Learning for life? – a brief look at death education

Orla Keegan, Irish Hospice Foundation

Our poet

• Noli timere

• Do not be afraid.

Death

• Death anxiety

• Terror management

• Death avoidance

• Death denial

• ‘Societies are standardised systems of death denial’ Ernest Becker

– Consciousness of death and realisation of death underpinning all human action

– Culture gives us meaning and defence against this; a symbolic sense we can live forever

Kicked the bucket....

Pushing up daisies....

Popped their clogs

Komaromy, C. and Woodthorpe, K. (2011) Investigating mortuaryservices in hospital settings.

• An association with death was a potential barrier to communicating with colleagues outside of the mortuary, as the APTs found themselves stigmatised by what they perceived to be and what would be called sociologically their literal ‘embodiment’ of medical failure. This could be isolating for the APTs, to the point that when they went to other hospital departments, they were treated with caution.

Yalom – Staring at the sun

• Fear of death as a primary source of anxiety; hard-wired

Consequences

• Psychologically defended but

– Less compassionate

– Less balanced

Man’s inhumanity to man....

Yalom – Staring at the sun

• Fear of death as a primary source of anxiety; hard-wired

• ‘I feel strongly as a man who will himself die one day... that confronting death allows us not to open some ... Pandora’s box but to re-enter life in a richer, more compassionate manner’

Confront death, learn about it... can be a way of enriching our life

• The aim of education about death, dying, and bereavement is to contribute to general education as a basis for personal development and responsible social participation. It must also contribute to the specific education of those who, as a result of personal or professional circumstances, are closely associated with dying, death, and bereavement.

Traditional Modern Neo-modern

Bodily Context

Death quick and frequent

Death hidden

Death prolonged

Social Context

Community Public vs private

Private becomes public

Authority Religion Medicine Self

Walter, 1994

• If the tide is turning towards ‘self’ there is a move towards sense making, meaning making, control and this is a trend in personal and professional life.

• One that is amenable to education and support

– Public

– Professional

– Personal

• Public empowerment – knowledge, understanding, comfort, language

• Professionals –technical and interpersonal skills

• Personal learning

http://www.independent.co.uk/life-style/health-and-families/features/the-death-cafe-movement-tea-and-mortality-8082399.html

Community Engagement at 3rd International Public Health and Palliative Care Conference

Professional education

ALL

SOME

FEW

Competencies(AIIHPC, HSE, IHF & IAPC, 2013)

• The Principles of Palliative Care

• Communication

• Optimizing Comfort and Quality of Life

• Care Planning and Collaborative Practice

• Loss, Grief and Bereavement

• Professional and Ethical Practice in the context of Palliative Care

Personal

• Self-awareness involves both a combination of self knowledge and development of dual-awareness, a stance that permits the clinician to simultaneously attend to and monitor the needs of the patient, the work environment, and his or her own subjective experience.

Kearney et al, Self-care of Physicians Caring for Patients at the End of Life

Working with death, dying, pain and loss

• Compassion fatigue has been described as the “cost of caring” for others in emotional pain

• Compassion satisfaction is pleasure derived from the work of helping others.

• “To cure sometimes, to relieve often, to comfort always,”

Model(s) for death education...

Cognitive.... Information....

Experiential

Arts

Lifecycle

a basis for personal development and responsible social participation.

Conclusion

• Death education... More than just a class

• Context for how students – and staff – are inducted

• Context for donors’ journeys; and donors’ families’ journeys

• Context for how we approach people who are bereaved

References

• International work group on death, dying and bereavement (1992) International work group on death, dying, and bereavement: A statement of assumptions and principles concerning education about death, dying, and bereavement, Death Studies, 16:1, 59-65

• Becker, E (1973) The denial of death New York: Free Press

• Kearney, M. K., R. B. Weininger, et al. (2009) "Self-care of Physicians Caring for Patients at the End of Life: "Being Connected . . . A Key to My Survival"." JAMA 301(11): 1155-1164.

• Komaromy, C. and Woodthorpe, K. (2011) Investigating mortuary services in hospital settings. CDAS report http://opus.bath.ac.uk/22612/

• Walter, (1994) The revival of death London; Routledge

• Yalom, Irvin D. 'Staring at the Sun: Overcoming the Terror of Death', The Humanistic Psychologist, 36:3, 283 – 297

http://hospicefoundation.ie/the-irish-hospice-foundation-pays-tribute-to-seamus-heaney-2/

• “I was thinking of when a tree is cut down; for a moment it’s as if the air is shaken and there is a new space in the world… an emptiness. So that clearances that stood open when the spirit goes... that’s what I was thinking of.I think that it’s very important that for the survivors, that they are there when that clearance happens, when that tree falls and when the moment of change is registered in them… it’s very simple, very mysterious, nothing like it ever happens anywhere else.”