DYING in USA healthcare system
describe sum challenges of dying in the US healthcare system
Death denying culture
Lots of money was spent the year before death on curative care
Stopping treatment means accepting that death is near
describe oregons death with dignity act, list some requirements
Must be 18+
Make 2 oral requests 15 days apart
6-month terminal prognosis
Psych exam if doc thinks is needed
Capable of making their own healthcare decisions
Attending and consulting doctor must inform pt of alternatives
If less than 15 days are left to live, then exempt from the waiting period
Must be able to administer yourself
SUICIDE demographhhics. list some for me please as many as you can mhm
Men die by suicide 4x more than women
Women attempt suicide 3x more than men
4//5 suicides are men, predominantly white
Occupation
Men: labor-intensive, arts, entertainment
Women: artists, chefs, massage therapists
Lowest rates: education, library, training, business
1-25 patients with self-harm in hospitals kill themselves in the next 5 years
list some environmental ways of burial
Buried in a biodegradable basket or pod and turned into a tree
Exposure burial: leave the body out for animals to eat
Infinity suit: turns you into food for mushrooms
things you can do for someone who is mourning
Offer to bring meals
Encourage rest
Offer to make funeral arrangements
Help make phone calls
Help assist with paperwork
Help assist with the care of young kids
Share memories
Send a condolence letter
what is PACE? describe what it is and also give some downsides muah
Program for all-inclusive care for the elderly
PACE Center has meals, doctors, showers, and a hairdresser. They are taken there and dropped at home
But can't live far away from the center
Have to give up previous providers
55+
describe and list the terms of euthanasia
Voluntary: patient says kill me, doctor does it
Passive: withhold life-sustaining support with approval
Nonvoluntary: someone decides to end their life for them as they cannot consent
Involuntary: kill a patient against their wishes
list some myths about suicide
If people get help, they won't be suicidal
Confronting people about suicide makes things worse
Only experts can prevent suicide
Once someone decides to attempt, there is nothing you can do
Talking about suicide will put the idea in their head
whats the HOPE assessment tool, describe it
Sources of hope
Organized religion
Personal spirituality and practices
Effects on medical care
define bereavement, grief, mourning
Bereavement: situation, state of loss
Grief: emotion, physical, and cognitive reaction to loss
Mourning: the process of adjustment
what is the FMLA
FMLA: Family and Medical Leave Act
12 weeks of unpaid leave during 12 months (can be paid based on the employer)
talk about 2 patient MAID cases
Bill: cancer, deaf, blind, makes a plan to OD and is told if it doesn't work, have wife put bag over ur head, Bill hates this and shoots himself
Jim Wichter: ALS, doesn't want LST, waits too long, and can't swallow, so starves himself to death
Varian Ayers: stage 4 glioblastoma, OD’s hospice calls 911, she's sent to the psych ward, so starves herself to death
Brittany Maynard moves to Oregon to get MAID, glioblastoma
Kitty: 56, uterine cancer, hospice, MAID, unable to take prescription, she waited too long and slipped into a coma
Dr Quill and Diane: leukemia, gets MAID and dies, publishes paper and gets investigated
Identify some predictors of suicide
Previous attempt
Substance abuse
A recent attempt by friends
Depression
Giving away prized possessions
Acquiring a gun, stockpiling pills
Loss of job, partner, divorce, terminal illness
Saying imma kms
describe some logistics involved in teh after death process
Cost: $8000-10,000
Pay funeral director, casket, embalming, funeral service, printed materials, car, grave site, digger, liner, headstone
3 gallons of embalming fluid per body - cancerou
what are the 3 dif types of grief
Abnormal Grief
Chronic, exaggerated, delayed grieving, masked - act out in other ways
Complicated Grief
Death is sudden - of a child, a lengthy illness, or a lack of social support perception
Disenfranchised Grief
Grievers are unrecognized, not supposed to grieve, and the loss is not acknowledged as genuine (from a pet, abortion, or suicide)
The relationship isn't recognized
Death isn't socially sanctioned (crime, suicide, autoerotica)
talk about some hospice utilization patterns
NY has low hospice enrollment percentages
A lot of people see 10+ drs in last 6 months of life
Other countries have higher hospital death rate, but US has 2x ICU utilization and chemotherapy in last 3 days of life
what is MAID like in the netherlabds?
A physician must consult another doctor
Must be experiencing unbearable suffering
12-16 need parents' permission, 16-18 can request, 18+ parents have no say
Request must be made voluntarily, well considered, durable, and preferably written
It's not legal, but no prosecution
The doctor must stay the whole time. If it doesn't work can give euthanasia
Can do MAID for mental illness
List some statistics about suicide
Highest rates in ages 85+
Decline in the last year and a half due to 988
For every 1 death, there are 25 attempts
50% had seen a primary care provider beforehand
30% had seen a mental health care provider months before
Highest states: Wyoming, Alaska, Idaho, New Mexico
Lowest States: NJ, CT, NY, MD, MA
Most common method: firearms
Describe the rituals that occur from death to buria
Deathwatch - vigil
Prep body
Embalming
wake/visitation
Funeral
Disposal of the corpse
Committal - putting the body in the ground and last words
Obituary
what are the 4 phases of mourning
Shock & Numbness
Yearning & Searching for life before
Disorganization & Dispair
Reorganization
what is medical futility
This term describes continuing to perform invasive medical procedures even when clinicians know they will provide zero clinical benefit.
provide 2 arguments that are PRO MAID and 2 arguments that are AGAINST MAID
Pros
It must be administered by the patient, so not forced
Less of a burden for caregivers
Not prolonging life for more than is necessary
Allows for autonomy and dying with dignity
Can save healthcare/hospital resources (time, money, etc.)
Cons
People might do it for the wrong reasons - get mom to do it to get the inheritance
Goes against the Hippocratic oath - not to kill
list some suicide prevention strats and say what QPR is
Strengthen economic supports
Improve access to care
Promote connectedness
Create protective environments
Coping mechanisms
Identify and support people at risk
QPR
Be direct
Listen and give hope
Walk someone to get help or refer and get a commitment
Diversity in Death Rituals
talk about one of these main religions death rituals: buddhist, judaism, christian, hindiusm
Judaism:
Before death confess sins
Burial ASAP, the body is never left alone
Simple funeral
Mourners shovel dirt on the casket, no flowers
The family sits shiva for 7 days
Christianity:
Before, confess sins, anointing of the sick
Wake, mass, burial, or cremation
Mourners leave before the casket is put into the ground
Buddhism
Before, peaceful prep for next life, avoid meds, have a clear mind
The body is laid with its head to the North
No embalming or autopsy
Islam
The dying is positioned toward Mecca
The body is washed and wrapped in a shroud
The dead are mourned in mosques
Burial happens before decomposition
Flowers on the grave
Hinduism:
Confess sins before death
Avoid touching the body, gender colors, and the funeral pyre
what are the types of listeners but like bad in a derailing way
Lost Listener: Absorbed in self-talk
Shrewd Listener: busy trying to solve problems
Interrupting Listener
Dramatic Listener: asking historical questions to relieve drama