Tuesday, November 08, 2005

Death and Dying discussion questions

Chapter Five Questions

2. Would you prefer to live with a person who is terminally ill or a person who is chemically dependent? Discuss the advantages and disadvantages of each.

It would depend on the specifics of the disease and the dependency, but in general I would prefer to live with a terminally ill person. With a terminally ill person, I would be more likely to have meaningful communications with them and succeed in some way in making the end of their life better by making sure that they don't die alone. True, there would be a lot of physical caretaking and little sleep, but at least there would be an end, even if it didn't feel that way sometimes. A chemically dependent person on the other hand, would be more mobile and possibly more destructive. I would also have to stay one step ahead of them for their sake and my own sanity, especially since I would be trying to help them to get over their addiction. A chemically dependent person usually loses more of their ability to temper their emotional outbursts than a terminally ill person.

7. Discuss Glasser and Strauss's four awareness contexts. Which do you think more often exists in a medical setting with a dying patient?

Closed Awareness - Patient is not told the truth about their condition or was “told” and refused to hear it. This is an unstable context of awareness since most patients are able to pick up on death-related situational and spatial clues. According to one study, nurses prefer to work in this context more often.

Suspicion Awareness - Patient suspects the truth, but receives no verification from the medical staff. This requires the medical staff to be united on not telling the patient. It is possible that it is an unspoken agreement, justified by excuses as in they just haven't found the right time to tell the patient yet. Legislation has reduced context over the years as patients are given more of a right to know the truth about their health.

Mutual Pretense - Everyone, including the patient, knows that the patient's condition is terminal, but all are pretending that the patient is going to beat the odds and live anyway. Considering the weight American doctors and others place on surviving as a measure of success and competency of a medical professional, this is probably the most frequent occurring context in a medical setting in the United States.

Open Awareness - Everyone knows the patient is going to die and are working towards a “proper” death for the patient. A study in England showed that most of the doctors there preferred this context. Unfortunately, the dying patient usually has no clue what a “proper” death is supposed to be like and often receives less care when they don't act as the medical staff expects them to.

Chapter Six Questions

1) What is hospice care? How does it differ from the treatment given by most acute-care hospitals? Identify the major functions of a hospice program.

Hospice is a form a palliative care, where the main goal is to “care” for the patient and family,while most acute-care hospitals focus almost exclusively on “curing” the patient. Not only are the physical needs considered, but also the psychological, social, financial and spiritual needs. The three primary concerns of hospice care are symptom and pain control, the apprehension caused by having others in control of one's life, and the anxiety about being alone at the time of death.

4) Pain control is not a goal of all dying patients. Discuss the cultural ramifications of controlling pain.

While there really isn't any reason for most dying patients to be in pain with the pain-killing medicines we have available, there are many reasons why some patients would rather deal with the pain than the drugs. One is the worry that the medicine will dull their mental capacity and the patient won't be able to interact with other on a meaningful level because of being sedated. Cultural reasons include beliefs about avoiding drugs, showing strength in the face of the final adversity, and the idea in some cultures that dying in pain means an honorable death. Enduring pain may be considered more natural and acceptable by some patients.

Chapter Seven Questions

2) How does “labeling theory” tend to make one a “deviant“?

It creates a set of accepted “norms” through labeling what is expected and what is not. Anything that cannot be given a normal label, becomes deviant and an area of insecurity for those indoctrinated with the labels.

5) Why do you think the medical schools have traditionally offered very little death education?

Because it runs counter to the overwhelming cultural belief of doctors being able to cure everything and therefore a very uncomfortable subject for many to deal with. After all, doctors help people live. If a doctor helped people die, it might be considered murder. The concept of care versus cure does not exist in most medical schools, so the idea of caring for someone who is dying creates confusion when compared to the rest of the medical education.

Chapter Eight Questions

1) Compare and contrast passive and active euthanasia. What difficulties does implementing each of these approaches have for current social policy dealing with health care for the terminally ill?

Passive euthanasia is allowing someone to die by not implementing measures that could prolong their life. It is legal in most of the technological countries of the world. While many people consider it acceptable and even preferable, there are some who see it as immoral not to do everything possible to sustain life, especially people who place the sanctity of life over the quality of life.

Active euthanasia is when the patient and/or doctor does something to accelerate the dying process. This is illegal in most countries and comparable to suicide or murder. Many fear that taking this path will lead to the slippery slope of a society choosing to euthanize non-terminal people who are not considered useful to that society.

Interestingly, quality of life is more of a concern for those in well-to-do segments of society. People who have had experienced more suffering and discomfort due to living in lower social economic levels tend to care more for the sanctity of life, since for them pain and misery is a common part of life and not a reason to end it.

6) Discuss your reaction to Dr. Timothy Quill's assisting his patient with leukemia, “Diane,” with her death.
Though I probably wouldn't have told her of the Hemlock Society, I'm not exactly appalled at him for giving her medication to do what she did. First off, he gave her directions for how to use the medicine in a non-life threatening way, before telling her the toxic doses. That gave her the chance to use the medicine in another, more acceptable, way. With that education, she could make her own decision. It was also obvious that he would have prefer she tried to stay alive and I believe that was obvious to her too, since she waited several months before finally doing it. And by making her tell him before she did, he made her more accountable for her actions because she couldn't just sneak in her suicide, she had to actually face the reality that she was ending her life.

Though I am a religious person and believe that suicide is wrong, I also believe that how accountable a person is for taking there own life depends on their knowledge and understanding of what they are doing. I also believe that I cannot know for sure how accountable they are and it's not my place to make that decision anyway. I don't condemn the doctor because while he did give her the means, he also gave her a clear knowledge of what she was considering. The was a very good chance that had he not educated her, she would have found another way to overdose herself.


Peggy said...

Interesting questions. I have lived with a chemically addicted person and a terminally ill person. The terminally ill person was so much easier to deal with.

Cosmic Siren said...

Well, for one thing, I would think the dying person is more likely to admit that there is a problem.