CH-10-12 Life After Loss: Bereavement, Grief, and Mourning – Death, Dying and Bereavement in a Changing World : Exam Guide

This Document Contains Chapters 10 to 12 Chapter 10: Life After Loss: Bereavement, Grief, and Mourning Test Questions Part I. Multiple Choice Questions Select the response that best answers the following questions. 1) The response to the loss of a close personal relationship is best described as __________. A) mourning B) bereavement C) grief D) depression Answer: B 2) __________ is a reaction to bereavement. A) Grief B) Mourning C) Anxiety D) Memory loss Answer: A 3) The process that survivors go through after experiencing loss is called __________. A) than to logy B) bereavement C) grief D) mourning Answer: D 4) Difficulty performing social roles is an example of a(n) __________ manifestation of grief. A) spiritual B) social C) emotional D) cognitive Answer: C 5) Shock, sadness, anger, relief, guilt, anxiety, and numbness are __________ manifestations of grief. A) emotional B) physical C) social D) spiritual Answer: A 6) After his wife died, Larry began attending counseling sessions to confront and deal with his loss. What is Larry doing? A) loss work B) cultural mourning C) than to logical work D) grief work Answer: D 7) What scholar defined and explained the term ‘grief work’? A) Ross B) Bowlby C) Freud D) Durkheim Answer: C 8) The broken bonds theory uses __________ as a key concept to help explain the interpersonal dimension of grief. A) intensive caring B) attachment C) bereavement D) mourning Answer: B 9) In his work, Parkes identifies __________ phases of grief that ebb and flow as the process unfolds. A) three B) five C) seven D) twelve Answer: A 10) It has been a year since Jenny became a widow. After going through an intense grieving process Jenny feels like she has adjusted to the loss of her partner and relearned how to live alone on a day-to-day basis. What outcome of grief would Parkes likely say Jenny experienced? A) pathological grief B) normal grief C) complicated grief D) chronic grief Answer: B 11) __________ help explain individual variation in completing the universal tasks of mourning. A) Mediators of mourning B) Mourning ambiguities C) Intercepts of grief D) Moderators of bereavement Answer: A 12) There is no widely accepted cultural word used to describe loss of a relationship from death for __________. A) husbands who lose a wife B) children who lose a parent C) wives who lose a husband D) parents who lose a child Answer: D 13) The first ‘task of mourning’, or the mourning work individuals do, is __________. A) emotionally relocate and move on with life B) adjust to an environment in which the deceased is missing C) accept the reality of loss D) work through the pain and grief Answer: C 14) The kind of loss generally experienced after a lengthy illness is __________ loss. A) sudden B) expected C) planned D) immediate Answer: B 15) __________ refers to grieving that begins in anticipation of someone’s death. A) Planned bereavement B) Sudden grief C) Anticipatory grief D) Disequilibrium Answer: C 16) Since the suicide of his brother Robert has had a difficult time coming to terms with loss. At times Robert feels guilty and angry at himself for not having a better relationship with his brother while he was alive. He feels that he had unfinished business with his brother. What type of delayed grief is Robert most likely experiencing? A) conflicted B) chronic C) dependent D) normal Answer: A 17) The process of __________ varies according to cultural context. A) libido B) expected loss C) mourning D) science Answer: C 18) Who did Bonanno and colleagues study in his exploration of grief patterns and trajectories? A) children who lost siblings B) parents who lost children C) widows and widowers D) children who lost parents Answer: C 19) What religious tradition is widely practiced by the Japanese? A) Hinduism B) Christianity C) Islam D) Buddhism Answer: D 20) In Japanese cultural traditions the __________ are considered to be the spirits closest to the living. A) shirei B) senzo C) hotoke D) kami Answer: A 21) Los Dias de Muertos and O Bon are holidays that celebrate the __________. A) end of a war B) spirits of ancestors C) new year D) current political leader Answer: B 22) The back and forth process of confronting and avoiding dealing with grief is called __________. A) oscillation B) bereavement C) respite D) broken bonds Answer: A 23) In the __________ model of coping following the death of a loved one, bereaved people often alternate between two different types of coping. A) loss-oriented B) dual-process C) restoration-oriented D) chronic grief Answer: B 24) To really embrace diversity, as a culture we must reject __________. A) politics B) capitalism C) rituals D) universals Answer: D 25) Grief and mourning are processes that occur in response to __________. A) anticipatory loss B) cultural change C) bereavement D) hospice care Answer: C Part II. Essay Questions Answer the following questions in your own words. 1) What does it mean to say that grief is a unique experience? In your essay, explain some of the various ways grief can manifest itself for individuals and how this framework can be used to better understand the experience of grief. Answer: Grief is a deeply personal and unique experience, as it is influenced by a variety of factors including the nature of the loss, the individual's relationship to the person or thing lost, and their personal coping mechanisms and support systems. This uniqueness is reflected in the diverse ways grief can manifest itself in individuals. Firstly, grief can manifest emotionally, leading to feelings of sadness, anger, guilt, or even relief, depending on the circumstances of the loss. These emotions may fluctuate over time and can be triggered by reminders of the loss. Secondly, grief can manifest physically, resulting in symptoms such as fatigue, changes in appetite, insomnia, or even physical pain. These physical manifestations can be a result of the stress and emotional turmoil associated with grief. Thirdly, grief can manifest cognitively, impacting a person's ability to concentrate, make decisions, or remember things. This can be particularly challenging as it can affect a person's daily functioning and quality of life. Lastly, grief can manifest behaviorally, leading to changes in a person's behavior such as social withdrawal, irritability, or engaging in risky behaviors. These behavioral changes can be a way for individuals to cope with their grief or express their emotions. Understanding grief as a unique experience can help us better support individuals who are grieving. By recognizing that grief can manifest in different ways for different people, we can offer more personalized and effective support. This framework also emphasizes the importance of allowing individuals to grieve in their own way and at their own pace, without judgment or pressure to "move on" from their loss. 2) Discuss the concept of ‘grief work.’ What is it? How is it accomplished? How might it vary for individuals? How has the concept been critiqued/criticized by scholars? Answer: The concept of "grief work" refers to the process through which individuals actively engage with and work through their grief in order to come to terms with a loss and eventually adjust to life without the lost person or thing. This concept was popularized by psychiatrist Elisabeth Kübler-Ross in her influential book "On Death and Dying," where she outlined the five stages of grief (denial, anger, bargaining, depression, and acceptance) as part of the grief work process. Grief work is accomplished through various means, including: 1. Emotional expression: Allowing oneself to feel and express the emotions associated with grief, such as sadness, anger, guilt, and despair. 2. Cognitive restructuring: Making sense of the loss and its impact on one's life, often through reflection, storytelling, or finding meaning in the experience. 3. Behavioral adjustments: Adapting to life without the lost person or thing, which may involve changing routines, roles, or relationships. 4. Social support: Seeking and receiving support from others, which can provide comfort, validation, and a sense of connection. 5. Memorializing: Finding ways to remember and honor the lost person or thing, such as through rituals, memorials, or creative expressions. Grief work can vary widely for individuals based on factors such as their personality, coping style, cultural background, and the nature of the loss. Some individuals may engage in grief work more actively and openly, while others may have a more private or internalized process. Additionally, the intensity and duration of grief work can vary, with some individuals experiencing prolonged or complicated grief that may require professional intervention. Critiques of the concept of grief work have been raised by scholars and clinicians, particularly in the context of its perceived normative or prescriptive nature. Critics argue that the concept of grief work implies that there is a "right" or "normal" way to grieve, which can be harmful to individuals who may have unique or non-conventional grieving styles. Additionally, the concept has been criticized for its potential to pathologize grief, suggesting that grief should be overcome or resolved within a certain timeframe. Despite these criticisms, the concept of grief work remains a valuable framework for understanding the process of grieving and can provide guidance for individuals and professionals seeking to support those who are grieving. 3) Explain how ancestor worship occurs in Japanese culture. Specifically, explain the various names for the deceased in the spirit world. Answer: In Japanese culture, ancestor worship, known as "kōrei," is a deeply rooted practice that honors and respects deceased ancestors. This practice is based on the belief that ancestors continue to influence the lives of their descendants and should be revered and remembered. One aspect of ancestor worship in Japan is the belief in the spirit world, which is often referred to by various names depending on the stage of the deceased's journey. Here are some of the names commonly used: 1. Mitama: This term refers to the spirit or soul of the deceased. It is believed that the mitama remains connected to the living world and can influence the lives of descendants. 2. Goryō: Goryō are vengeful spirits of the deceased who have not been properly appeased or respected. They are believed to bring misfortune or illness to their descendants until they are appeased through rituals or offerings. 3. Shinrei: This term broadly refers to spirits or ghosts, including both benevolent and malevolent spirits. Shinrei are believed to exist in the spirit world and can interact with the living world. 4. Reikon: Reikon refers to the spirit or soul of the deceased, particularly in the context of Buddhist beliefs. It is believed that the reikon undergoes a journey after death, eventually reaching a state of enlightenment or rebirth. 5. Bukimi no tani: This term, which translates to "valley of eerie sights," refers to a place in the spirit world where the deceased may reside. It is often depicted as a dark, eerie place where spirits linger. Ancestor worship in Japanese culture often involves rituals and ceremonies to honor and appease the spirits of deceased ancestors. These rituals may include offerings of food, drink, and incense, as well as prayers and chants to communicate with the spirits. Ancestor worship is not only a way to honor the past but also a means of seeking guidance, protection, and blessings from ancestors for the present and future. 4) What aspects of contemporary Western life stifle the process of survivors coming together to share the stories of a recently deceased person’s life that, in a sense, ‘recreate’ the person’s biography? How, if at all, are these characteristics different in non-Westernized cultures? Answer: Contemporary Western life presents several challenges that can stifle the process of survivors coming together to share the stories of a recently deceased person's life and "recreate" the person's biography. Some of these aspects include: 1. Individualism: Western societies tend to emphasize individualism, which can lead to a focus on personal achievements and experiences rather than collective memories or narratives. This can make it less common for survivors to come together to share stories and create a collective biography of the deceased. 2. Busy lifestyles: Western societies often have fast-paced and busy lifestyles, which can leave little time for extended gatherings or storytelling sessions. This can make it difficult for survivors to find the time and space to come together to share stories and memories. 3. Geographic mobility: Many Western societies are characterized by high levels of geographic mobility, with individuals often moving away from their hometowns or family members. This can make it challenging for survivors to physically come together to share stories and memories, especially if they are scattered across different locations. 4. Digital communication: While digital communication technologies can facilitate sharing stories and memories, they can also have a paradoxical effect by reducing the need for face-to-face interaction. This can make it easier for individuals to share stories and memories but can also result in more fragmented and isolated forms of communication. 5. Cultural norms around grief: Western societies often have specific cultural norms around grief, such as the expectation to grieve privately or to "move on" from loss quickly. These norms can discourage survivors from coming together to share stories and memories, as they may feel pressure to conform to these expectations. In contrast, non-Westernized cultures may approach the process of sharing stories and memories of the deceased differently. Non-Western cultures often place a greater emphasis on communal and collective experiences, which can lead to more opportunities for survivors to come together to share stories and create a collective biography of the deceased. Additionally, non-Western cultures may have different cultural norms around grief, which can encourage survivors to engage in more public and communal forms of mourning and remembrance. 5) Explain the four possible roles played by deceased loved ones in the lives of survivors. How, if at all, do any of these roles help explain the attachments survivors have to a lost loved one? Answer: The four possible roles played by deceased loved ones in the lives of survivors, as outlined by grief researcher Robert Neimeyer, are: 1. Continuing bond: In this role, the deceased is seen as continuing to exist in some form and maintaining a relationship with the living. Survivors may feel a sense of ongoing connection and communication with the deceased, seeking comfort and guidance from them. 2. Integrated presence: Here, the deceased is integrated into the survivor's ongoing life and identity. Memories and experiences shared with the deceased become a part of the survivor's narrative and sense of self, contributing to their personal growth and understanding. 3. Mourning remains: This role involves the physical, emotional, or symbolic remnants of the deceased that are kept or preserved by the survivor. These remnants serve as tangible reminders of the deceased and can provide comfort and a sense of closeness. 4. Reconciliation of loss: In this role, the survivor works to reconcile the reality of the loss with the ongoing presence of the deceased in their life. This involves accepting the finality of the loss while also acknowledging the continued impact and influence of the deceased. These roles help explain the attachments survivors have to a lost loved one by highlighting the ongoing nature of the relationship between the living and the deceased. By maintaining a continuing bond, integrating the deceased into their identity, preserving memories and mementos, and reconciling the loss, survivors are able to keep the connection to the deceased alive in meaningful ways. These attachments can provide comfort, support, and a sense of continuity in the face of loss and can help survivors find meaning and purpose in their grief journey. Chapter 11: When Grief Goes Awry: Complicated Grief Test Questions Part I. Multiple Choice Questions Select the response that best answers the following questions. 1) Loss that is experienced severely for a longer period of time than normal is referred to as __________. A) sudden grief B) complicated grief C) bereavement D) mourning Answer: B 2) __________ was the first modern grief expert to raise concerns about the possible health consequences of complicated grief. A) Parkes B) Freud C) Bonanno D) Lindemann Answer: A 3) Researchers feel it is important to distinguish complicated grief from __________. A) major depression B) anxiety disorder C) social bereavement D) chronic grief Answer: A 4) Scholars have advocated for bereavement-related disorders to be included in __________. A) medical directories B) bereavement counseling C) the DSM-V D) the APA manual Answer: C 5) After the death of her favorite movie star Stacey was ridden with grief. She found her family and friends to be unsupportive in helping her cope with her feelings of loss. They constantly told her she was being ‘too hysterical’ mourning for someone she didn’t even know personally. What type of grief is Stacey likely experiencing? A) chronic grief B) sudden grief C) PTSD grief D) disenfranchised grief Answer: D 6) While working with 100 bereft families after the Coconut Grove fire in Boston, Lindemann and colleagues identified __________. A) four styles of mourning B) six key traumatic grief reactions C) twenty two survivors D) two key elements of grief Answer: B 7) Somatic grief is characterized by __________. A) bodily distress B) preoccupation with an image of the deceased C) hostility D) taking on characteristics of the deceased Answer: A 8) When a person experiences a(n) __________ they may develop post-traumatic stress disorder. A) brain injury B) traumagenic event C) complicated grieving process D) acute feeling of distress Answer: B 9) Individuals with PTSD often experience nightmares and flashbacks; also referred to as __________. A) intrusive reexperiencing B) somatic response C) hostility D) traumagenic events Answer: A 10) According to DSM-IV-TR, __________ is when a person develops short-term anxiety, dissociative, or other symptoms as a result of experiencing trauma. A) post-traumatic stress disorder B) acute stress disorder C) avoidance D) somatic response Answer: B 11) When a person experiences a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment they are experiencing __________. A) a complicated grieving process B) hyperarousal C) a traumagenic event D) a dissociative disorder Answer: D 12) Sandy could not remember the day that her car accident resulted in her brother’s death. She is likely to be experiencing __________. A) depersonalization disorder B) dissociative fugue C) dissociative identity disorder D) dissociative amnesia Answer: D 13) A treatment for PTSD that progressively helps an individual confront distressing thoughts and memories called __________. A) disclosure therapy B) exposure therapy C) virtual reality therapy D) stress inoculation therapy Answer: B 14) What is the most common approach used to treat dissociative disorders? A) individual psychodynamically oriented psychotherapy B) exposure therapy C) stress inoculation therapy D) dissociative amnesia Answer: A 15) Research suggests that the difference between a survivor experiencing separation distress and traumatic distress is __________. A) traumagenic event exposure B) dependent on personal mental health C) mourning process variation D) the cause of the deceased’s death Answer: D 16) Parkes points out that chronic complicated grief is largely caused by __________. A) traumatic stress B) denial of the deceased C) excessive dependency on the deceased D) numbness and anger Answer: C 17) The yearning of chronic grief tends to be focused on one thing: _________. A) finding the lost beloved B) suicide C) forgetting the lost loved one D) returning to normalcy Answer: A 18) When grief is not openly acknowledged, socially accepted, or publically mourned it is referred to as __________. A) attachment theory B) an interpersonal factor C) disenfranchised grief D) a personal risk factor Answer: C 19) In her study of terminally ill gay men and their partners, Folkman identified a problem-oriented focus, positive reappraisal, and using religious/spiritual beliefs to cope with death as __________. A) positive forms of coping B) negative forms of coping C) dissociative disorders D) disenfranchised grief Answer: A 20) The multidimensional process whereby one restructures one’s self, relationships, and world to the reality of loss is referred to as __________. A) grieving B) bereavement C) coping D) PTSD Answer: C 21) Complicated grief treatment has a two-pronged approach that focuses on __________ and __________. A) the bereft, the deceased B) guiding the patient’s focus on the loss, rebuilding life C) using psycho-pharmaceutical therapy, intensive psychotherapy D) changing the relationship to the deceased, to others Answer: B 22) Neimeyer and his colleagues believe that complicated grief is mediated by __________. A) how we find meaning in our experiences of grief B) how our grief is acknowledged by others C) how the deceased died D) when the grieving process begins Answer: A 23) The dual process grief model demonstrates that healthy coping is a process in which people deal with their grief by using a strategy that __________. A) alternates between counseling and wellness therapies to deal with grief B) alternates between avoidance and ignoring therapies to deal with mourning C) focuses on many approaches that are fused into one plan for dealing with grief D) alternates between using avoiding and confronting strategies to deal with grief Answer: D 24) Narrative therapy in counseling involves __________. A) storying B) therapeutic instruction C) journaling D) group sessions Answer: A 25) Therapy focused on caring for and being there with the client is referred to as __________ therapy. A) palliative B) storying C) narrative D) collaborative Answer: D Part II. Essay Questions Answer the following questions in your own words. 1) Explain some of the criteria for bereavement-related disorders put forth by scholars for the DSM-V. Why have scholars been unsuccessful getting bereavement related disorders into the book? Answer: In the DSM-5, the criteria for Major Depressive Disorder (MDD) specify that the diagnosis should not be made if the symptoms occur exclusively during the course of bereavement. However, if the symptoms persist for more than two months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation, then a diagnosis of MDD may be appropriate, even during the first two months of bereavement. Scholars and clinicians have argued for the inclusion of bereavement-related disorders in the DSM, suggesting that the experience of grief can manifest in ways distinct from typical depression and should be recognized as such. They propose that this recognition would lead to more appropriate treatment approaches that acknowledge the unique aspects of grief. However, there has been resistance to including a separate diagnostic category for bereavement-related disorders in the DSM. Some argue that grief is a normal and expected response to loss and should not be pathologized. Others are concerned that including such a category could lead to overdiagnosis and unnecessary medicalization of the grieving process. Overall, the debate highlights the complexities of defining and diagnosing mental health disorders, especially those that are closely tied to universally experienced life events like bereavement. 2) Despite past controversies regarding dissociation, trauma and its treatment, the International Society for the Study of Dissociation (ISSD) has acknowledged a consensus for treating these disorders. What are the elements of this treatment and what does each stage focus on? Answer: The International Society for the Study of Dissociation (ISSD) has acknowledged a consensus regarding the treatment of dissociative disorders, particularly those related to trauma. The treatment approach typically involves several key elements, often implemented in stages: 1. Establishing Safety and Stabilization: This initial stage focuses on ensuring the safety of the individual and stabilizing their symptoms. It may involve creating a safe therapeutic environment, developing coping skills, and addressing immediate safety concerns. 2. Trauma Processing: Once safety and stabilization are established, the focus shifts to processing traumatic memories and experiences. This may involve various techniques, such as trauma-focused cognitive behavioral therapy (TF-CBT), eye movement desensitization and reprocessing (EMDR), or narrative exposure therapy (NET). 3. Integration: The final stage of treatment focuses on integrating the different aspects of the individual's personality and experience. This may involve helping the individual develop a coherent narrative of their life and identity, as well as addressing any remaining dissociative symptoms. Each stage of treatment is typically tailored to the individual's specific needs and may involve a combination of approaches, including therapy, medication, and support from a multidisciplinary team. The goal is to help the individual heal from the effects of trauma and develop a sense of coherence and continuity in their life. 3) In studies of long-term adjustment and grief, researchers found both positive and potentially adverse effects that are influenced by gender and social context. Explain some of these long-term adjustment effects, how they vary by gender, and the social contexts that influence them. Answer: In studies of long-term adjustment and grief, researchers have identified several effects that can vary based on gender and social context: 1. Positive Growth: Some individuals experience post-traumatic growth or positive changes following a loss, such as increased personal strength, a greater appreciation for life, enhanced relationships, and a deeper sense of meaning or spirituality. Gender differences in positive growth are not well-established, but social support and coping strategies can influence the likelihood of experiencing growth. 2. Complicated Grief: Complicated grief is characterized by intense and prolonged grief reactions that can impair daily functioning. Women are more likely than men to experience complicated grief, possibly due to differences in coping styles and social expectations. Social support and the nature of the loss (e.g., sudden vs. expected) can also influence the development of complicated grief. 3. Depression and Anxiety: Grief can increase the risk of depression and anxiety disorders, particularly in individuals who have difficulty processing their loss. Women are generally more likely than men to experience depression and anxiety in response to grief, which may be influenced by societal norms around emotional expression and coping strategies. 4. Health Outcomes: Grief can impact physical health, with some studies suggesting an increased risk of cardiovascular problems, immune dysfunction, and other health issues. Social support plays a crucial role in mitigating these effects, with strong social networks often associated with better health outcomes. 5. Social Support: Social support is a critical factor in long-term adjustment to grief. Women tend to seek more social support than men, which may contribute to gender differences in grief outcomes. The availability and quality of social support can vary based on cultural norms and individual circumstances. In summary, long-term adjustment to grief is influenced by a complex interplay of factors, including gender, social support, coping strategies, and the nature of the loss. Understanding these factors can help tailor interventions to support individuals experiencing grief and promote healthy adjustment. 4) Write an essay that presents and explains Doka’s five basic types of disenfranchised grief. What are the reasons for disenfranchised grief and the negative consequences for bereft individuals? Answer: Disenfranchised grief, a concept developed by Kenneth Doka, refers to grief that is not openly acknowledged, socially validated, or publicly mourned. This type of grief can occur when individuals experience a loss that is not recognized or socially supported, leading to a sense of disenfranchisement and isolation in their grieving process. Doka identified five basic types of disenfranchised grief, each with its own unique characteristics and challenges: 1. Relational Grief: This type of disenfranchised grief occurs when the relationship between the bereaved and the deceased is not recognized or valued by society. Examples include the grief experienced by ex-spouses, former partners, or non-biological family members. 2. Hidden Grief: Hidden grief occurs when the loss is not visible or acknowledged by others. This can happen in cases of miscarriage, abortion, or the death of a pet, where the significance of the loss is not always recognized by society. 3. Stigmatized Grief: Stigmatized grief occurs when the circumstances surrounding the death or the relationship with the deceased are stigmatized or taboo. Examples include deaths related to suicide, AIDS, or addiction, where societal attitudes may lead to feelings of shame or isolation in the grieving process. 4. Ambiguous Grief: Ambiguous grief occurs when the loss is not clearly defined or understood. This can happen in cases of missing persons, unresolved relationships, or situations where the status of the deceased is uncertain, leading to a prolonged and complicated grieving process. 5. Disenfranchised Grief of the Self: This type of disenfranchised grief occurs when individuals feel they are not entitled to grieve or express their emotions openly. This can happen in situations where the individual feels responsible for the death or when societal norms discourage emotional expression. There are several reasons why disenfranchised grief occurs. In some cases, societal attitudes and norms may minimize the significance of certain types of losses, leading individuals to feel that their grief is not valid or worthy of recognition. In other cases, individuals may internalize these attitudes and feel ashamed or guilty for grieving openly. Additionally, the stigma surrounding certain types of losses can contribute to feelings of isolation and disenfranchisement. The negative consequences of disenfranchised grief can be profound. Bereft individuals may experience feelings of loneliness, isolation, and shame, which can exacerbate their grief and lead to depression, anxiety, and other mental health issues. Without the support and validation of others, individuals may struggle to process their grief and find meaning in their loss, prolonging their suffering and impeding their ability to heal. In conclusion, disenfranchised grief is a complex and often overlooked aspect of the grieving process. By understanding the different types of disenfranchised grief and the reasons behind them, we can work to validate and support individuals experiencing these types of losses, helping them to navigate their grief and find healing and meaning in their loss. 5) Why have traditional therapies been ineffective for treating complicated grief? What are some of the protocols/approaches researchers have proposed for treating complicated grief? Answer: Traditional therapies have often been ineffective for treating complicated grief due to the unique nature of this condition. Complicated grief is characterized by intense and prolonged grief reactions that can impair daily functioning. Unlike normal grief, which tends to lessen over time, complicated grief is persistent and can last for years, leading to significant emotional distress and functional impairment. One reason traditional therapies may be ineffective for complicated grief is that they may not adequately address the specific symptoms and underlying mechanisms of the disorder. Complicated grief is thought to involve a complex interplay of psychological, biological, and social factors, which may require a more targeted and comprehensive approach to treatment. Researchers have proposed several protocols and approaches for treating complicated grief, including: 1. Complicated Grief Treatment (CGT): CGT is a psychotherapeutic approach specifically designed to treat complicated grief. It focuses on helping individuals process their grief, confront and restructure maladaptive thoughts and beliefs about the loss, and gradually reintegrate the loss into their lives in a healthy way. CGT typically involves a structured, time-limited treatment format, consisting of individual therapy sessions. 2. Mindfulness-Based Grief Therapy: This approach combines principles of mindfulness meditation with grief therapy techniques to help individuals develop a non-judgmental awareness of their grief and learn to tolerate and accept their emotions. Mindfulness-based grief therapy aims to help individuals cultivate a sense of presence and acceptance of their grief, rather than trying to avoid or suppress it. 3. Integrative Cognitive-Affective Therapy (ICAT): ICAT is an approach that combines elements of cognitive-behavioral therapy (CBT) with techniques from emotion-focused therapy (EFT) to treat complicated grief. ICAT aims to help individuals identify and change maladaptive thoughts and behaviors related to their grief, while also addressing underlying emotional issues and promoting emotional processing and expression. 4. Eye Movement Desensitization and Reprocessing (EMDR): EMDR is a therapy approach that has been used to treat various forms of trauma, including complicated grief. EMDR involves a structured protocol that includes elements of exposure therapy, cognitive restructuring, and bilateral stimulation (e.g., eye movements, tapping) to help individuals process traumatic memories and alleviate distress. 5. Group Therapy: Group therapy can be an effective approach for treating complicated grief, as it provides a supportive environment where individuals can share their experiences, receive validation, and learn coping strategies from others who have experienced similar losses. Group therapy can also help reduce feelings of isolation and loneliness, which are common in complicated grief. Overall, the key to treating complicated grief is to tailor the approach to the individual's specific needs and circumstances, addressing the underlying mechanisms of the disorder and promoting adaptive coping strategies. By employing these specialized protocols and approaches, clinicians can help individuals with complicated grief navigate their grief and find a path toward healing and recovery. Chapter 12: Physician-Assisted Suicide and Euthanasia Test Questions Part I. Multiple Choice Questions Select the response that best answers the following questions. 1) Only __________ U.S. States have laws that permit physician-assisted suicide. A) three B) five C) six D) ten Answer: A 2) Any act that speeds the dying process is referred to as _________. A) terminal suicide B) active euthanasia C) hastened death D) physician-assisted suicide Answer: C 3) Kenny is terminally ill and wants his doctor to help him legally end his life. The doctor and Kenny agreed that providing a carefully administered dose of a lethal drug is the care plan. What term best describes this scenario for ending life? A) nonvoluntary euthanasia B) physician-assisted suicide C) passive euthanasia D) involuntary euthanasia Answer: B 4) If a medical provider intentionally withheld necessary life-sustaining measures that resulted in ending a patient’s life, they would likely be accused of __________. A) intensive euthanasia B) active euthanasia C) passive euthanasia D) hastened suicide Answer: C 5) During WWII the Nazi regime used __________ to eliminate individuals from society they regarded as undesirable. A) passive euthanasia B) nonvoluntary euthanasia C) physician-assisted suicide D) involuntary euthanasia Answer: D 6) When a person is not capable of making their own medical choices and are deliberately given life-shortening substances with the intent of ending their life it is called __________. A) nonvoluntary euthanasia B) involuntary euthanasia C) passive suicide D) Kevorkian euthanasia Answer: A 7) The public debate about physician-assisted suicide in the U.S. became noteworthy as a result of Dr. __________ actions. A) Lou Gehrig’s B) Sam Kennedy’s C) Sigmund Freud’s D) Jack Kevorkian’s Answer: D 8) In __________ terminally ill residents with six months or fewer to live are legally able to obtain a prescription for a lethal dose of a controlled substance to end their life as long as a physician does not administer the drug. A) New York B) Idaho C) Oregon D) California Answer: C 9) Patients with advanced __________ are most likely to utilize legal euthanasia in Washington State. A) MS B) heart disease C) cancer D) diabetes Answer: C 10) What landmark legislation was passed by the Oregon legislature in 1997 regarding euthanasia? A) Oregon Anti-Euthanasia Act B) Death with Dignity Act C) Physician-Assisted Suicide Ban Act D) Physicians Against Euthanasia Act Answer: B 11) The __________ is used by experts who grapple with moral questions about illness, medical, treatment, and the end of a person’s life. A) hastened death clause B) hospice care effect C) passive euthanasia doctrine D) principle of double effect Answer: D 12) Which European country is well-known for its laws permitting legal physician-assisted suicide and euthanasia? A) Italy B) Germany C) The Netherlands D) Greece Answer: C 13) Doctors use the __________ as a moral and legal compass for patient care. A) Hippocratic Oath B) Scientific Method C) Euthanasia Principle D) Slippery Slope Hypothesis Answer: A 14) Americans are more likely to support physician-assisted suicide and euthanasia when __________. A) laws also acknowledge the rights of minors B) patients are terminally ill and have chronic pain C) patients are terminally ill but not in pain D) practices are endorsed by life insurance organizations Answer: B 15) The argument that relaxing laws on hastened death will lead to abuse of such practices is referred to as a __________. A) slippery slope hypothesis B) Hippocratic double-standard C) involuntary threat D) principle of double effect Answer: A 16) For medical professionals, there is a fine line between __________ and illicit hastened death. A) active euthanasia B) voluntary euthanasia C) physician-assisted suicide D) unintentional overdose Answer: D 17) Dr. Jack Kevorkian is also known as “__________” for his involvement with physician-assisted suicides. A) Dr. Immoral B) Dr. Grim C) Dr. Death D) Dr. Defiant Answer: C 18) What do Oregon, Washington, and Montana have in common? A) All are states with laws permitting involuntary euthanasia. B) All are states with laws permitting physician-assisted suicide. C) All are states with laws banning physician-assisted suicide. D) All are states with laws banning hospice and palliative care. Answer: B 19) What term best describes a situation where a patient refuses to take life-preserving medication to intentionally speed up the dying process? A) hastened death B) nonvoluntary euthanasia C) physician-assisted suicide D) active euthanasia Answer: A 20) The act of ending another’s life against their will and without their consent is called __________. A) passive suicide B) physician-assisted suicide C) nonvoluntary euthanasia D) involuntary euthanasia Answer: D 21) Euthanasia is illegal in all but __________ European countries. A) two B) three C) six D) eight Answer: B 22) In the U.S. there are __________ states that legally endorse euthanasia. A) no B) five C) twenty D) forty Answer: A 23) Physician-assisted suicide can also be described as __________. A) intentional grief B) suicide C) involuntary euthanasia D) active euthanasia Answer: D 24) Lethal injections given as a result of the death penalty could arguably be referred to as __________. A) death with dignity B) hastened suicide C) involuntary euthanasia D) the principle of double effect Answer: C 25) Through 2010, approximately __________ Oregonians have ended their lives using medications legally prescribed by physicians under the Death with Dignity Act. A) 175 B) 250 C) 500 D) 1,200 Answer: C Part II. Essay Questions Answer the following questions in your own words. 1) Discuss the ethical debate that exists around physician-assisted suicide. Why is this practice so controversial? How does this contentious issue relate to cultural beliefs and practices Americans have regarding death? Answer: The ethical debate surrounding physician-assisted suicide (PAS) centers on fundamental questions about autonomy, beneficence, and the sanctity of life. On one side, proponents argue that individuals have the right to make decisions about their own lives, including the right to end their suffering when facing a terminal illness or unbearable pain. They argue that PAS can be a compassionate choice that respects a person's autonomy and allows them to die with dignity. On the other side, opponents argue that PAS violates the Hippocratic Oath and the principle of "do no harm." They express concerns about the potential for abuse, coercion, and the slippery slope toward euthanasia. They also raise questions about the role of physicians in intentionally ending a patient's life, which goes against the traditional role of healers. The controversy surrounding PAS is deeply rooted in cultural beliefs and practices regarding death in America. In American culture, there is often a strong emphasis on the value of life and the belief in fighting against death and illness. This cultural perspective can clash with the idea of accepting death as a natural part of life and allowing individuals to have control over the circumstances of their death. Additionally, religious beliefs play a significant role in shaping attitudes toward PAS. Many religious traditions view life as sacred and believe that only a higher power should have the authority to end it. This can lead to moral objections to PAS among individuals who hold these beliefs. Overall, the debate over physician-assisted suicide is complex and multifaceted, reflecting deeply held beliefs about autonomy, compassion, and the sanctity of life. 2) Explain the details of the Death with Dignity Act. Under the law, what are patients entitled to and what is legally required of physicians and witnesses of a patient’s voluntary death? Answer: The Death with Dignity Act is a law that allows terminally ill adults in certain states to request and receive a prescription for medication that they can self-administer to end their own lives. The specifics of the law can vary slightly from state to state, but generally, the following are the key provisions: 1. Eligibility: Patients must be adults (usually 18 years or older) who are mentally competent and have a terminal illness that is expected to result in death within a certain timeframe (usually six months). 2. Request Process: Patients must make two oral requests to their physician, separated by a mandatory waiting period (usually 15 days), and provide a written request signed in the presence of two witnesses, one of whom cannot be a relative, entitled to any portion of the patient's estate, or an employee of a health care facility where the patient is receiving care. 3. Consultation: Patients must receive a diagnosis and prognosis from their attending physician and a second opinion from a consulting physician, both of whom must confirm the patient's eligibility and competence. 4. Informed Decision: Patients must be fully informed of their diagnosis, prognosis, the potential risks and benefits of the medication, and other available treatment options, including palliative care and hospice. 5. Medication Prescription: If the patient meets all the requirements, the attending physician may prescribe the medication, but the patient is not obligated to use it. 6. Administration: The patient must self-administer the medication. No one else, including the attending physician, is allowed to administer the medication. 7. Documentation and Reporting: Physicians are required to document all requests and confirmations in the patient's medical record. They must also report certain information to state health departments, such as the number of prescriptions written and patient demographics. It's important to note that the Death with Dignity Act is controversial and has sparked debates about the ethics and legality of physician-assisted suicide. Supporters argue that it gives terminally ill patients autonomy and control over their end-of-life care, while opponents raise concerns about the potential for abuse, coercion, and the devaluation of life. 3) What is the principle of double effect and what does it have to do with the debate about the legal and moral questions regarding physician-assisted suicide? Answer: The principle of double effect is a moral principle often invoked in ethical debates, particularly in medical ethics, to justify actions that have both a good and a bad effect. According to this principle, an action that is morally permissible may produce both a good outcome and a bad outcome, as long as certain conditions are met: 1. The action itself must be morally good or neutral. 2. The agent intends only the good effect and not the bad effect, even though they may foresee that the bad effect will occur. 3. The good effect must outweigh the bad effect. 4. There must be no other reasonable way to achieve the good effect without also causing the bad effect. In the context of the debate about physician-assisted suicide (PAS), the principle of double effect is often invoked by opponents of PAS to argue that while alleviating suffering is a good intention, intentionally causing or assisting in the death of a patient is morally wrong. Proponents of PAS, however, argue that the principle of double effect supports their position. They argue that the primary intention behind PAS is to relieve suffering and respect the autonomy of terminally ill patients, rather than to cause death. They assert that while death may be a foreseeable consequence of PAS, it is not the intended outcome. The application of the principle of double effect to PAS highlights the complex moral and ethical considerations involved in end-of-life care and the tension between respecting patient autonomy, relieving suffering, and preserving the sanctity of life. 4) Compare and contrast the tenants of the Death with Dignity Act and the Dutch Termination of Life on Request and Assisted Suicide Act. Answer: The Death with Dignity Act in the United States and the Dutch Termination of Life on Request and Assisted Suicide Act (often referred to as the Dutch Euthanasia Act) have similarities in that they both address the issue of physician-assisted dying. However, there are key differences in their scope, eligibility criteria, and procedural requirements: 1. Scope: • The Death with Dignity Act is limited to terminally ill adult patients who are residents of states where the law is in effect (currently Oregon, Washington, Vermont, California, Colorado, Hawaii, New Jersey, Maine, and New Mexico). • The Dutch Euthanasia Act, on the other hand, applies to all competent adult patients, not just those with a terminal illness, in the Netherlands. 2. Eligibility Criteria: • The Death with Dignity Act requires patients to have a terminal illness with a prognosis of six months or less to live, to be mentally competent, and to make voluntary and informed requests for medication to end their lives. • The Dutch Euthanasia Act allows for euthanasia or assisted suicide for patients with unbearable suffering without prospect of improvement, regardless of whether they have a terminal illness. The suffering can be physical or mental. 3. Procedural Requirements: • Under the Death with Dignity Act, patients must make two oral requests to their physician, at least 15 days apart, and provide a written request signed in the presence of two witnesses. Physicians must confirm the diagnosis and prognosis, ensure the patient is mentally competent, inform them of alternatives, and offer the opportunity to rescind the request. • The Dutch Euthanasia Act requires patients to make a voluntary and well-considered request for euthanasia or assisted suicide. A second, independent physician must also confirm the diagnosis, prognosis, and patient's suffering, and both physicians must be satisfied that the request meets the due care criteria. 4. Physician Involvement: • Both laws require the involvement of physicians, but the extent of their involvement and the specific requirements differ. In the United States, physicians prescribe medication for patients to self-administer, while in the Netherlands, physicians may administer euthanasia or provide assistance with suicide. Overall, while both the Death with Dignity Act and the Dutch Euthanasia Act address the issue of physician-assisted dying, they have significant differences in their scope, eligibility criteria, and procedural requirements, reflecting the different legal and cultural contexts in which they operate. 5) Discuss some of the repercussions for physicians who assist with voluntary patient suicide illegally. In your essay, use examples from the chapter of doctors who faced such repercussions. Answer: Assisting with voluntary patient suicide illegally can have severe repercussions for physicians, including legal, professional, and personal consequences. In the chapter "Doctors Who Cross the Line" from the book "When Doctors Kill" by Stephen J. Cina and John M. Cina, several examples illustrate the potential repercussions for physicians who engage in illegal assisted suicide. One consequence is legal action. Physicians who assist with suicide outside the bounds of the law may face criminal charges, including manslaughter or murder. For example, in the case of Dr. Jack Kevorkian, also known as "Dr. Death," he was charged with murder in several cases where he provided assistance with suicides. He was eventually convicted of second-degree murder in one case and served prison time. Professional repercussions are also significant. Physicians who violate ethical standards and laws regarding assisted suicide may face disciplinary action from medical boards, including the loss of their medical license. This can effectively end their medical career and tarnish their professional reputation. For instance, Dr. Michael Swango, a physician who was convicted of poisoning patients, faced repercussions that included the revocation of his medical license and imprisonment. Personal consequences can be profound as well. Physicians who assist with illegal suicides may face public scrutiny, social stigma, and damage to their personal relationships. The emotional toll of being involved in a patient's death, especially in a controversial and illegal manner, can also be significant. In conclusion, assisting with voluntary patient suicide illegally can have serious repercussions for physicians, including legal, professional, and personal consequences. The cases of Dr. Jack Kevorkian and Dr. Michael Swango serve as stark examples of the potential repercussions that physicians may face for engaging in illegal assisted suicide. Test Bank for Death, Dying and Bereavement in a Changing World Alan R Kemp 9780205961009