to say goodbyes and to take care of final arrangements is what many people hope for. Such a death might be considered a “good death.” But of course, many deaths do not occur in this way. Not all deaths include such a dialogue with family members or being able to die in familiar surroundings. People die suddenly and alone. People leave home and never return. Children precede parents in death; wives precede husbands, and the homeless are bereaved by strangers.
In this lesson, we look at death and dying, grief and bereavement. We explore palliative care and hospice. And we explore funeral rites and the right to die.
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