4th Global Conference
Wednesday 12th July - Friday 14th July 2006
Mansfield College, Oxford
Session 6A: Preferences - Managing
Dying and Professional Settings
Chair: Carol Komaromy
Older People's Preferences at the End of Life: A Review of the Literature
Eileen
Sutton and Joanna Coast
MRC, Health Services Research Collaboration, University of Bristol, and
University of Birmingham, United Kingdom
Death is now most likely to occur at the end
of a long life and the recent growth in hospice and palliative care services
has drawn attention to the importance of quality of death and dying,
in addition to quality of life, in old age. Questions around how to separate,
or measure quality of death, rather than quality of life, have been raised. Is
there a particular point in time when people can be regarded as being “actively
dying”, and is this dependent upon the “dying trajectory” or
perceived course of a particular disease or condition?
A review of the literature on older people’s preferences for care
at the end-of-life revealed three main areas of focus: treatment decisions,
place of care/death and good death (quality of care/dying). However,
there is some evidence of a cultural variation in research focus. Whilst
much of the research on treatment preferences originates from the US,
where advanced care statements are more popular, research on place of
care tends to have been carried out in the UK.
Studies present conflicting evidence on the impact of socio-demographic
variables such as age, gender, religiosity and ethnicity on treatment
preferences and preferred place of care/death, and there are indications
that patient choice may be service-led, with older people’s preferences
tempered by personal circumstances such as the availability of informal
care, the existence of local service provision, and awareness of this
provision. Although it is difficult to disentangle the relationship between
age, health status and the dying experience, it would appear that there
may be certain features of a good death that remain constant.
This paper presents evidence from a review of 60 studies looking at older
people’s preferences at the end of life which were published between
1995 and 2005, and highlights the potential for future research in this
area.
Religion and Medicine in the Process of Managing
Death and Dying: The Case of Hospice Circle in Poland
Malgorzata
Zawila
Jagiellonian University,
Krakow, Poland
Religion and medicine are both very meaningful phenomena
when considering death and dying. They can be understood as important
elements constructing social
attitudes toward death and dying as well as factors helpful in the process
of managing the individual with death and dying. The question of place
and role of religion and medicine in the context of attitudes toward
death and dying is important especially in the conditions of medicalization
and secularisation on one hand and the New Age movement and growth of
spirituality on the other.
In the context of the processes mentioned
above (medicalization, secularisation) religion and medicine are often
understood as opposite to each other. According to some sociologists
(T. Walter) and historians (P. Aries) in the XX century the place and
role of religion in handling the death and dying takes medicine. In my
opinion it is worth to raise the question of this process once more nowadays, in
the XXI century.
The paper focuses mainly on the results of the research
conducted, in three Polish hospices, on the patients, their relatives
and the staff. The main research goal was to study attitudes toward death
and dying among the hospice circle. The method chosen for analysis was
Grounded Theory. Initial analysis of the empirical material gathered
during the research allows to treat medicine and religion as complimentary
and not opposite to each other, when attitudes toward death and dying
are considered.
"Fear of Feeling": Working on Death and
Dying and Professional Settings
Jeremy
A. Weinstein
London South Bank University
There have been consistent concern about
the support professionals need when working with difficult emotional
situations, such as loss, death and bereavement. Within health care
settings, Menzies Lyth (1961) analysed the ways hospitals defend their
nurses against anxiety while recent research repeatedly documents bad
practice around ‘breaking bad news’ (e.g.
Danbury, 1996). Nurland, as a brother of a terminally ill patient, refers
to doctors who were ‘untouchably aloof and self absorbed … too
distanced from the truth of their own emotions to have any sense of ours’ (1994:
226).
It seems, then, that bereavement and bureaucracy do not easily
co-exist. Schools struggle to find the emotional and organizational resources
to manage the deaths of pupils while in social work a death, in child
protection cases or mental health settings, means that workers and organizations
alike retreat into a defensive posture in the face of the inquiry culture.
Although recent writings emphasize the importance of recognizing and
working with ‘vicarious trauma’ (Raasmussen, 2005) other
writers, (see Cooper and Lousada, 2005), argue that a ‘fear of
feeling’ lies deep within the culture of modern state welfare.
This
paper moves from this wider perspective to a sharper focus on the presenter’s
own research into how two professional groupings cope with the difficult
issues that arise around loss. The first group consists of counsellors,
both trainees and experienced practitioners, who are asked about the
impact of their own personal experiences of bereavement on client work.
The second, ongoing, study focuses on social workers in a variety of
settings, statutory and voluntary, child care and mental health. It asks
difficult questions about the stories professionals tell about their
work and the support they need to find containment.
© Inter-Disciplinary.Net 2006