6-2 Short Paper PSY 225

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Apr 29, 2024

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1 Future Directions of Health Psychology Barbara Ruiz Department of Psychology, Southern New Hampshire University PSY 225: Health Psychology Dr. LaVerne Chandler April 27, 2024

2 The PBS Frontline production entitled “Facing Death” was extremely emotionally difficult to watch all the way through. It brought to life the different and often tough decisions that people have to make when it comes to end-of-life treatment, including the decision to end treatment or sign a do-not-resuscitate order. These decisions are sometimes made by the patient; however, can also be made by a patient’s power of attorney or healthcare proxy. This video solidified my decision not to be sustained on artificial life support should I fall ill with no hope of improvement and I already have an advanced directive in place from when I had 2 brain surgeries. Should I ever become terminally ill, I would also sign a DNR. There are many issues involved in end-of-life decision-making. One of the issues discussed in this production surrounding this is the decision to withhold or withdraw intervention or treatment. Factors that can affect this decision are the patient’s personal feelings or wishes, the wishes of a healthcare proxy, the patient’s health status, and whether or not there is benefit in continuing intervention. Other factors that can influence end-of-life decision-making, particularly when it comes to family caregivers, are personal characteristics such as housing situation, patient needs, and preferences. Also discussed from the point of view of the medical providers was a good death versus a bad death, goals in working towards a decent death for the patients portrayed, whether or not a patient was actively dying, hospice care approach, compassion, making sure the patient and family understand all options, and how the physicians feel personally and some of the difficult decisions that need to be made.

3 The Kubler-Ross model of the five stages of grief is important when trying to understand a terminally ill patient, their family, as well as decision-making in end-of-life scenarios. In 1969, Elisabeth Kubler-Ross described five common stages of grief including denial, anger, bargaining, depression, and acceptance. The initial stage, denial, may lead to a patient thinking that life makes no sense and has no meaning, and it can be quite overwhelming. This can lead to feelings of avoidance, confusion, elation, shock, and fear. Next comes anger where reality begins to set in. Commonly, patients have thoughts of life not being fair or asking the question, “Why me?” Frustration, irritation, and anxiety are often experienced. An example of bargaining would be trying to make a deal with God, whether it is a patient or one of the family members or friends. “Please God, if you heal my husband, I will be the best wife I can be and never complain again.” Struggling to find meaning, reaching out to others, and sharing one's story are present within the bargaining stage. Depression is a symptom that is commonly and strongly associated with grief. Being overwhelmed, feelings of helplessness, hostility, and flight are often expressed. In this stage, a patient might withdraw from life, feel numb, live in a fog, or not want to get out of bed. The last stage, acceptance, can involve exploring new options, having a plan in place, and moving on. It does not necessarily mean that everyone involved is okay with the dying process itself, it just means that everyone is going to be okay no matter what happens (Psycom, 2022). Based in the Intensive Care Unit at Mount Sinai Hospital in New York City, one of the examples of these stages that stands out to me is that of John Moloney and his wife. John, who was diagnosed with multiple myeloma at the age of 55, had been in the hospital for nearly 9 months with multiple complications. Previously a corrections officer, he had tried every available treatment, including two bone marrow transplants; however, his myeloma continued to return. He was initially in an extensive stage of denial, continuing to reiterate to his wife that he

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