Death and Dying
Death and Dying Issues
How does one define a “good death” for the person whose life has been constrained by disadvantage, or whose imminent death may result, in whole or in part, from societal factors responsible for socioeconomic inequalities or racial or ethnic-based inequalities (Rice, D. Ethics and equity in U.S. health care: The data. Int J Health Serv, 1991;21(4):637-651). Many factors, including cultural and ethnic heritage, determines how one thinks about death and dying, advance directives, hospice, and the concept of a good death. Consequently, it is important for the provider to pay particular attention to these issues as they enter conversations with patients and families about a terminal illness and dying, while at the same time avoiding any temptation to engage in stereotyping by social, racial, ethnic, or cultural categories. This can be achieved by maintaining a focus on the quality of care offered to each individual or family (Talmadge & Wheeler, 2007. Medical Management of Vulnerable and Underserved Patients. NY , NY , McGraw Hill Publisher: pages 225-233).
Death and Dying Interventions
Quality palliative care- the total active medical, psychological, social, and spiritual care of patients who have received a diagnosis of a serious, life-threatening illness-requires a different health care system than the acute care conventional model that is currently dominant. Multiple models of palliative care have emerged in the past decade. Palliative care provisions vary by hospital, ranging from consultative services to fully staffed wards. The funding of these services remains a challenge for most institutions.
Consumer groups have sought to empower patients to participate in decisions regarding their care. The Five Wishes (available through Aging with Dignity) is one such program, developed to encourage patients to address their medical, personal, emotional, and spiritual values with their family and physicians. Perhaps the first step in caring for the dying is for providers to recognize their own mortality and to explore how their different life experiences influence interactions with patients.
Social Issues & Barriers To Care
Facing one’s own mortality is perhaps life’s greatest challenge, on that makes all persons vulnerable to some extent. Despite the success of the hospice movement and advances in the field of palliative medicine, many people are still at risk for physical and existential suffering at the end of life. For those marginalized by social and economic circumstances, illiteracy, or cultural or language barriers, this suffering may be compounded by additional burdens that are equally overwhelming. As a result, end-of-life care goals and priorities for marginalized patients extend beyond clinical concerns and may require providers to act as advocates on behalf of social and economic equity.
Life expectancy among vulnerable persons is generally lower than for more privileged counterparts (Anderson & Smith. Deaths: Leading causes for 2001. National Vital Statistics Report 2003;52(9):9).
The elderly, poor, and other vulnerable persons are at greater risk of their pain being misdiagnosed, inadequately addressed, or poorly managed (Bureau of National Affairs. California : jury decides undertreatment of pain was elder abuse, sets $1.5 million damages. BNA Health Law Report 2001;982(June 21):10).
Death & Dying Resources
Hospice Haven – 352-378-2121
Elder Helpline– 800-262-2243
Elder Care of Alachua County– 352-265-9040
As many as 80% of all U.S. deaths occur in hospitals despite the emergence of the popularity of dying at home through hospice and home healthcare.
In New York, NY, USA, more people commit suicide than are murdered, yet the news are filled with reports of deaths by murder.
People with diabetes have the same high risk for heart attack or stroke or cardiovascular death as people who’ve already had a heart attack, researchers reported in Circulation: Journal of the American Heart Association.
Did you know that the USA does not classify “old age” to be a cause of death although dying of old age is very common?