Workshop 2- Issues around death and dying

Need to consider different cultural viewpoints Western, encouraged to talk about death Other parts of the world its the opposite, its taboo We are going to have to respond to that, what do we say to people who are dying? How do you respond to someone who has a different viewpoint/culture to yours? Cultural background is what we need to be competent pharmacist.

How can we be involved in the grief process? Filling their prescriptions o Whats on it can give you an idea of their condition o Frequency of prescriptions, tends to increase as they get more ill o Person coming in may no longer be the one picking it up, it might be a caregiver Overall, they wont come up and say Im dying, you should be picking up on hints How can we help? o Offer different ways of giving medicines, like blister packing o Treat them with respect when talking to them; you dont want to make their already bad lives worse. Empathy, is even more important here as well o So do your job as well as possible There are five stages of grief o Denial Deny youre dying or someone else is dying (reject diagnosis; can lead to later stage cancer etc.) o Anger Why me? o Bargaining If family member is dying, offer to take their place o Depression Not the clinical illness Sadness o Acceptance Finally come to the terms of whats happening Will respond properly (like to treatment), theyre calmer Can happen rapidly, take a while, skip a few or not even in that order. Case Elderly man with multiple diseases with multiple medicines Regularly visiting GP o Doctors keep changing medicines after symptoms (pain) and different tests We can notice this through different prescriptions o Pain doesnt improve, gets referred to hospital after 5 weeks after initial referral Long delay because its not an emergency o Reviewed by GP in the meantime, abdominal lump found Admitted to hospital

Discharged after 2 weeks for terminal care (palliative care) Lots of people involved now How can we deliver medicines well? Help the family out as well Family gather around GP and District Nurses visit- support the family in looking after patient; medication care o i.e. were also important here 5 days after discharge, patient dies with family attending; peaceful. o Everyone has been able to do their part o That includes the pharmacist as well

Reading and discussion 1. In what ways have ideas about what constitutes a good death changed over time in Western societies? Instantaneous death vs. long drawn out death; a challenge today is how to die well from the slow, degenerative diseases of old age. o Used to be infectious diseases killing people off o How long does a person have to live to die a good death? More religious back then, religion and secularism influence ideas about the good death o Searched for the priest instead of a doctor o Secularism was associated with the rise of the individual o Lets them organise their death their own way to make a good death. A good death depends on the culture and changes over time o Did they follow their rules/processes which constitute a good death? o E.g. the maid died a good death, died at home after seeing a priest. Not being in a hospital being seen by a doctor today Autonomy valued these days, individualistic societies promote the personal autonomy of the dying, including palliative care and voluntary euthanasia o Not so much back then o Plus autonomy is lost over time for some current diseases, like dementia There are different notions of the good death, especially in a multicultural society o So we need a good background

NOTE: Read the box summary points in the paper 2. In a modern multicultural society, what three factors does the author believe influences ideas about a good death? Explain. Religion and secularisation Community and individual Quick dying, slow dying

Approaches to death among NZs cultures and faiths Religious vs. non-religious o Non-religious Although they might identify themselves as non-religious, people still have some sense of spirituality

Therefore, some non-religious people while theyre dying may start to explore or ask questions like what was the purpose in life They might even want to talk to a chaplain or asked to be prayed for Falling back on religion Bargaining phase of grief However, it is important not to force this upon the person, emphasis is placed that they are able to make decisions i.e. individualism This is reflected in their funerals, as non-religious people can ask for a hymn to be sung However, there is a great deal of individualism, people are free to have a funeral their way o Religious Presbytarian Different parishes Wide range of attitudes/diversity in death Make arrangements with minister in advance They get to choose between burial or cremation Minister visits the dying person, as companion or rebuild relationships or remove sins Afterlife debatable Funeral can be anywhere, individual choice Ministers will be there for support for anyone Samoan vs. Fijian o Similarities Always family to be around the body, but in Samoa is was both post and pre mortem, while the Fijians will fiercely guard the body afterwards People sleeping beside the coffin Both had a great gift giving ceremony-type thing If it was a chief, it would have to be more lavish Women deal with the body, while men prepare everything else Mourning restricted to women, men need to be stoic Both prefer burial Chinese and Indian o Indian Main is Hinduism Teach acceptance around death Believes in karma, reincarnated better if acting good Family handles bodies, men must handle men and vice versa 30 days for no cooking at the deceaseds home Cremation preferred 30 days= earthly ties cut Sihkism Same, but men dont have to handle men Only cremated, dont believe in headstones 30 days as well o Chinese Quite similar Specific numbers and colours are important (white and 4) Family members will come back to pay tribute (otherwise shamefur display) Bad deeds= can be punished later

Body dressed in best clothes, and gives jade and stuff Burns paper and food to ensure they have stuff in the afterlife Cremation is preferred, have pots which are placed where it has good fengshei After the funeral, they come together to celebrate and share memories Maori ideals (older and newer traditions) o New: o A woman had to stay with the body, eat with it etc. o Fufil all the needs (spiritual and medical) o Quite comfortable around death o Changing views about the tangi experience o Dont have to fight to have to return it to the place of birth o People dont tend to travel back to the funeral around the world, because of cost o Important for people to die at home o The Maori way is diverse, changing o Old: o Call to welcome during funeral, encourage to come around to pay their respects o Before death, would encourage to come Private room for Maori people in hospitals to cater for rituals etc. o Combination of maori beliefs, Christian beliefs and medicine o They dont bury people right away, place in the meeting house o Wailing and crying from immediate family o Speeches from the elderly, conveys sadness and pain o Monetary gift to the family to cover costs and to cover grief o Respect via rubbing of noses o Support by everyone having their roles around the funeral e.g. kitchen o Burial

In other words, just have an idea about the diversity around NZ with regards to death and dying THEREFORE: RESPECT is important. You cant learn all these different things, just be aware and sensitive to peoples needs, just google it if you want to be more sensitive.