1. DEATH & DYING Lecture Outline Where we’ve been, Where we are, and Where we are going What is dying like? –Elizabeth Kubler-Ross’s 5 stages Attitudes on dying Pharmacist’s role

2. Where We Have Been Infectious disease and epidemics No life sustaining measures Shorter life span –Less chronic diseases Process of dying shared by entire family –patients died and were waked at home Sums up to people having more experience around death

3. Today & Tomorrow Kept alive –Life span continues to increase –Medical advances Lab diagnosis & drugs have replaced support, concern & counseling More chronic diseases Patients treated and die in medical facilities Most serious of health problems are not solved by medical science Quality of life becomes an issue –death with dignity Less experience with dying process and coping

4. Attitudes on Death Ranges from little concern (finite nature of life) to overreaction process Medical profession focuses on “cure” and often overlooks “care” of patients Majority of research is in maintenance & regaining of good health –do we want to prolong life or diminish human suffering?

5. 5 Typical Stages by Dr. Ross Denial Anger Bargaining Depression Acceptance

6. DENIAL Initial reaction of “No, not me, it cannot be true” and/or “the X-rays must have gotten mixed up Buffer period during which the patient prepares his/her emotional defenses Periods of denial may re-appear at later stages of illness Valid defense and never force information on a patient until they are ready

7. ANGER Involves feelings of rage, resentment, envy, and bitterness Reaction to the seemingly “injustice” of the disease, loss of control, and pain Often displaced and projected to family, friends, and health care professionals Result is often avoidance and/or criticism from others

8. BARGAINING Brief attempt to postpone the inevitable Often kept a secret –may relate to religious or spiritual beliefs – retribution for previous failings –may manifest in feelings of guilt If a patient suggests such an approach, acceptance and discussion is helpful

9. DEPRESSION Occurs when denial is no longer possible Natural process of preparatory grief and mourning Often withdrawn an isolated Result of hospitalization, surgery, symptoms, financial burdens, loss of self- esteem, and loss of independence Need support & understanding

10. ACCEPTANCE Depression and anger no longer present Calm, peaceful, and comfortable, but not necessarily a happy phase Circle of interest, and communication diminishes “the final rest before the long journey” Often time when family needs help and support

11. Pain Management Many don’t fear death, they fear dying in pain Pain may be excruciating Anxiety and depression may accompany chronic pain Obey controlled substance laws, but be helpful and accommodating

12. Pharmacist’s Role Be supportive of patient’s and family members –Replace feelings of frustration and helplessness with openness, education and communication Be ready to listen Recognize patient’s fear Be ready to give explanations

13. Pharmacist’s Role (continued) Aware of local support groups Empathy –explore your feelings & beliefs –realize it is a natural and finite nature of life Read, think and talk to other colleagues & patients about the dying process Can not always “cure”, but you can always provide “good care”