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A personal story about attitudes on death

Advanced Search The confluence of two factors—major medical advancements in treatments that extend life in confluence and the unparalleled growth of our aging population—yields both great challenges and opportunities for changing the culture of dying in America. With age, most older people develop one or more chronic illnesses before they die and experience a period of progressive functional dependence, frailty, and increasing a personal story about attitudes on death for assistance.

The continued growth of the older population, coupled with their increasing need for health care as death approaches, presents one of the largest public health challenges in history Morrison, 2005. People who are terminally ill identify their top priorities as avoiding suffering, being with family, having the touch of others, being mentally aware, and not becoming a burden to others Gawande, 2010. Continued improvements in medical technology fuel the temptation to ignore its limits and elude the distress of facing these limits Cassel, 1997.

The possibility for technological rescue from death supports denial and creates a defiant attitude about death and dying. People have many concerns about life-prolonging treatment, but our system of technological medical care fails to meet these needs.

The cost of failure is measured in far more than dollars Gawande, 2010.

Medical technology can obscure humanistic compassion for people who are dying and those who love them. Dying, which once was viewed as natural and expected, has become medicalized and unwelcome in medical care Aries, 1981. Acceptance of the naturalness of dying directly conflicts with the medicalization and legalization of death that characterizes the culture of dying in 21st century America. The progressive movement of dying from the home setting to institutions may indicate that medicalization is an irreversible process McCue, 1995.

Although hospice and palliative medicine have improved the care that is potentially available, changes in attitudes have been limited. Three recent books address the modern culture of dying.

Each is aimed at a different audience, but when considered together, they deepen our perspectives on the current culture of death and dying and on opportunities for change. This review essay examines the orientation of the health care system toward care for people who are dying through the lenses provided by these books: Each book identifies particular aspects of the health care system that contributes to a culture that both denies and defies death.

Final Acts Final Acts is a collection of essays on death, dying, agency, and choice. Nan Bauer-Maglin and Donna Perry sought to inspire people to have conversations about final acts that can ease their deaths or those of loved ones.

This book illustrates both how people can make informed and caring choices about dying and what can happen in the absence of planning. Ten personal stories spanning a variety of issues illuminate how unique and distinct each death is.

  • Contrary to the above researches and explanation about death anxieties, attitude towards death is can be positive, as there are still differences among individuals, religious beliefs, cultures and socio-economic conditions that can affect attitude towards death;
  • These include the inclusion versus exclusion of transcendence dimension vertical axis , which specifies whether or not people belief in a transcendental reality.

Part II includes 10 perceptive and persuasive essays that illustrate the complex issues that influence end-of-life decisions. Personal Stories The personal stories are engaging and illustrative of the intimacy, sorrow, joy, meaning, and pain that accompany death. This story illustrates how the knowledge of terminality can be transformative.

Barnes identifies two truths: This book also illustrates some of the complex relationship dynamics that can accompany protracted dying.

  1. In most societies in Africa especially in Nigeria rural communities, there is a lot of bitterness which is overtly or covertly shown after burial. People may be unable to hear both at the same time.
  2. No one, not even children, is sheltered from these images, or from ritual dances re-enacting death. According to Spilka et al.
  3. We have to be ready for the moment we cease to exist. J Pers Soc Psychol 48.

Two stories illustrate the family dynamics that accompany suicide in terminal illness. Oyster raises the questions: This story underscores the concept of death with dignity while recognizing that for many, dignity is taken away.

People may be unable to hear both at the same time. She proposes communication with empathy, honesty, and the straightforward discussion of options. This story illustrates transitions in our relationships with those who have died. Although the experience of death is universal, it paradoxically remains unique and personal to each individual not only in the terminal physical manifestations but also in the ramifications for those left behind.

The essays address issues about which there are passionate arguments on all sides. In the past, life ended swiftly, but today most people die incrementally. Too often, conventional health care fosters the belief that when there is no possibility of recovery, nothing more can be done. Kiernan argues that America needs to establish a responsive system for summoning excellent end-of-life care and a way to teach people how to seize the opportunity presented by slow dying.

  1. Duriez B, Hutsebaut 2000 The relation between religion and racism. More so, curiosity about death could be tallied with preparation for demise and joy about rest based on religious doctrine and cultural beliefs [ 31 ].
  2. This perception has religious, cultural and socio-psychological undertones. Another study by Florian and Mikulincer [ 25 ], applied a more multidimensional framework of analyzing death anxiety involving the cultural, religious, conventional science as they are connected to fear, anxiety and doubt about death.
  3. Finally, it is important to note that each of the three books incorporates case material that always enriches education and each includes lists of additional references e.
  4. Thus, the assumed correct patterns of death and dying are in connection to the value of the society and are as much social as well biological, people do not simply die; they die in socially and biologically interpretable ways [ 20 ]. Both MacGregor and Tucker grapple with such decisions in the context of intolerable pain, futile treatment options, fears of becoming a burden to family members, and the small number of people who experience intractable suffering, even with pain and symptom management, such that they determine that hastening an impending death is the least bad alternative.
  5. The three books reviewed in this essay reflect on both the current challenges and the opportunities for change.

She describes an inhospitable hostile hospital environment, made worse by what may be the inevitable inadequacies of the hospice system—its inability to meet the expectations that its very existence creates. She questions the ideals that are at the core of its identity: In her chapter on ethical principles for decision making at the end of life, Candace Cummins Gauthier addresses difficult end-of-life conflicts that arise around the question of ineffective interventions or medical procedures that are unable to achieve recovery and only postpone death.

Bhutan’s dark secret to happiness

She recommends that people must be permitted to make their own medical decisions, even if it results in death, and she argues for voluntary euthanasia with requirements such as those in the Oregon Death with Dignity Act.

Assisted dying is tackled in two essays. Kathryn Tucker raises the question: Is a state sufficiently compassionate to allow the choice of aid in dying to terminally ill competent people who are receiving end-of-life care but continuing to suffer?

Both MacGregor and Tucker grapple with such decisions in the context of intolerable pain, futile treatment options, fears of becoming a burden to family members, and the small number of people who experience intractable suffering, even with pain and symptom management, such that they determine that hastening an impending death is the least bad alternative.

They summarize the living—dying experiences of Karen Ann Quinlan, Nancy Cruzan, and Terri Schiavo that clearly have shaped public discourse on the issue of the right to die.

Older adults who want active care may be subtly coerced into forgoing the possibility by relatives who are in favor of advance directives. Moreover, he posits that public policy should support social structures that make it possible for communities to respond to those who are facing the end of life in comprehensive caring ways.

Death is not the worst thing: The mixture of personal experiences with persuasive and well-written essays is highly effective in creating a snapshot of dying in 21st century America.

No Place for Dying No Place for Dying provides an extraordinarily well-written critical analysis of the current culture of hospital care for people who are dying.

Helen Stanton Chapple conducted ethnographic research in two hospitals: She interviewed clinicians from a variety of disciplines about 211 patients who had died. She presents an unwavering look at the stark realities of dying in a hospital and a compelling argument for the need to change the culture of dying in this country.

Dazzling flashy technology is particularly germane in U. Chapple argues that rescue has become the gold standard for the delivery of acute care in the United A personal story about attitudes on death because it resonates with ideologies of heroism, technology, individuality, and universality as well as the dramatic win over death.

This priority profoundly influences how death occurs in hospitals. Three key strands of U. Chapter 1 presents an important backdrop for the book by incorporating the stories of five people who were dying in hospitals. These cases focus the reader on the lived experience of dying in a hospital today and are used for illustration of important points throughout the book.

The ritual of intensification involves one or more life-saving measures: The ritual of intensification yields more time alive and fosters hope that healing will occur. Stabilization rights the wrongs of fate and focuses on more time as an unquestioned priority. The human drama of medical rescue contributes to the ideology that death can be defied. Helen Stanton Chapple does a masterful job of portraying the ways that rescue minimizes death and contributes to death denial in our culture.

In hospitals where almost every aspect of care has a code or label, dying patients are uncategorized. Clinicians in the acute care setting often feel helpless when a person is dying and see themselves as being held hostage to the dying instead of feeling a sense of honor. Acute and high tech care can support vital signs and delay death, but it also promotes the illusion that death can be infinitely postponed. When hospitalized dying patients are minimized, each member of society is shortchanged.

Hospice and Palliative Care Hospice and Palliative Care is a comprehensive and authoritative text that provides an overview of the hospice and palliative care movement in the past, present, and future. In addition to providing thorough information about all aspects of hospice and palliative care, this book is seasoned with insights about changing the culture of dying in the Unites States.

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The book begins with a comprehensive informational overview of how hospice care in the United States is organized and delivered, including the history of hospice, hospice philosophy, and the standards for care.

Interdisciplinary team functioning and roles, symptom management, psychosocial and spiritual care, and community education are described in a clear and informative manner Chapters 1—6. The presentation of information on all aspects of hospice and palliative care is strengthened by use of conceptual frameworks.

The delivery of hospice and of palliative care is discussed in the context of, and situated on, different trajectories of dying. Bereavement care, which is a fundamental aspect of hospice and palliative care, is presented within the conceptual models of normal grieving, pathological grief, and depression, all of which are used to underscore the risks that contribute to poor outcomes.

Direct experience with a hospice community program seems a key to deconstructing illusions about, and denial of, death and dying. Hospice and Palliative Care provides an in-depth look at the challenges facing the hospice and palliative care community. Physician attitudes are a significant challenge. Most physicians view the cure or control of major diseases as primary and the relief of suffering as perhaps secondary.

The health care system does not value palliative care. As a corollary, Stephen Connor notes that hospice and palliative care providers suffer from arrogance, thinking that they know what is best for the person when choices are made for many complex reasons.

Provider attitudes are symptomatic growing pains of this movement. Pervasive societal denial of death is underscored as a challenge to hospice and palliative care.

Death, once a home-based experience, has evolved to be a far-removed event that happens in hospitals and institutions. Hospice has become a modern reminder of death. However, whatever the care is called, it will be associated with dying.

In sum, the hospice movement began as a revolution against the way the health care system treats those who are dying. It is now a positive force for excellence in the care of those facing life-threatening illnesses. However, whether hospices will succeed in changing the culture of dying in the 21st century is uncertain.

Stephen Connor argues that public policy currently limits reimbursement for hospice care so that many who could benefit are unable to do so. Moreover, it also will be incumbent upon hospices to stretch beyond their own limitations to improve access for people of color and those with limited resources for caring. Conclusions and Recommendations Death is inevitable, but severe suffering is not. We must all look toward the day when compassionate and skilled end-of-life care becomes so much a part of the fabric of American communities and the American health care system that a personal story about attitudes on death is not necessary to request it—it is simply offered when needed Foley, 2003.

The culture of dying in 21st century America is in flux. The three books reviewed in this essay reflect on both the current challenges and the opportunities for change. Each identifies aspects of our medical system that have become barriers to compassionate and skilled end-of-life care.

  • View image of Schoolgirls in traditional Bhutanese dresses Credit;
  • Human being can only think, imagine or belief something about death as a phenomenon but cannot change or stop its existence rather, human beings can only improve on the chances of longevity by looking at the socio-economic and health factors that surround life expectancy in a particular society or among a particular group.

These books deal with issues of choice and dying, where we die, and the care we receive. Each presents hope that one day this care will simply be offered when needed.