On the dynamics of dying

This study is concerned with dynamic processes that underly the rapid, degenerative changes associated with the “dying” stage of the multicellular organism's life cycle. The interaction between negative and positive feedback cycles is discussed: negative feedback cycles underly the superstability characteristic of health and illness. When negative feedback cycles fade in the dying phase of life, positive feedback cycles, previously held in check by the negative feedback cycles to which they had been coupled, rise explosively, driving physiologic variables from their normal values towards extremes. This results in the rapid downturn that we associate with dying—an accelerating disintegration terminating in death. A medical case history is analyzed.     

Conversation Orientation Moderates the Relationship between Information Sharing of Medically Assisted Reproduction and Child Adjustment

Parents who experienced infertility have increasingly used medically assisted reproduction (MAR) to add children to their families over the past few decades. These parents will need to decide if they will tell their children about being conceived using MAR. Although MAR information sharing operates within family contexts, little is known about the role of conversation orientation—one family contextual factor—in child outcomes associated with MAR information sharing in middle childhood. Derived from the Family Communication Patterns Theory, this study proposes that conversation orientation moderates the associations between MAR information sharing and children's psychosocial adjustment. This proposal was tested using a sample of 81 6- to 12-year-old MAR-conceived children from 55 families and a structured observational measure of conversation orientation. Multiple regression analyses showed that MAR information sharing interacted with conversation orientation to influence children's behavioral and attention problems but not emotional problems. In families with high conversation orientation, MAR information sharing was not significantly associated with children's behavioral and attention problems. In families with low conversation orientation, MAR information sharing was significantly associated with an increase in children's behavioral and attention problems. Results of this exploratory study demonstrate the potential significance of general communication orientation in understanding child outcomes of MAR information sharing and highlight the needed family context nuances in MAR research.     

Touching Mortality, Touching Strength: Clinical Work with Dying Patients

This paper outlines some of the special stresses that must be shouldered by clinicians—physicians, nurses, chaplains, social workers, pastoral staff, and others—whose work focuses on dying and extremely vulnerable patients. The utility of a theory of generative death anxiety as a framework for interpreting the nature of these special stresses is suggested. Three common burnout reactions are examined. The paper concludes that positive acceptance of personal mortality may help clinicians avoid burnout and lead to better therapeutic practice. This framework for interpreting therapeutic practice demonstrates the integral role spirituality plays in work with this particular patient group.     

Ronald Dworkin on Abortion and Assisted Suicide

In the first part of this article, I raisequestions about Dworkin's theory of theintrinsic value of life and about the adequacyof his proposal to understand abortion in termsof different ways of valuing life. In thesecond part of the article, I consider hisargument in ``The Philosophers' Brief on AssistedSuicide', which claims that the distinctionbetween killing and letting die is morallyirrelevant, the distinction between intendingand foreseeing death can be morally relevantbut is not always so. I argue that thekilling/letting die distinction can be relevantin the context of assisted suicide, but alsoshow when it is not. Then I consider why theintention/foresight distinction can be morallyirrelevant and conclude by presenting analternative argument for physician-assistedsuicide.     

L’avis du CCNE no 126 (15 juin 2017) sur les demandes sociétales de recours à l’assistance médicale à la procréation : un pas en avant et deux en arrière…

On June 15, 2017, the National Consultative Ethics Committee released an opinion in favour of the extension of medically assisted procreation (MAP) to lesbian couples and single women. This opinion recommends a reversal of the medical model, which serves as the starting point for the regulatory framework concerning MAP, and expresses its support to social and family evolutions. Nonetheless this liberal and progressive stand could be a mere smokescreen, if it does not result in any meaningful implementation due to practical hindrances; moreover, this seemingly progressive stand could be questioned in view of the conservative position expressed on the issues of surrogacy and oocyte self-preservation by the committee in the same opinion.     

Fears of death and fears of dying in the counter-transference

It is commonplace for people to say they are not afraid of death but they are afraid of dying. I discuss unconscious aspects of fears of dying and fears of death which are revealed in counter-transference experiences in therapy with people suffering from terminal illnesses and with older people. Studying the counter-transference shows that fears of dying, which usually refer to lingering and disabling illnesses, unconsciously are linked with fears of dependency and the apprehension that if one becomes dependent then no-one will want to look after you. This apprehension is often a residue of failures in the early dependency relationship which can be re-enacted in adult life through projective identification when therapists and carers may be induced to abandon the caring role. Despite the ubiquitous denial, fears of death surface in the counter-transference, often obliquely but always with a particular terror for the survival of the self. This unconscious terror confirms Freud’s insight about the denial of death that what is unthinkable is the annihilation of the self. I conclude with a discussion about the importance of setting an ending date in therapy with those who are old or terminally ill.     

A Narrative Analysis of Sibling Grief

Sibling grief is linked to serious physical and mental health outcomes, yet remains the least researched of all family bereavement. This exploratory study created a shared sibling grief narrative. Open-ended interviews were conducted with 27 participants who lost a sibling. Primary themes included Shared Life: Identity Within the Sibling Arrangement; Sibling Death: Pivotal Moments in Time; Life After Sibling Loss: Emotional Suffering, Life After Sibling Loss: Missing Roles & Changing Relationships; and The Sibling Lives On. The following study findings clarify the overlooked impact that sibling death has on the surviving sibling and demonstrate the crucial need for more sibling loss research.     

The ‘Connection’ Health Care Providers Make with Dying Patients

SUMMARY

The literature confirms illness and hospitalisation can become spiritual encounters for patients and their families. Further, it has been established that both patients and their families are better equipped to deal with loss and change if they have a healthily developed spiritual sense of self. The aim of the study sought to determine the benefit or otherwise of a previous model of spiritual care. It asked ‘from the perspective of the nurse and other health care providers, what constitutes spiritual care giving?’ An ethnography was undertaken where data consisted of field notes, interviews, records, and diary entries. This paper reports on interview data, from which themes were derived. The major theme titled their space is expressed via a new model of spiritual care. It was shown that when caring for patients and their relatives, nurses and other health care professionals enter the world of the other to determine the other's needs. In so doing they typify agapé (altruistic love), where the individual cares for a complete stranger as if that stranger were family. This connection with the patient and their family is the foundation for spiritual care.     

Duke University's Program on Religion,Aging, and Health

ABSTRACT

Assisted living facilities (ALFs) offer a level of care between independent living and nursing homes. Recently researchers have begun to explore quality-of-life issues concerning residents of ALFs. Considerable research suggests that religion is positively associated with both emotional and physical health. This study examines how residents use religious practices to cope with the challenges of life in ALFs. Qualitative analysis of in-person interview data from 55 residents of ALFs revealed a variety of religious practices, such as prayer, church attendance, and Bible reading. Most residents deemed religion important and reported that religious practices provided a framework for coping with problems. Coping ranged from the mundane (e.g., attending a gospel concert to offset the otherwise dull routine of the home) to the transcendent (e.g., enlisting the support of an omnipotent ally in the face of adversity). Six ways residents utilized religion as a coping mechanism emerged. Residents used religion to maintain continuity with their previous lives; to obtain relief from physical or emotional pain; to provide a framework for socialization; to develop courage; to maintain a purpose for their lives; and to prepare for death. Suggestions for enhancing the quality and variety of religious activities within ALFs are offered.