This Document Contains Chapters 13 to 15 Chapter 13: Withdrawing Life Support and Organ Transplantation Test Questions Part I. Multiple Choice Questions Select the response that best answers the following questions. 1) A patient who is mechanically breathing is using a(n)__________. A) ventilator B) IV C) tuning fork D) nebulizer Answer: A 2) The irreversible cessation of activity from the whole brain, the brain stem, or the higher brain is referred to as __________. A) clinical death B) rigor mortis C) brain death D) social death Answer: C 3) The dead donor rule shifted the definition of death from the cessation of heartbeat to __________. A) clinical death B) brain death C) comatose patients D) rigor mortis Answer: B 4) The Harvard Committee was convened to accomplish the important task of establishing __________. A) a criteria for determining brain death B) rules for when a person may receive an organ transplant C) a process for legally declaring a patient as terminal D) restrictions on the harvesting of organs from the dead Answer: A 5) The Uniform Determination of Death Act defined brain death as the __________. A) cessation of respiration and oxygen to the brain B) irreversible cessation of circulation, respiration, and all functions of the entire brain C) irreversible cessation of bodily movement and speech skills D) cessation of conscious brain function and blood flow Answer: B 6) What do the United Kingdom and many other English-speaking countries use to determine brain death? A) the whole brain criteria B) the neocortical criteria C) the brain stem criteria D) the respiration criteria Answer: C 7) Neocortical death can occur in a healthy person as a result of the loss of blood supply and oxygen to the __________. A) heart B) lungs C) brain D) spinal cord Answer: C 8) Ischemia refers to __________. A) the loss of blood supply to the brain B) the loss of oxygen supply to the brain C) too much fluid in the brain D) the loss of fluids to the brain Answer: A 9) __________ occurs when the neocortex loses functioning over time. A) Comatose B) Persistent vegetative state C) Locked-in syndrome D) Dementia Answer: D 10) Transhumanism refers to the belief that __________. A) it is unethical to remove body parts from one human to transplant them in another B) technology will allow us to transcend the limitations of the human body C) placing brain dead individuals into facilities can help maintain and extend their life D) all humans have the right to life saving procedures Answer: B 11) To relieve the discomfort associated with the dying process, and perhaps even hasten it, some physicians use __________. A) ventilation B) terminal acceleration C) terminal sedation D) organ transplantation Answer: C 12) Another term for the avoidance of doing harm is __________. A) nonmaleficence B) autonomy C) justice D) terminal sedation Answer: A 13) The __________ requires hospitals, skilled nursing facilities, home health agencies, hospices, and HMOs that receive federal dollars to notify patients they have the right to give advance directives about future care. A) beneficence B) nonmaleficence C) persistent vegetative state D) patient self-determination act Answer: D 14) Medical futility is a term that has been applied to __________. A) patients in a persistent vegetative state B) the inability of comatose patients to speak C) treatments that medical experts don’t believe will benefit the patient D) rulings by healthcare providers that restrict procedures Answer: C 15) Babies born without major portions of their brains or skulls are diagnosed as __________ and rarely survive more than a few days. A) anencephalic B) neocortical C) maleficence D) comatose Answer: A 16) Some patients experience __________ after being removed from life support. This results in the loss of water and salt in the body. A) terminal starvation B) terminal dehydration C) delirium D) vomiting Answer: B 17) Patients who cannot survive without assisted breathing are referred to as __________. A) comatose B) persistently vegetative C) ventilator dependent D) lethargic Answer: C 18) Terminal weaning refers to __________. A) removing the drugs that manage pain during death B) patients who slowly become better and no longer need oxygen through a ventilator C) the removing of patients from hospitals to bring them home to die D) the slow decreasing of oxygen and pressure from the breathing tube of the patient Answer: D 19) When a patient is hooked up to tubing for a ventilator it is referred to as __________. A) intubation B) extubation C) ventilation D) terminal weaning Answer: A 20) Oral or written instructions given by the patient before decision-making capacity is lost is the __________ for terminating life support. A) substituted judgment standard B) subjective standard C) best interests standard D) institutional standard Answer: B 21) The substituted judgment standard is a determination __________. A) made by courts to decide whether or not to ending life support B) illegally made by family members to end life support C) of how cases should be handled for insurance purposes D) made about patient care that is based on their known preferences and values Answer: D 22) The post biological model describes __________. A) being dead B) transferring consciousness to a different platform than the human body C) using machines to save a person’s life D) medicine being more technological than personal Answer: B 23) When a patient has cognitive function, but does not appear to be conscious because they are unable to move or communicate, they are experiencing __________. A) locked-in syndrome B) brain stem death C) terminal dehydration D) coma Answer: A 24) When the brain stem remains intact, but the neocortex is irreversibly damaged, a person is diagnosed to be __________. A) terminal B) on life support C) in a coma D) in a persistent vegetative state Answer: D 25) Hypoxia causes severe damage to the neocortex through a lack of __________ to the brain. A) oxygen B) blood flow C) electrolytes D) nutrition Answer: A Part II. Essay Questions Answer the following questions in your own words. 1) Explain the differences between partial brain and whole brain criteria for determining brain death. Why was this a medical issue that needed to be settled by authorities in the medical community and the government? Answer: The differences between partial brain and whole brain criteria for determining brain death revolve around which parts of the brain are considered essential for life and function. 1. Partial Brain Criteria: This approach focuses on the irreversible loss of function in the brainstem, particularly the upper brainstem, as the criterion for declaring brain death. The rationale is that the brainstem is responsible for regulating basic life functions such as breathing and heart rate. If this part of the brain is irreversibly damaged, the body cannot sustain life, even with mechanical ventilation. 2. Whole Brain Criteria: This approach considers the irreversible loss of function in the entire brain, including the cerebrum and brainstem, as the criterion for declaring brain death. This means that not only the brainstem but also the higher brain functions responsible for consciousness, thoughts, and emotions are irreversibly lost. The debate over these criteria stems from the complexity of defining death in the context of modern medical technology. Historically, death was determined by the cessation of heartbeat and respiration, but advances in life support technology made it possible to maintain these functions artificially. This raised ethical, legal, and medical questions about the definition of death, particularly regarding when to withdraw life support. The need for authorities in the medical community and government to settle this issue arises from several factors: 1. Legal and Ethical Implications: Determining brain death has profound legal and ethical implications, such as deciding when to terminate life support, organ donation, and the rights of patients and their families. Consistency and clarity in the criteria are crucial to ensure ethical and fair practices. 2. Medical Practice and Standards: Establishing clear criteria for brain death is essential for medical practitioners to make accurate and consistent diagnoses. This helps in providing appropriate care and making decisions regarding end-of-life care. 3. Organ Donation: The criteria for brain death are also important for organ donation. Patients who are declared brain dead may still have viable organs that can be used for transplantation. Clear criteria ensure that organs are procured ethically and safely. 4. Public Trust: A clear and consistent definition of brain death is crucial for maintaining public trust in the medical profession and healthcare system. The public needs to have confidence that medical authorities are making decisions based on sound scientific and ethical principles. In summary, the debate over partial brain versus whole brain criteria for determining brain death is a complex issue with profound implications for medical practice, ethics, and society. The involvement of authorities in the medical community and government is necessary to establish clear and consistent standards that ensure ethical, legal, and medically sound practices. 2) How are neocortical death and brain stem death different? What influence do these differences have on the medical community in determining death? Answer: Neocortical death and brain stem death are two different concepts related to the determination of death, particularly in the context of brain function. Here's how they differ: 1. Neocortical Death: Neocortical death refers to the irreversible loss of function in the cerebral cortex, which is the outer layer of the brain responsible for higher brain functions such as consciousness, thoughts, and voluntary movements. A person in a state of neocortical death may still have some brainstem function, allowing for basic life support functions like breathing and circulation to be maintained artificially. However, they lack higher brain functions and are considered unable to regain consciousness or interact with their environment. 2. Brain Stem Death: Brain stem death, on the other hand, refers to the irreversible loss of function in the brainstem, which is responsible for regulating basic life functions such as breathing, heart rate, and blood pressure. A person who is brain stem dead has lost the ability to maintain these vital functions, even with mechanical support. Brain stem death is often considered synonymous with legal death in many jurisdictions, as the loss of brainstem function is viewed as incompatible with life. The influence of these differences on the medical community in determining death is significant: 1. Medical Practice and Ethics: The distinction between neocortical death and brain stem death raises important ethical considerations regarding the determination of death and the withdrawal of life support. In cases of neocortical death, where some basic life functions may still be maintained, there may be ethical debates about the appropriateness of continuing life support versus allowing natural death to occur. 2. Organ Donation: The differences between neocortical death and brain stem death also have implications for organ donation. In cases of brain stem death, organs may still be viable for transplantation, whereas in cases of neocortical death, the viability of organs may be more limited. Clear criteria are needed to determine the suitability of organs for donation. 3. Legal Definitions: The distinction between neocortical death and brain stem death may have legal implications, as different jurisdictions may have varying definitions of death. Understanding these distinctions is important for ensuring compliance with legal requirements related to death certification and organ donation. In summary, while both neocortical death and brain stem death are related to the irreversible loss of brain function, they differ in terms of the brain regions affected and the implications for medical practice, ethics, and organ donation. Clarity in defining these concepts is crucial for ensuring ethical and consistent practices in determining death. 3) What is “transhumanism” and how has it changed medical science and the debate regarding the determination of death? Answer: Transhumanism is a philosophical and social movement that advocates for the use of science, technology, and other interdisciplinary approaches to enhance human capabilities, both physical and cognitive. It often focuses on overcoming human limitations through advancements such as genetic engineering, artificial intelligence, and biotechnology. In the context of medical science, transhumanism has influenced the development of technologies and treatments that aim to improve human health and longevity. For example, advancements in genetic engineering and regenerative medicine have the potential to treat diseases and injuries that were once considered incurable. Additionally, technologies such as brain-computer interfaces and prosthetic limbs have improved the quality of life for individuals with disabilities. The debate regarding the determination of death has been influenced by transhumanist ideas, particularly in relation to the concept of "brain death." Transhumanists argue that as medical technologies continue to advance, the criteria for determining death may need to be reevaluated. For example, some transhumanists suggest that a person who is "brain dead" according to current medical standards could potentially be revived or restored to life in the future with the help of advanced technologies. This perspective has led to discussions about whether the current criteria for determining death are adequate and whether they should be revised to account for future advancements in medical science. Critics of transhumanism argue that such ideas are speculative and could lead to ethical dilemmas, such as prolonging the suffering of individuals who are deemed "dead" by current standards. Overall, transhumanism has sparked important debates about the boundaries of human life and the ethical implications of using technology to enhance human capabilities, including how these advancements may impact the determination of death in the future. 4) What are the three agreed-on standards for terminating life support in the United States? How did the case of Nancy Cruzan influence these standards? Answer: In the United States, the three generally agreed-upon standards for terminating life support are: 1. Clear and Convincing Evidence Standard: This standard requires that there be clear and convincing evidence that the patient would have chosen to discontinue life-sustaining treatment if they were able to make the decision. This standard is often used when the patient's wishes are known through advance directives or other forms of evidence. 2. Substituted Judgment Standard: This standard allows the surrogate decision-maker to make decisions on behalf of the patient based on what the surrogate believes the patient would have wanted. This standard is used when the patient's wishes are not explicitly known but can be reasonably inferred based on their values, beliefs, and past statements. 3. Best Interest Standard: This standard allows the surrogate decision-maker to make decisions based on what is in the best interest of the patient. This standard is used when the patient's wishes are unknown and cannot be reasonably inferred. The decision-maker must consider factors such as the patient's medical condition, prognosis, and quality of life. The case of Nancy Cruzan was a landmark case that influenced these standards. Nancy Cruzan was a young woman who was in a persistent vegetative state following a car accident. Her family sought to have her feeding tube removed, believing that she would not want to be kept alive in that condition. However, the hospital refused to remove the tube without a court order. The case eventually made its way to the Supreme Court, which ruled that a state could require clear and convincing evidence of a patient's wishes before life-sustaining treatment could be discontinued. This ruling established the clear and convincing evidence standard as a requirement for terminating life support in many states. The Cruzan case also highlighted the importance of advance directives and the need for individuals to communicate their end-of-life wishes to their loved ones and healthcare providers. It underscored the complexity of end-of-life decision-making and the challenges faced by families and healthcare providers when the patient's wishes are unclear. 5) What is the Patient Self-Determination Act and why is it important to understanding the rights of patients that are terminal due to illness or injury? Use some example cases from the chapter to demonstrate how this legislation is important. Answer: The Patient Self-Determination Act (PSDA) is a U.S. federal law passed in 1990 that requires healthcare facilities to inform patients about their rights to make decisions about their medical care, including the right to refuse or request life-sustaining treatments. The PSDA also requires healthcare facilities to document any advance directives, such as living wills or durable power of attorney for healthcare, that patients may have. The PSDA is important to understanding the rights of terminally ill patients because it empowers patients to make informed decisions about their end-of-life care and ensures that their wishes are respected. By requiring healthcare facilities to inform patients about their rights and document their preferences, the PSDA helps to ensure that patients receive care that aligns with their values and preferences. One example case that demonstrates the importance of the PSDA is the case of Nancy Cruzan, mentioned earlier. Nancy Cruzan's family sought to have her feeding tube removed based on their belief that she would not want to be kept alive in a persistent vegetative state. The case ultimately led to the Supreme Court's ruling that a state could require clear and convincing evidence of a patient's wishes before life-sustaining treatment could be discontinued. This ruling reinforced the importance of advance directives and the right of patients to make decisions about their end-of-life care. Another example case is the case of Karen Ann Quinlan, a young woman who was in a persistent vegetative state after overdosing on drugs and alcohol. Karen's parents fought to have her removed from a ventilator, believing that she would not want to be kept alive in that condition. The case led to a landmark court decision that established the right of patients and their families to refuse life-sustaining treatment, even in the absence of clear evidence of the patient's wishes. Overall, the Patient Self-Determination Act is important in understanding the rights of terminally ill patients because it empowers patients to make decisions about their care and ensures that their wishes are respected, even in situations where they are unable to communicate their preferences. Chapter 14: Life After Life Test Questions Part I. Multiple Choice Questions Select the response that best answers the following questions. 1) Ancient __________ beliefs regarding the afterlife are some of the most widely recorded. A) Egyptian B) Sumerian C) Greek D) Roman Answer: A 2) An Ancient Egyptians practice was to place a __________ in the sarcophagus of a dead body to provide a full set of instructions on how to reach their version of heaven. A) box of organs B) stone tablet C) hieroglyphics message D) rolled papyrus Answer: D 3) Instructions for the Ancient Egyptian dead are known as the __________ by researchers. A) map of the underworld B) Egyptian book of the Dead C) path of heaven D) Egyptian tablet of life Answer: B 4) For Tibetan Buddhists __________, literally meaning “in between,” is a period of 49 days where the mind experiences a series of events before reincarnation. A) Ba B) Ka C) Aalu D) Bardo Answer: D 5) The Dalai Lama suggests that the dying process has eight phases split into the first four, the __________, and the second four, the __________. A) cessation of breath through life, “death rattle” B) beginning of the end, reforming of the life anew C) dissolution of the four basic elements, dissolution of the consciousness D) dissolution of the four elements, resurrection of the four elements Answer: C 6) The three monotheistic faiths that make up the __________ are Christianity, Islam, and Judaism. A) Abrahamic tradition B) tradition of Scripture C) Middle Eastern tradition D) Modern religious tradition Answer: A 7) Greek traditions of paradise were centered on the __________, which was a place for the virtuous dead. A) Atticus Caves B) Temple of Horus C) Sheol D) Elysian Fields Answer: D 8) In Muslim traditions, Muhammad was on a quest to find __________ or the “true one.” A) Horus B) al-Haqq C) Sheol D) Yahweh Answer: B 9) In Islam, Munkar and Nakir, two __________, question the dead in their graves about their belief in God. A) prophets B) wise men C) angels D) women Answer: C 10) The book Life After Life by Dr. Raymond Moody was a ground-breaking work that interviewed people who __________. A) had near-death experiences B) were contacted by deceased loved ones C) had close friends who were deceased D) didn’t believe in any form of afterlife Answer: A 11) Autoscopic is the term for having __________ when being near-death. A) no sensations B) blindness C) an out-of-body experience D) an inability to speak Answer: C 12) Some who have had near-death experiences report that they met a powerful spiritual being. This entity is referred to as the __________. A) guide to the afterlife B) gatekeeper of heaven C) leader D) being of light Answer: D 13) The extremely vivid reliving of life experiences, and revelation of their impact on the life of others, during the near-death experience is called the __________. A) replaying of life B) panoramic life review C) inventory of experience D) life renewed Answer: B 14) Reluctance to return is one of the core elements of near-death experience and is described as __________. A) being reluctant to return to the God from which one first came B) feeling a transformation of personality C) being greeted by a being of light D) being told one must return to life and not wanting to Answer: D 15) Some who experience near-death describe horror, terror, anger, and loneliness. This is referred to as __________. A) distressing near-death experiences B) negative near-death experiences C) true near death experiences D) darkened death Answer: A 16) The experience of being cut off and completely alone in absolute emptiness is referred to as __________. A) loss B) the darkness C) drifting D) voided Answer: D 17) Kübler-Ross was criticized for her __________. A) use of children in research B) controversial denial of an afterlife C) unscientific views of what happens after we die D) experiences with death Answer: C 18) Kübler-Ross claimed that people who were close to death often reported __________. A) seeing angels and deceased relatives B) seeing flashing lights and a tunnel C) seeing nothing but a void D) hearing voices that comforted them Answer: A 19) The metaphor of the butterfly and the cocoon was how __________ explained the three stages that unfold at the moment of death. A) Raymond Moody B) Michael Sabom C) Kübler-Ross D) Karl Jansen Answer: C 20) Many scientists don’t agree with the accounts of those experiencing near-death experiences because they argue that they are too __________ and __________. A) objective, verifiable B) subjective, unverifiable C) different, unreliable D) unscientific, fantastical Answer: B 21) Some argue that the near-death accounts of people are simply __________. A) neurotransmitters in the brain shutting down B) blood flooding the brain C) the first stage in a longer process D) nothing more than the end of life Answer: A 22) Some scientists argue that the “tunnel and light experience” is caused by the effect of oxygen deprivation or __________. A) hallucinations B) the right temporal lobe C) endorphins D) cortical disinhibition Answer: D 23) The neuropsychological explanation of the near-death experience accounts for the experiences as being __________. A) part of the process of socialization B) due to the process of the dying brain C) a subjective experience D) different for everyone Answer: B 24) The socially constructed meaning of the near-death phenomenon is referred to as the __________. A) psychosocial explanation B) neuropsychological explanation C) cortical disinhibition theory D) ketamine theory Answer: A 25) The assertion that near-death experiences are an adaptive mechanism that function to help the human race cope with death claims that near-death experiences are part of __________. A) everyday life B) modern socialization C) evolution D) denial of death Answer: C Part II. Essay Questions Answer the following questions in your own words. 1) Explain how the Semitic conception of hell changed through exposure to different religious reformers and conquerors throughout ancient history. Answer: The Semitic conception of hell evolved significantly over ancient history, influenced by various religious reformers and conquerors. Initially, in ancient Mesopotamian religions like Sumerian and Babylonian, the afterlife was believed to be a gloomy underworld called the "kur." This concept likely influenced early Semitic beliefs. With the rise of Judaism, particularly during the Babylonian exile (6th century BCE), the Hebrew conception of the afterlife began to take shape. The Hebrew Bible mentions Sheol as the realm of the dead, a shadowy place where both the righteous and the wicked went after death, devoid of specific punishment or reward. During the Hellenistic period, Greek influence introduced ideas of dualism and a more defined concept of punishment and reward after death. This likely influenced Jewish apocalyptic literature, where ideas of resurrection and judgment began to emerge, leading to a more developed concept of hell for the wicked, known as Gehenna. With the spread of Christianity, particularly after the 1st century CE, the concept of hell as a place of eternal punishment for the wicked became more prominent. This was influenced by early Christian theologians like Augustine, who emphasized the eternal nature of punishment for sin. Later Islamic theology, influenced by both Christian and Jewish traditions, developed its own concept of hell (Jahannam), described as a place of torment for the unbelievers, sinners, and hypocrites, with varying degrees of punishment based on one's deeds. Throughout ancient history, the Semitic conception of hell evolved from a vague underworld to a more defined place of punishment and torment, influenced by various religious reformers, conquerors, and cultural exchanges with neighboring civilizations. 2) What is the Christian tradition of the afterlife and how has it changed over time? How is it different in the old and new testaments? Answer: The Christian tradition of the afterlife has evolved over time, influenced by various theological developments and interpretations of scripture. The concept of the afterlife in Christianity is primarily based on the teachings of Jesus Christ as recorded in the New Testament, but it also draws upon Jewish beliefs found in the Old Testament. In the Old Testament, particularly in the Hebrew Bible, the afterlife is not as clearly defined as in the New Testament. The concept of Sheol is mentioned, which is often understood as a shadowy underworld where all the dead, both righteous and wicked, go after death. There is little emphasis on punishment or reward in Sheol, and it is portrayed as a place of silence and darkness. In contrast, the New Testament, especially in the teachings of Jesus and the writings of Paul and other early Christian leaders, introduces the concept of a more defined afterlife. Jesus speaks of heaven as the dwelling place of God and the righteous, contrasting it with hell or Gehenna, a place of punishment for the wicked. The New Testament also introduces the concept of resurrection, where believers are raised to eternal life and non-believers to judgment and punishment. Over time, Christian theology developed further nuances and doctrines regarding the afterlife. Early Christian theologians like Augustine and Aquinas contributed to the development of the doctrine of hell as a place of eternal punishment for the wicked. The idea of purgatory, a temporary state of purification for souls destined for heaven but not yet fully purified, also emerged in Christian theology, particularly in the Roman Catholic tradition. In summary, the Christian tradition of the afterlife has evolved from the vague concept of Sheol in the Old Testament to a more defined understanding of heaven, hell, and resurrection in the New Testament and subsequent theological developments. The emphasis on punishment and reward, as well as the inclusion of doctrines like purgatory, distinguishes Christian beliefs about the afterlife from those found in the Old Testament. 3) What are the core elements of the near-death experience? How do these experiences contribute to the transformation of those that have them? Answer: Near-death experiences (NDEs) typically involve a set of core elements that are reported by many individuals who have undergone such experiences. These elements can vary somewhat from person to person but often include: 1. Out-of-body experience (OBE): Many people report feeling as though they have left their physical bodies and are observing the world from a different perspective, often from above. 2. Feelings of peace and joy: Despite the often traumatic circumstances that lead to a near-death experience, many individuals report feeling a profound sense of peace, joy, and serenity during the experience. 3. Moving through a tunnel: Some people describe moving through a dark tunnel towards a bright light. This light is often described as warm, welcoming, and loving. 4. Encountering deceased loved ones: Many individuals report seeing deceased relatives or friends during their near-death experience. These encounters are typically described as comforting and reassuring. 5. Life review: Some people report experiencing a review of their life, during which they see and sometimes re-experience significant events from their past. This review is often described as non-judgmental but is intended to help the individual understand the consequences of their actions. 6. Encountering a being of light: Many people report encountering a being of light, often described as divine or angelic. This being is often perceived as loving, wise, and compassionate. 7. Decision to return: Some individuals report being given a choice to return to their physical bodies or to continue on in the afterlife. Those who choose to return often do so because they feel they have unfinished business or because they want to be reunited with loved ones. These core elements of near-death experiences can have a profound impact on those who experience them. Many people report that their near-death experience has led to a transformation in their lives, including: 1. Reduced fear of death: Many people report losing their fear of death after experiencing an NDE, believing that there is an afterlife or some form of continuation of consciousness beyond death. 2. Increased spiritual beliefs: NDEs often lead to a deepening of spiritual beliefs, as many individuals report feeling a strong connection to a higher power or a sense of purpose and meaning in life. 3. Changed priorities: People who have had an NDE often report a shift in their priorities, placing more emphasis on relationships and experiences rather than material possessions or achievements. 4. Increased compassion and empathy: Many individuals report feeling a greater sense of compassion and empathy towards others after their NDE, often leading to changes in behavior such as increased altruism and a desire to help others. 5. Changed attitudes towards life: People who have had a near-death experience often report feeling more grateful for life and more willing to take risks or pursue their passions. Overall, near-death experiences can be profoundly transformative, leading to changes in beliefs, attitudes, and behaviors that can have a lasting impact on the individual's life. 4) How are distressing near-death experiences different from near-death experiences? How would you describe the impact of both of these on individuals who experience them? Answer: Distressing near-death experiences (NDEs) are experiences that involve similar elements to typical NDEs but are characterized by feelings of fear, terror, and discomfort rather than the typical feelings of peace, joy, and serenity. While the core elements of distressing NDEs can vary, they often include: 1. Fear and terror: Unlike typical NDEs, which are often described as peaceful and serene, distressing NDEs are characterized by intense feelings of fear, terror, and anxiety. 2. Negative encounters: Some individuals report encountering malevolent beings or experiencing a sense of being in a dark, oppressive environment during a distressing NDE. 3. Feelings of isolation: People who have had a distressing NDE often report feeling isolated and alone, with no sense of connection to a higher power or to other beings. 4. Confusion and disorientation: Distressing NDEs can be accompanied by feelings of confusion and disorientation, making it difficult for the individual to understand or make sense of their experience. 5. Sense of impending doom: Many individuals report feeling as though they were facing imminent danger or death during a distressing NDE, adding to the overall sense of fear and discomfort. The impact of both typical and distressing NDEs on individuals who experience them can be profound and long-lasting. Typical NDEs are often described as transformative, leading to changes in beliefs, attitudes, and behaviors. People who have had a typical NDE may experience: 1. Reduced fear of death: Many individuals report losing their fear of death after a typical NDE, believing that there is an afterlife or some form of continuation of consciousness beyond death. 2. Increased spirituality: NDEs often lead to a deepening of spiritual beliefs, as individuals report feeling a strong connection to a higher power or a sense of purpose and meaning in life. 3. Changed priorities: People who have had a typical NDE often report a shift in their priorities, placing more emphasis on relationships and experiences rather than material possessions or achievements. 4. Increased compassion and empathy: Many individuals report feeling a greater sense of compassion and empathy towards others after a typical NDE, often leading to changes in behavior such as increased altruism and a desire to help others. In contrast, distressing NDEs can have a negative impact on individuals, leading to: 1. Increased fear and anxiety: People who have had a distressing NDE may experience increased fear and anxiety, particularly related to death and dying. 2. Post-traumatic stress symptoms: Distressing NDEs can sometimes lead to symptoms of post-traumatic stress disorder (PTSD), including flashbacks, nightmares, and avoidance behaviors. 3. Spiritual crisis: Instead of deepening spiritual beliefs, distressing NDEs may lead to a crisis of faith or a sense of spiritual disconnection. 4. Difficulty integrating the experience: Unlike typical NDEs, which are often integrated into the individual's life in a positive way, distressing NDEs may be more difficult to integrate and make sense of, leading to ongoing confusion and distress. Overall, both typical and distressing NDEs can have a significant impact on individuals, shaping their beliefs, attitudes, and behaviors in profound ways. However, while typical NDEs are often described as transformative and positive, distressing NDEs can be more challenging and may require additional support and coping mechanisms to process. 5) Compare the scientific view of near-death experience and the views and research of Kübler-Ross. Specifically, what are the neuropsychological and psychosocial types of scientific explanation? Answer: The scientific view of near-death experiences (NDEs) generally seeks to explain these phenomena through neuropsychological and psychosocial perspectives. 1. Neuropsychological explanations: These explanations focus on the brain's role in producing NDEs. Some scientists argue that NDEs are the result of physiological and neurochemical processes that occur in the brain during a crisis, such as reduced oxygen supply or abnormal brain activity. These processes can lead to the activation of certain brain regions responsible for generating vivid sensory experiences, such as the feeling of floating outside the body or encountering bright lights. From this perspective, NDEs are seen as a natural, albeit extraordinary, product of brain function rather than evidence of an afterlife or spiritual realm. 2. Psychosocial explanations: Psychosocial explanations emphasize the role of psychological and social factors in shaping NDEs. Elisabeth Kübler-Ross, a prominent psychiatrist, proposed a model of the five stages of grief, which includes acceptance as the final stage. She also extensively studied death and dying, including experiences such as NDEs. Kübler-Ross viewed NDEs as a natural response to the fear of death and the unknown, suggesting that they serve as a coping mechanism for individuals facing mortality. From this perspective, NDEs are understood as meaningful psychological experiences that help individuals come to terms with death and find comfort in the face of uncertainty. In summary, while the scientific view of NDEs acknowledges their profound impact on individuals, it seeks to explain these experiences through neuropsychological and psychosocial frameworks, emphasizing the role of the brain and psychological processes in shaping these phenomena. Kübler-Ross's work contributes to the psychosocial perspective by highlighting the emotional and existential significance of NDEs in the context of death and dying. Chapter 15: The Road Ahead Test Questions Part I. Multiple Choice Questions Select the response that best answers the following questions. 1) The __________ of death refers to the process whereby we systematically isolate the experience of death from everyday life. A) isolation B) secularization C) sequestration D) equalization Answer: C 2) Our social abandonment of traditional religious belief systems about death is also known as __________. A) secularization B) sequestration C) liberation D) exemplification Answer: A 3) The professionalization of the death system in the United States exemplifies __________. A) dimensionality B) DE modernization C) DE secularization D) sequestration Answer: D 4) According to __________, human awareness of our own mortality causes fear and, in turn, psyche protection. A) social adaptation theory B) enlightenment theory C) terror management theory D) disenfranchised grief models Answer: C 5) During the ___________ scientific principles began to replace religious beliefs. A) 12th century B) Enlightenment C) Dark Ages D) Cold War Answer: B 6) __________ is often considered “the father of sociology.” A) August Comte B) Karl Marx C) Emile Durkheim D) Sigmund Freud Answer: A 7) __________ is largely responsible for the increase in hospital instead of home deaths. A) Terrorism B) Globalization C) Rationalization D) Modernization Answer: D 8) The trend of __________ creates people who are well equipped to deal with death, but also limits agency over the death, dying, and bereavement processes. A) industrialization B) professionalization C) secularization D) thanatology Answer: B 9) Max Weber describes the process of displacing the mystique of religious belief with the certainty of science and reason as __________. A) industrialization B) differentiation C) disenchantment D) professionalization Answer: C 10) Religion becomes a matter of personal faith, not social obligation as a result of __________. A) privatization B) globalization C) theology D) bereavement Answer: A 11) The United States is generally considered a __________ society. A) monolithic B) one-dimensional C) communist D) pluralistic Answer: D 12) A __________ is a cohort of people born around the same time who have similar events, trends, and developments. A) class B) generation C) panel D) trajectory Answer: B 13) The youngest generation is referred to as __________. A) Generation X B) Generation Y C) Generation Z D) The Greatest Generation Answer: C 14) Ellie lives with her mother and stepfather who recently had a child of their own Jeremiah. Which term best describes Ellie’s family? A) broken family B) instant family C) adoptive family D) blended family Answer: D 15) __________ families are those where children alternate between living with their mothers and fathers. A) Nexter B) Binuclear C) Adoptive D) Blended Answer: B 16) An infant is more likely to die from __________ than __________. A) congenital birth defects, heart disease B) stroke, SIDS C) cancer, respiratory distress D) heart disease, SIDS Answer: A 17) What generation is generally associated with ‘hippie culture’? A) The Greatest Generation B) Baby Boomers C) Generation X D) Generation Z Answer: B 18) Generation Z is broadly characterized by being born in __________. A) The Great Depression B) World War II C) digital technology D) non-diverse families Answer: C 19) The leading cause of death for young people ages 15-24 is __________. A) heart disease B) accidents C) homicide D) cancer Answer: B 20) Janet is a 90 year old woman recently diagnosed with breast cancer. Her oncologist, Dr. Johnson, wants to aggressively treat the disease with the goal of eradicating it to prolong Janet’s life as long as possible. What medical perspective does Dr. Johnson most likely prescribe to? A) the palliative model B) the medical model C) the holistic model D) the wellness paradigm Answer: B 21) What health care perspective accepts death as the normal conclusion of life? A) the wellness paradigm B) the medical model C) the diagnostic paradigm D) the intensive care model Answer: A 22) According to Joan Erikson, the ninth and final stage of human development is __________. A) self-awareness B) humility C) existentialism D) gerotranscendence Answer: D 23) The process of __________ lessens in intensity over time and eventually recedes into the background of daily life, but never completely goes away. A) bereavement B) grief C) transcendence D) human development Answer: B 24) It is more common for individuals to experience __________ than __________. A) normal grief, complicated grief B) complicated grief, normal grief C) chronic grief, complicated grief D) complicated grief, chronic grief Answer: A 25) Being inadequately prepared for death increases one’s risk of __________. A) bereavement B) heart disease C) complicated grief D) mourning Answer: C Part II. Essay Questions Answer the following questions in your own words. 1) Explain how the concept of secularization relates to thanatology. How does secularization impact the death, dying, and bereavement processes in contemporary society? Answer: Secularization, in the context of thanatology (the study of death, dying, and bereavement), refers to the process by which society becomes less influenced by religious beliefs, practices, and institutions. This trend has significant implications for how individuals experience and perceive death, dying, and bereavement in contemporary society. One major impact of secularization is the shift in the way people understand the meaning and significance of death. In religious societies, death is often viewed as a transition to an afterlife or a part of a divine plan. However, in secularized societies, death is often seen as a natural and inevitable part of life, with no inherent spiritual or supernatural meaning. This can lead to a more pragmatic and rational approach to death, focusing on practical matters such as medical care, legal issues, and funeral arrangements. Secularization also affects the rituals and practices surrounding death and dying. In religious societies, these rituals are often deeply rooted in religious beliefs and traditions, providing comfort and guidance to the bereaved. In secularized societies, however, there may be a greater diversity of beliefs and practices, with individuals and families creating their own rituals or drawing on a mix of religious and secular traditions. Additionally, secularization can impact the support and care available to the dying and the bereaved. In religious societies, religious institutions often play a central role in providing spiritual guidance, emotional support, and practical assistance. In secularized societies, these roles may be taken on by other institutions, such as healthcare providers, counseling services, or community organizations, or individuals may rely more on their own resources and social networks for support. Overall, secularization has led to a more individualized and diverse approach to death, dying, and bereavement in contemporary society, with less reliance on traditional religious beliefs and practices and more emphasis on personal beliefs, values, and experiences. 2) Describe how generational membership might impact an individual’s understanding of death and dying. In your essay compare and contrast at least two major generations. Answer: Generational membership can significantly influence an individual's understanding of death and dying, as each generation tends to have distinct cultural, social, and historical experiences that shape their perspectives. Two major generations that can be compared and contrasted in terms of their understanding of death and dying are the Baby Boomers and Generation Z. 1. Baby Boomers (born approximately 1946-1964): • Influence of Religion: Baby Boomers, especially those raised in traditional households, often have a strong influence of religion on their understanding of death. Many Baby Boomers grew up in religious communities where death was often viewed as a transition to an afterlife, and religious rituals played a significant role in the grieving process. • Experience with Loss: Baby Boomers have experienced significant societal changes, including wars, civil rights movements, and economic fluctuations. These experiences have often shaped their understanding of mortality and the importance of cherishing life. • Views on Aging and End-of-Life Care: Baby Boomers are now reaching older ages, and many are facing issues related to aging and end-of-life care. They may have different perspectives on death and dying compared to younger generations, with a greater emphasis on quality of life and end-of-life planning. 2. Generation Z (born approximately mid-1990s to early 2010s): • Digital Native Generation: Generation Z has grown up in a digital age, where information about death and dying is more accessible than ever before. This easy access to information may impact their understanding of death, making it seem more familiar and less mysterious. • Influence of Social Media: Social media has become a significant part of how Generation Z communicates and expresses themselves. This includes how they grieve and memorialize loved ones online, which can shape their understanding of death and dying in a more public and interconnected way. • Environmental Concerns: Generation Z is known for its strong focus on environmental and social issues. This concern for the planet and future generations may influence their views on death and dying, leading to a greater emphasis on sustainability and eco-friendly funeral practices. In conclusion, generational membership can play a significant role in shaping an individual's understanding of death and dying. While Baby Boomers may have a more traditional and religious view influenced by their upbringing and societal experiences, Generation Z may have a more digital, interconnected, and environmentally conscious perspective. 3) In what ways can we argue health-care professionals are becoming more aware of the depersonalization and dehumanization of death and dying? What are some of the theoretical frameworks, movements, and practices that, in recent years, have ‘rehumanized’ the experience of death and dying? Answer: Health-care professionals are increasingly recognizing and addressing the depersonalization and dehumanization of death and dying in several ways: 1. Patient-Centered Care: There is a growing emphasis on patient-centered care, which focuses on the individual needs and preferences of patients. This approach recognizes the importance of treating patients as whole persons, including addressing their emotional and spiritual needs during the dying process. 2. Communication Skills Training: Health-care professionals are receiving more training in communication skills, including how to have difficult conversations about death and dying with patients and their families. This training helps professionals convey empathy and compassion, enhancing the human connection in end-of-life care. 3. Palliative Care and Hospice Services: Palliative care and hospice services aim to provide holistic care for patients with serious illnesses, focusing on improving quality of life and addressing physical, emotional, and spiritual needs. These services prioritize dignity and comfort, helping to rehumanize the dying experience. 4. Death Education Programs: Some health-care institutions are implementing death education programs for their staff, which provide information and training on death, dying, and bereavement. These programs help increase awareness of the human aspects of death and dying among health-care professionals. 5. Narrative Medicine: Narrative medicine emphasizes the importance of listening to patients' stories and understanding their experiences of illness and dying. This approach helps health-care professionals connect with patients on a deeper level, acknowledging their humanity in the face of death. 6. Death Cafés and Death Over Dinner: These movements encourage open and honest discussions about death and dying in informal settings. By normalizing conversations about death, they help rehumanize the experience and reduce stigma surrounding end-of-life issues. 7. Compassionate Communities: Some communities are implementing compassionate care initiatives, which aim to support individuals and families facing death and dying. These initiatives involve community members in providing emotional and practical support, reestablishing a sense of community and humanity in the dying process. In conclusion, health-care professionals are becoming more aware of the depersonalization and dehumanization of death and dying, and they are implementing various theoretical frameworks, movements, and practices to rehumanize the experience. These efforts are essential for ensuring that individuals facing death receive compassionate and dignified care. 4) Discuss the various ways individuals deal with the financial aspects of end-of-life care and death. What social programs are available to assist people financially? What are the strengths and limitations of these programs? Answer: Dealing with the financial aspects of end-of-life care and death can be challenging for individuals and families. Various ways people manage these costs include: 1. Insurance: Many individuals have health insurance that covers some or all of the costs associated with end-of-life care. This can include hospital stays, medication, and hospice care. Some individuals also have life insurance policies that provide financial support to their beneficiaries upon their death. 2. Savings and Investments: Some people use their savings or investments to cover end-of-life care costs. This can include using retirement savings, selling assets, or using funds from investment accounts. 3. Government Programs: Several government programs are available to assist people financially with end-of-life care and death. These include: • Medicare: Medicare is a federal health insurance program for people aged 65 and older, as well as some younger people with disabilities. It covers some hospice care costs for terminally ill individuals. • Medicaid: Medicaid is a joint federal and state program that helps with medical costs for people with limited income and resources. It covers a broader range of services than Medicare, including long-term care in nursing homes. • Social Security Survivor Benefits: Social Security provides survivor benefits to the spouse, children, or parents of a deceased worker. These benefits can help cover living expenses after the death of a family member. 4. Charitable Assistance: Some charitable organizations provide financial assistance to individuals and families facing end-of-life care costs. These organizations may offer grants or other forms of support to help cover medical expenses. 5. Crowdfunding: In recent years, crowdfunding platforms like GoFundMe have become popular ways for individuals to raise money to cover medical and end-of-life care costs. These campaigns can help supplement other forms of financial support. While these programs and strategies can provide valuable assistance, they also have limitations: • Coverage Gaps: Some individuals may not qualify for certain government programs or may find that their insurance coverage is insufficient to cover all their end-of-life care costs. • Financial Burden: Even with insurance and government programs, end-of-life care can be expensive, especially for individuals with limited financial resources. • Complexity: Navigating the various programs and options for financial assistance can be complex and overwhelming, especially for individuals and families already dealing with the stress of illness and death. • Availability: Not all individuals have access to the same level of financial assistance, depending on factors such as income, location, and eligibility criteria. In conclusion, while there are various ways individuals can manage the financial aspects of end-of-life care and death, including insurance, government programs, and charitable assistance, there are also limitations to these programs. Efforts to improve access to affordable end-of-life care and support for individuals and families facing financial hardship are ongoing. 5) At the conclusion of this chapter the author presents a list of things an individual can do to prepare for their own death. What are some of these things? What challenges might an individual face, practical or otherwise, in preparing for their death? Answer: At the conclusion of the chapter, the author presents a list of things an individual can do to prepare for their own death. Some of these things include: 1. Advance Directives: Create advance directives, such as a living will or durable power of attorney for healthcare, to outline your wishes for medical care in the event you are unable to communicate them yourself. 2. Financial Planning: Make financial arrangements for your end-of-life care, including setting up a trust or establishing a funeral plan to cover expenses. 3. Legal Matters: Ensure your legal affairs are in order, including creating or updating your will, and making arrangements for the distribution of your assets. 4. Communicate Your Wishes: Have conversations with your loved ones about your wishes for end-of-life care, burial or cremation, and other important decisions. 5. Emotional and Spiritual Preparation: Engage in activities that bring you peace and comfort, such as meditation, prayer, or spending time with loved ones. Challenges an individual might face in preparing for their death include: 1. Emotional Challenges: Facing one's mortality and making decisions about end-of-life care can be emotionally difficult and may require support from loved ones or mental health professionals. 2. Financial Challenges: Planning for end-of-life care can be costly, and individuals may need to navigate complex financial matters to ensure their affairs are in order. 3. Logistical Challenges: There are many logistical details to consider when preparing for death, such as making funeral arrangements, updating legal documents, and ensuring that one's wishes are clearly communicated and documented. 4. Family Dynamics: Family dynamics and relationships can add complexity to end-of-life planning, as not all family members may agree on the best course of action or may have different ideas about how to handle the process. 5. Cultural and Religious Considerations: Cultural and religious beliefs may influence how an individual approaches end-of-life planning and may present challenges in balancing personal wishes with cultural or religious traditions. Overall, preparing for one's own death can be a challenging and deeply personal process, but taking the time to plan and communicate your wishes can help ensure that your end-of-life care is managed according to your preferences and provide peace of mind for both you and your loved ones. Test Bank for Death, Dying and Bereavement in a Changing World Alan R Kemp 9780205961009
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