1. Exploring Death as a Series of Losses and Facilitating an “Appropriate Death” A Presentation by Elizabeth Causton, MSW

2. “The dying process midwifes a person into depth” Dr. Michael Kearney from “Mortally Wounded ” Good palliative care provides the dignity of good symptom control with the integrity of a holistic approach in order to make this inner shift into depth possible

3. Baggage Beliefs Opinions Prejudices Values Biases Blindspots How we define and respond to loss, just as how we define a good or bad death is subjective, personal and profoundly influenced by the baggage we all carry

4. Questions to consider to increase self awareness: In my experience death is…. For me an acceptable quality of life exists when…. The choices that I believe should be available to people at end of life are…. I think that ‘bad things happen to good people’ because….

5. Death as a series of losses One’s future A sense of safety and predictability Work and activities Roles Physical image Ongoing change and loss are certain

6. What is perceived as a loss is what is grieved Companionship / privacy Prepared meals / prepared meals Help in the home / help in the home What is perceived as a loss also affects the quality of one’s life

7. Anticipatory Grief: the grieving that occurs before death for what has already been lost as well for what will be lost it is not the same as, nor does it replace bereavement

8. Exercise on Loss: Series of losses First reaction

9. Common first reactions: Anger Fear Denial With greater awareness we can work with less judgement and more compassion

10. Bad Death In pain Alone Burning Choking Drowning As the result of violence Confused Unable to communicate Young Old Lingering Sudden In hospital Incontinent With unresolved business/relationships Afraid Without dignity In chaos Others???

11. Good Death Pain free Peaceful With loved ones At home Old (very old) With music Accepting Prepared Sudden With time to say goodbye In sleep Able to communicate Dignified In control With good scotch on the mouth swab Others???

12. “Appropriate Death” * a death with dignity in the context of who a person is as an individual and in their relationships with others *a Mansell Pattison term

13. Facilitating an Appropriate Death Making sure the patient/resident is as comfortable as possible ( or as they want to be) Asking the questions that explore context and history Giving accurate information with compassion so that patients and families can make informed choices…without judgement

14. Empowering information about the possibility of choosing one’s time of death “Dad was a very private man” “I won’t tell him our daughter’s on the way” “Wasn’t that just like mom”