American Experience of Death/ Thanatology
Who was Catherine Woodford and Cicely Saunders?
Cicely Saunders: baddie from England who is the founder of modern hospice
Catherine Woodford: Union student, class project starts first Medicare-covered hospice in Schenectady
Qualitative vs Quantitative
Qualitative: observational, grouping of common data
Quantitative: statistical analysis, looking at how many how much of something
Define Death
Death is universal, irreversible, a loss of mental and physiological function.
What is the Patient Self-determination act?
Federal law, right to accept/deny treatment if hospital recieves federal funding
Right to participate in healthcare descions
The right to accept or refuse medical treatment
The right to prepare an advance directive
What are the Corr Tasks of Dying?
1. Physical
2. Psychological
3. Social
4. Spiritual
What was death like in 1900 vs 2024?
1900: deaths were quick and were often due to an absence of public health
2024: slow and chronic,
Alternate explanations for NDE's?
Temporal lobe seizures from excess firing cuases hallucinations and unusual bodily experiences
Anoxia - exaggerating thoughts and sensations
Angular gyrus being affected - out of body experiences, retrieval of memories and words
Lying
Describe the different states of consciousness
Hint: theres 8 including death
Dead: no heartbeat no breathing
Brain Dead: prolonged irreversible cessation of brain activity
Coma: lack of consciousness, unresponsive, <2-4 weeks
Vegetative State: no awareness but brain stem activity
Minimally Conscious: fluctuating signs of awareness
Catatonia: psychic and motor disturbance
Locked in Syndrome: fully conscious but paralyzed except for eye movements
Covert Consciousness: hidden state of awareness, able to follow commands via brain activity
What are the 5 wishes in the Five Wishes Form?
1. Person to make descions
2. Medical treatment i want
3. Comfort
4. How i want people to treat me
5. What I want my loved ones to know
What is the Elizabeth Kubler Ross Stage Theory on Dying?
1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance
Identify some gaps in EOL research
Cultural differences, what one person wants another dosent
Hard to afford care
Lack of longitudinal studies
Lack of clinical training
Lack of caregiving availability
Operationalization of terms differs
Example of evidence for reincarnation and NDE
Children claim memories of time between death and birth
Hospice patients rights before they die say they see dead people both who they know and who they dont
identify factors that may influence the chances of recovery following brain injury
Timing: longer - less likley to gain consciousness
Type: recovery more likley from TBI
Location: recovery less likely if damage to thalamus which sends sensory info to high cortical areas, no thalamus you dont know who you are
What is a Health Care Proxy?
Someone who will make medical end of lfie descisions on your behalf, they must be over 18 and can be anyone except for your doctor.
What is Hospice vs Palliative Care
Palliative Care: seriously ill, focused on improving quality of life and comfort, can still have curative care
What are the types of awareness in dying? Describe em
Closed awareness: dying person is unaware but everyone else knows
Suspected awareness: dying person is sus
Mutual pretense awareness: everyone knows, nobody talking abt it
Open awareness: everyone knows, everyone talks abt it
What is Autoscopy vs Heutoscopy
Autoscopy: seeing a copy of themselves
Heutoscopy: alternating perspective from self and copy of self
What happened in Terri Schavo's case?
She had brain damage from cardiac arrest caused by fertility drug & anorexia, husband got her thalamic implants and cared for her until he wanted to remove her feeding tube, becomes national issue and parents argue - feeding tube is taken out and put back in 3x
Out of the three which is the strongest advanced directive: Living Will, DNR, MOLST
define the strongest one !
Bonus Point: what color is the paper?
MOLST: Medical Order for Life Sustaining Treatment, A written form that must be signed by a doctor that indiciated what you want to happen if a life threatning event occurs outside of a clinical setting
Bonus Point: its pink!
What is the Pre-Active vs Active Phase of Dying?
Pre Active: 1-2 weeks before, confusion, agitation, restlessness, decreased food and liquid intake, patient requests family to come to tie up loose ends
Active; 1-2days/hours before, difficulty to arouse, confusion, hallucinations, agonal breathing, death rattle, decreased circulation
What is an independent variable, dependent variable, and operationally definition of a variable?
IV: whats getting changed
DV: what is affected by the change
Operationally define a variable: metric, give it a way to be measured but dont describe the methods
Types of studies
Correlational analysis: + or -, cant conclude causation
Cross sectional: one point, different samples
Longitudinal: over time, one samples
What happened in the case of George Melendez?
He was in a vegetative state being cared for by his mother who gave him ambien when he was agitated over night and it caused him to briefly enter a state of consciousness and awareness
What are 3 common pitfalls faced by Health Care Proxies?
Call of love: cant imagine living w/o them
Call of duty: feel responsibility for saving the person
Call of redemption: feel guilty
What is the Social Model for Hospice Residential Care Homes?
A community run, non-medical residence for terminally ill pateints with a prognosis of less than 3 months enrolled in hospice, only 2 beds, non-profit