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An overview of the article on the fear of death by elisabeth kubler ross

Swiss psychiatrist Elizabeth Kubler-Ross described five normative stages of grief faced by someone who is dying: However, neither patients with end-stage illness nor their families necessarily experience these stages sequentially or one by one, and they may experience myriad related emotions including guilt, desperation, hope, powerlessness, and despair. The current health care system often provides inadequate time and space to acknowledge or validate these emotions.

It is not uncommon for patients and families to never reach the last stage acceptancewhich robs them of an opportunity to take advantage of their final moments with a loved one in a peaceful, dignified way.

Because patients and families have not thought about or discussed death, they are ill-equipped to manage it. In many ways, the health care system places unfair demands on patients and families. Society lulls the public into believing death is optional. Having never planned for the dying process, families are asked to make time-pressured decisions regarding artificial nutrition and hydration, intubation, and withdrawal of life support. Again, this can lead to care demands that physicians, given their medical knowledge, training, and experience deem futile.

Health care professionals may even become angered by requests they perceive as placing undue burden on patients and prolonging suffering and, in fact, it may actually be doing so. Frustration is often part of this decision-making process and may lead to disagreement and dissatisfaction with the health care professionals involved Baker et al.

What must be remembered is that patients and families, by definition, are vulnerable. They may never have considered these issues before, and even if they have, they may not have discussed them with their physicians or each other.

They are often unfamiliar with the medical literature regarding the treatments they are choosing, and may never have been asked to make such life and death decisions about their treatment plans. Navigating the medical system is often intimidating for patients and families, especially the frail elderly for whom chronic illness can be confusing and frightening. Further, many patients have limited insight into their disease processes.

When hospitalized, patients are often made to feel marginalized. They are given tests, procedures, and treatments they may not understand. The flow of information tends to be impersonal and either inadequate or unidirectional, i.

  1. Emotion cannot be separated from end-of-life care. Having never planned for the dying process, families are asked to make time-pressured decisions regarding artificial nutrition and hydration, intubation, and withdrawal of life support.
  2. If handled poorly, communication can break down, which can ultimately lead to poor preparation for the end of life.
  3. This case exemplifies the limbo where an acutely ill patient winds up on a ventilator and family is forced to make an immediate decision, often over the course of merely hours or days, about how to handle the situation.
  4. Clinical psychologists could be enormously helpful members of the health care team but they are rarely found in the inpatient setting where much of end-of-life care currently takes place. This case exemplifies the limbo where an acutely ill patient winds up on a ventilator and family is forced to make an immediate decision, often over the course of merely hours or days, about how to handle the situation.
  5. But rarely do physicians criticize patients or family for being carried away by reason.

But some families may not even understand the concept of advance directives. The fact that decisions by surrogates are not supposed to be what they want for the patient but rather what the patient would want for him or herself is a subtle but important distinction that clinicians must make clear.

However, it was also important to consider her perspective, even though she technically was not the patient. Suppose no one had ever addressed with her or her husband the inevitable worsening of his chronic disease and its prognosis.

Related terms:

Suppose he had made his living will many years before his illness and the couple never had a meaningful discussion about it. This case exemplifies the limbo where an acutely ill patient winds up on a ventilator and family is forced to make an immediate decision, often over the course of merely hours or days, about how to handle the situation.

But rarely do physicians criticize patients or family for being carried away by reason. Emotion cannot be separated from end-of-life care. Yet many physicians and the very design of U.

Clinical psychologists could be a great asset in maintaining clarity. Every patient—family dyad interacts differently with the health care system and some feel more empowered or engaged than others. While patient and family empowerment is ostensibly positive, physicians are often chagrined by the onslaught of online articles eager families and patients print and bring to physicians, with hope that they have somehow found a cure for their illness.

If handled poorly, communication can break down, which can ultimately lead to poor preparation for the end of life.

Kübler-Ross model

Current health care reform and policymakers are turning to quality metrics and further implementation of electronic medical records as possible methods to enhance patient care. However, such transitions are difficult, and recent changes have spurred patients and physicians alike to feel more time is spent on paperwork and interfacing with a computer screen than with each other Ogden et al.

  1. However, it was also important to consider her perspective, even though she technically was not the patient.
  2. However, such transitions are difficult, and recent changes have spurred patients and physicians alike to feel more time is spent on paperwork and interfacing with a computer screen than with each other Ogden et al.
  3. The flow of information tends to be impersonal and either inadequate or unidirectional, i. They may never have considered these issues before, and even if they have, they may not have discussed them with their physicians or each other.
  4. If handled poorly, communication can break down, which can ultimately lead to poor preparation for the end of life.

Clinical psychologists could be enormously helpful members of the health care team but they are rarely found in the inpatient setting where much of end-of-life care currently takes place. As noted, better integration could bridge divides, bolster communication, and offer emotional support to patients, families, and health care team members.

As illustrated in this chapter, high quality care provision at the end of life is challenged by medical, societal, and systemic barriers. Underlying these obstacles is the profound, uniquely human, psychological discomfort of confronting mortality.

This chronic symptom of the human condition is unlikely to abate. Therefore, integration with those most trained to understand and manage these concerns certainly seems indicated.