FACING DEATH

Hospice Home of Hope, Brasov, 2006

Coping with a life-threatening illness and

death

Ilona Gorog psychologist -psychotherapist


Motto:ZorbaWhy do the young people die? Why does anyone die, tell me? Scholar I don’t know. ZorbaWhat’s the use of all your damn books? If they don’t tell you that, what the hell do they tell you? Scholar They tell me about the agony of man who can’t answer questions like yours.


Content

Hospice philosophy on death and dying Fears and uncertainties that accompany

a life-threatening illness Needs of the patients Children facing death and dying


Death - a taboo subject ?

Death, the one certainty in all life, if life's greatest uncertainty.

Death is a difficult subject, and even those who hold strong beliefs may avoid talking about it.

Coming to terms with death can be a lifelong process


Attitudes along the history

Once death was an integral part of family life – Adults and children were together at the bed of a dying relative

Today death is lonelier. Most people die in hospitals and nursing

homes


Hospice philosophy regarding death and dying Unlike conventional medicine, where death is

seen as the ultimate failure, hospice care embraces death as a natural part of life

Hospice affirms life and neither hastens nor postpones death.

It’s an ultimate opportunity for medicine to contribute to human peace, comfort and dignity.

Advocates of hospice care compare dying to birth.– http://www.thedoctorwillseeyounow

.com/articles/senior_living/

http://www.thedoctorwillseeyounow.com/articles/senior_living/




What is your first thought about…

Please, continue the phrases: Death is….. Dying might be…. Sudden death … Death of a child…. Dying in the hospital… Dying at home ….


« The Five Stages » model

• The « 5 Stages of Receiving Catastrophic News » were defined by Elisabeth Kübler-Ross in her book "On Death and Dying« (1969)

• E.K-R. considers the stages of mourning are universal and are experienced by all people, in response to an individual's own terminal illness or to the death


The Five Stages model.

1. Denial and isolation - The "This can't be real" stage.: "This is not happening to me."

2. Anger - The "Why me?" stage.: "How dare you do this to me?!"

3. Bargaining - The "If I do this, you’ll do that" stage.: "Just let me live to see my son graduate."


The Five Stages model.

4. Depression - The "Defeated" stage.: "I can't bear to face going through this, putting my family through this."

5. Acceptance - The "This is going to happen" stage.: "I'm ready, I don't want to struggle anymore."


For and against of the Kübler-Ross model This model has been widely adopted by

other authors and applied to many other situations where someone suffers a loss or a major change.

Not all workers in the field agree with, and some feel the stages are too rigid, and even as source for misunderstandings– http://www.growthhouse.org/books/kubler1.htm– http://www.counselingforloss.com/article8.htm

http://www.growthhouse.org/books/kubler1.htm




http://www.counselingforloss.com/article8.htm


R. Buckman: A three-stage model In the initial stage of "facing the threat,"

patients have feelings such as anxiety, shock, disbelief, anger, denial, guilt, hope/despair or bargaining. Humor, also might be present

In the second stage of "being ill," most of the above emotions are either resolved or decrease in severity. Depression is quite common.

In the final stage, "acceptance," patients become less anxious and less distressed.– (Buckman R. How to Break Bad News, 1992)


Reaction depends on many factors

Education Personality Relationship styles (social support) Spirituality and religious beliefs Previous experiences


Patient-centred approach

Each person's approach to dealing with the life-threatening illness is unique

Caring for dying is an ongoing creative process


Hopes/needs of the patients close to death

Feeling valued Realistic goalsPain and symptom relief


Hopes/needs of the patients close to death

Meaningful relationship with othersRelationship with God or a higher

beingNot to be left alone to dieA peaceful death


Questions and comments


What to say about death to children

Depend ono their ages and

experiences, on our own

experiences, beliefs, feelings,

the situations.


Developmental Stages

Studies show that children go through a series of stages in their understanding of death


Understanding death

• Some children ask questions about death as early as 3 years of age.

• Some may never mention death, but act out their fantasies in their play;

• They may pretend that a toy or pet is dying and express their feelings and thoughts in their make-believe game.


Understanding death

Preschool children usually see death as reversible - similar to what happens to the

cartoon characters on television, which miraculously rise up whole again after having been crushed or blown apart,

and temporary, like sleeping.


Understanding death

Between the ages of 5 and 9, most children are beginning to realize that death is final and that all living things die, but they still believe it will never happen to them or anyone they know.

Children also tend to personify death. They may associate death with a skeleton or the angel of death


Understanding death

From 9-10 yrs through adolescence, children begin to comprehend fully that death is irreversible, that all living things die, and that they too will die some day.

Some are developing philosophical views of life and death, seeking the meaning of life.


Left alone

Children with life threatening illness often know that they are dying but seldom have the opportunity to talk about it


How to support children

Careful listening and watching are important ways to learn how to respond appropriately to a child's needs.


How to support children

No matter how children cope with death or express their feelings, they need sympathetic and nonjudgmental responses from adults.


Impact on sieblings Younger children

believe they are the cause of what happens around them, and

May believe a brother or sister died because he or she had once "wished" the person dead (the wish "came true.“)


Normal childhood responses to a death in the family

Parents should be aware of, that it is normal during the weeks following the death for some children to feel immediate grief or persist in the belief that the family member is still alive.

Long-term denial of the death or avoidance of grief is unhealthy and can later surface in more severe problems.


Some danger signals to watch for:

an extended period of depression (the child loses interest in daily activities and events).

inability to sleep, loss of appetite, prolonged fear of being alone. acting much younger. excessively imitating the dead person.


Some danger signals to watch for:

o repeated statements of wanting to join the dead person.

o withdrawal from friends.o sharp drop in school performance or

refusal to attend school.These warning signs indicate that

professional help may be needed.


Questions and comments


Each person’s death is special and different

Dying is both a fact of life and a very deep mystery.

The way a person dies is very important. No one should have to feel alone, or be in pain, when facing the end of life. People who are dying should not be afraid that those who care for them will ignore their wishes or those of their loved ones.


Bibliography

Davis-Ali, Susan, 1997, Oncology Issues 12(6):12-17

Kubler-Ross, E., 1993, On Death and Dying, First Collier Books Trade Ed.

Kubler-Ross, E., 1975, Death – The Final Stage of Growth, Prentince Hall, Inc., Englewood Cliffs


Bibliography

Twycross Robert, 1999 - Introducing Palliative Care, 3rd ed., Abingdon : Radcliffe Medical Press.


Bibliography on Net Talking To Children About Death,

http://www.hospicenet.org/html/talking.html www.pallmed.net www.abcd_caring.org www.ktc.net/ritesofpassage/ www.careofdying.org/ www.dyingwell.org

http://www.hospicenet.org/html/talking.html

http://www.pallmed.net/

http://www.abcd_caring.org/

http://www.ktc.net/ritesofpassage/

http://www.careofdying.org/

Documents

FACING DEATH