Am I Ready to Die? Death 101

In a patient with malignant disease, although the exact day of death may be unpredictable, one can normally identify a terminal phase in which he or she has not long to live. In the USA, Medicare funds hospice care both domiciliary and inpatient when death is likely within six months. The cost to Medicare of end-of-life care for people aged 85 and over is one-third lower than for people aged This may be because more people are dying at older ages after lengthy chronic illnesses and long periods of functional decline 17 ; and it may be the absence of a definable terminal stage that excludes many older people from hospice care.

This is not always possible when elderly people die. Seale, a sociologist, has questioned accepted views about the needs of dying people and their carers, on the basis of findings in a nationally representative sample of adults who died in the UK in 20 , A smaller parallel study compared reports given by some people with terminal illness with reports from relatives after their death.

He noted that an important function of bereavement processes is to repair the damage that a death causes to social cohesion. He referred to other work that describes the maintenance of the human social bond as the most crucial human motive. Dying is a severance of this bond. He also noted that many bereaved people who were interviewed wanted to portray their actions in a moral light, expressing concerns about their moral reputations as part of re-establishing themselves in the social order.

In some circumstances they used the research interview to help them in this process. When Lawton has spoken publicly about her research, she has often been approached by people who felt a sense of failure because their relative had not died in the way he or she had expected and hoped for 9. Seale noted the importance of cleanliness and food as part of the social order of life. Clearly those who do not feel such a sense of self will suffer and often become very agitated.

However, this script was most appropriate for those with a specific terminal disease.

Seale found that relatives whom he interviewed for his research used the interview to assert their relationship to the moral order. They may use complaints in a similar way. In a study of complaints to a department of medicine for elderly people, relatives were more likely to complain about aspects of care relating to their own moral adequacy, if the patient had died The approach in this paper should not be misunderstood as suggesting that, in old age, a dignified death is impossible or that relatives who complain are not pointing out real issues of care.

Nevertheless, the findings do suggest that the issues outlined above have relevance to deaths of patients in general hospitals and the bereavement processes of their relatives. By understanding these processes, those working in such wards will become more sensitive to the feelings of relatives.

Integrated care pathways for dying people—a system aimed at improving care for people dying in general hospitals, based on dying processes of people with cancer—may not be totally relevant to people dying from other conditions Even in cancer, modern psychosocial support provides a broader view than that of Kubler-Ross, emphasizing intra-individual and inter-individual variation and cultural differences such as issues relevant to gay men or black communities 8.

A common notion is that much of the distress of relatives is due to guilt for not doing enough for their parents or living up to their parents' aspirations. It is easy for staff to collude in this and so think less of relatives; and these thoughts may be unwittingly communicated to the relatives, provoking antagonism. The idea that bereavement is a disruption of the social order is similar but involves no criticism. Strategies to sympathize with relatives who are going through such internal struggles may help relieve distress. These strategies could include emphasizing the inevitability of death in old age as a normal part of human existence and the importance of registration procedures and funeral arrangements in retaining bereaved people within the social order.

In Jewish tradition, following on from a funeral as soon as possible after death, there is a week of mourning when there is open house at the home of one of the immediate family.

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Family, friends and neighbours congregate in the house, particularly in the evenings when a short religious service takes place. The atmosphere, while serious, is rarely filled with gloom unless there has been the shock of a sudden death. The event is an accepted part of the social and moral order, allowing mourners to feel that they are part of society, not cut off from it. In Hindu contexts, the death of the person is believed to regenerate the entire cosmic order Hanson and colleagues interviewed bereaved relatives to find out their perceptions of what could be wrong with end-of-life care They concluded that the primary concern of bereaved relatives was communication failure; discussions that focus on specific treatment decisions may not satisfy the real needs of dying patients and their families.

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In times of emotional stress, no one wants to deal with all the messy practical details that come with the death of a loved one. You need to prepare now, so your relatives won t have to worry about how to carry out your final wishes after you pass. She hopes to develop a hospital program that uses hypnotherapy for pain management for pre and postoperative patients, and for those with hospital-related anxieties, such as procedures and child birth.

Meredith lives in North Idaho and is the mother of five children: Kelsie, Cody, Austin, Hudson and Alexis.



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Full of practical advice on an oft-neglected subject, this book will help you answer all of the following questions, along with many more. Have I chosen a funeral home? Have I set up my memorial funds or donations? Does my family know my wishes regarding organ and tissue donation?