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A Good Death? Changing Expectations and Plans Osher Lifelong Learning Institute

A Good Death? Changing Expectations and Plans Osher Lifelong Learning Institute. John Amson Capitman , PhD. Nickerson Professor of Health Policy Central Valley Health Policy Institute California State University, Fresno. A Good Death: Preliminary Outline. Day 1:

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A Good Death? Changing Expectations and Plans Osher Lifelong Learning Institute

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  1. A Good Death?Changing Expectations and PlansOsher Lifelong Learning Institute John AmsonCapitman, PhD. Nickerson Professor of Health Policy Central Valley Health Policy Institute California State University, Fresno

  2. A Good Death: Preliminary Outline Day 1: Overview and Individual Goals Changing Context of Death and Disability Death and Life Review “Recipes” for a Good Death Day 2: Anticipating Long-term Care Needs Caring for Caregivers Living Will: the 5 wishes Long-term Care Insurance

  3. Identifying Individual Goals(answer for self, share in small group) • How often do I think about death, dying, disability? What feelings come up? • What questions do I have about death, dying, disability? What do I want to learn from this program? • How have I been learning about death, dying and disability? (Who? What sources?) What are the main issues I have been examining? What do I feel I have learned enough about and don’t want to explore anymore

  4. Changing Context of Dying • Epidemiological Transition---life course change • Change in nature of death • Change in place of death • Change in cost of death • Increasing costs for health-related services

  5. Death and Life Review • Fear of death: common, overlooked, rarely addressed • Fear of death develops over life course • Fear of death is most often about: • Fear of missed opportunities • Fear for fate of loved ones • Fear of judgment/spiritual doubts • Making the most of life as principal feature of a good death

  6. Death and Life Review (D-I-Y Obituary) • Outside observers would probably say that my main achievements have been ... • For myself, what I am most pleased with and proud of in my life, are ... • One of the most important lessons that I have learnt in my lifetime is that ... • During my life I have used my ... [list three positive personal characteristics, for example: imagination, sense of humour and intelligence] through my ... [list three activities, for example: writing, running groups and parenting] with the underlying vision, I now realise, of helping work towards a world in which, one day, ... [describe your long-term Utopia, for example: 'people are kind and sensitive to each other, nature is at ease and magic is alive']. • The people I have felt closest to in my life have been ... • One generalisation I could make about the quality of my relationships with others is that ... • If I regret anything, it is that ... • If I had known how short a time I had left to live, I would probably have ...

  7. Stages in Grief (Kubler-Ross, 1969) Kubler-Ross famously said, all grief goes through 5 stages • Denial • Anger • Bargaining • Depression • Acceptance Recent research finds: (1) model is culture specific, does not apply for many, (2) even among US/Europe, pattern not upheld

  8. “Recipes” for a Good Death THE FOUR TASKS OF LIVING AND DYING (A Buddhist Perspective) • Understanding and transforming suffering. • Making a connection, healing relationships andletting go. • Preparing spiritually for death. • Finding meaning in life.

  9. “Recipes” for a Good Death • Task #1: Ask For Forgiveness • Task #2: Offer Forgiveness • Task #3: Offer Heartfelt Thanks • Task #4: Offer Sentiments of Love • Task #5: Say Goodbye

  10. ““Recipes” for a Good DeathA medical consensus 1 • To know when death is coming, and to understand what can be expected. • To be able to retain control of what happens. • To be afforded dignity and privacy. • To have control over pain relief and other symptom control. • To have choice and control over where death occurs (at home or elsewhere). • To have access to information and expertise of whatever kind is necessary.

  11. “Recipes” for a Good DeathA medical consensus 2 • To have access to any spiritual or emotional support required. • To have access to hospice care in any location, not only in hospital. • To have control over who is present and who shares the end. • To be able to issue advance directives which ensure wishes are respected. • To have time to say goodbye, and control over other aspects of timing. • To be able to leave when it is time to go, and not to have life prolonged pointlessly.

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