Mortality and motivations: Clinicians’ integrity engaging death within complex cultural context

Christopher Jenner

VAMC Togus, Winthrop, USA.

DOI: 10.4236/ojn.2013.31011                

Abstract

This broad ranging discussion examines the clinical encounter and deconstructs psychological and cultural context and implications, finally honoring the comprehensive awareness that the clinician requires for best practice in encountering mortality. Clinicians engage client disease and dying presentions, and ultimate mortality. Communicating mortality openly or subliminally is not always conscious. Mortality awareness can produce stress and untoward behaviors. Psychological mortality avoidance, citing Kierke-gaard’s existential paradox, and the death (in both senses) of Joseph Campbell’s cultural hero illumine socio-cultural elements including the elusive “good death”, sequestration of death from society, and the concept of managing death in volume. Cultural diversity awareness and the concept of transcendence clarify outlier and hybrid cultural client presentations demanding maximal clinician flexibility. Mortality Salience Theory predicts contracted world view when confronted with mortality, demanding sensitivity to a variety of responses. A hospice approach may not be best for some, despite a lack of new alternative to that paradigm. Managing mortality awareness and dying stresses the clinician by the weight and loneliness of perhaps unpopular decisions, by responsibility to community in managing death, and by the take-home exposure of the clinician’s family to the concept of death and mortality. Aptitude for managing death depends on clinician self awareness and a good match with practice venue. Clinician integrity and consciousness of motives and responses allows engagement or deferral as necessary without threat to identity.

Keywords

Death Avoidance; Mortality; Cultural Awareness

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Peretti-Watel, P., Bendiane, M., Obadia, Y., Lapiana, J., Galinier, A., Pegliasco, H., et al. (2005) Disclosure of prognosis to terminally ill patients: Attitudes and practices among French physicians. Journal of Palliative Medicine, 8, 280-290. doi:10.1089/jpm.2005.8.280
[2]	Tse, C., Chong, A. and Fok, S. (2003) Breaking bad news: A Chinese perspective. Palliative Medicine, 17, 339-343. doi:10.1191/0269216303pm751oa
[3]	Froggatt, K. (1997) Rites of passage and the hospice culture. Mortality, 2, 123-136. doi:10.1080/713685862
[4]	Ardeldt, M. (2003) Wisdom, religiosity, purpose, and death attitudes of hospice patients, nursing home residents, and community-dwelling elders. The Annual Meeting of the American Sociological Association, Atlanta, 16 August 2003.
[5]	Smith, G.S. (1995) How well are we doing with dying? Maine Health Care Association Symposium, Sunday River.
[6]	Becker, E. (1973) Denial of death. Simon and Schuster, New York.
[7]	Marrone, R. (1999) Dying, mourning, and spirituality: A psychological perspective. Death Studies, 23, 495-519. doi:10.1080/074811899200858
[8]	Neimeyer, R.A. (2008) Death anxiety. http://64.233.169.104/search?q=cache:ZQWncGaZF_4J:web.mac.com/neimeyer/iWeb/Site/Scholarship_files/Dea th%2520Anxiety.doc+Neimeyer+death+anxiety&hl=en&ct=clnk&cd=2&gl=us
[9]	Griffie, J., Nelson-Marten, P. and Muchka, S. (2004) Acknowledging the “elephant”: Communication in palliative care: Speaking the unspeakable when death is imminent. American Journal of Nursing, 104, 48-58. doi:10.1097/00000446-200401000-00019
[10]	Eggly, S., Penner, L., Albrecht, T., Foster, T., Naughton, M., Peterson, A. and Ruckdeschel, J. (2006) Discussing bad news in the oncology clinic: Rethinking current guidelines. Journal of Clinical Oncology, 24, 716-719. doi:10.1200/JCO.2005.03.0577
[11]	University of Washington School of Medicine (2008) End-of-life issues: What is a good death: A medical perspective? Ethics in Medicine. http://depts.washington.edu/bioethx/topics/eol.html#ques1
[12]	MacDonald, D. (1992) Hospice patients without primary care givers: A critique of prevailing intervention strategies. Home Healthcare Nurse, 10, 24-26. doi:10.1097/00004045-199201000-00006
[13]	Randall, F. and Downie, R.S. (2006) The Philosophy of palliative care: Critique and reconstruction. Oxford University Press, Oxford. doi:10.1093/acprof:oso/9780198567363.001.0001
[14]	Ellershaw, J. and Ward, C. (2003) Care of the dying patient: the last hours or days of life. BMJ, 326, 30-34. doi:10.1136/bmj.326.7379.30
[15]	Zimmermann, C. and Rodin, G. (2004) The denial of death thesis: Sociological critique and implications for palliative care. Palliative Medicine, 18, 121-128.
[16]	Kaufman, S.R. (2005) A time to die: How American hospitals shape the end of life. Scribner, New York.
[17]	Rich, B.A. (2003) Reflections on the social construction of death. The Journal of Legal Medicine, 24, 233-240. doi:10.1080/713832156
[18]	Peck, M.S. (1978) The road less traveled. Simon & Schuster, New York.
[19]	Bassett, J. (2007) Psychological defenses against death anxiety: Integrating terror management theory and firestone’s separation theory. Death Studies, 31, 727-750. doi:10.1080/07481180701490628
[20]	Eisenstein, C. (2008) Life, death and the struggle against the world. The Ascent of Humanity. http://www.ascentofhumanity.com/chapter5-3.php
[21]	Devries, R.G. (1979) Birth and death: The social construction of cosmic status passage. Annual Meeting of American Sociological Association, Boston, 27-31 August.
[22]	Taubman-Ben-Ari, O. and Findler, L. (2005) Proximal and distal effects of mortality salience on willingness to engage in health promoting behavior along the life span. Psychology & Health, 20, 303-318. doi:10.1080/08870440512331317661
[23]	Arndt, J., Routledge, C. and Goldenberg, J. (2006) Predicting proximal health responses to reminders of death: The influence of coping style and health optimism. Psychology & Health, 21, 593-614. doi:10.1080/14768320500537662
[24]	Seale, C. (1998) Constructing death. The sociology of dying and bereavement. Cambridge University Press, Cambridge.
[25]	Rousseau, J. (1765) Cole, G.D.H., Trans. (2005) The social contract. Barnes and Noble, New York.
[26]	Timmermans, S. (2005) Death brokering: Constructing culturally appropriate deaths. Sociology of Health and Illness, 27, 993-1013. doi:10.1111/j.1467-9566.2005.00467.x
[27]	Berta, P. (2007) Death as empirical taboo and the consequent ambivalence; the concept of death as social product. Afterlife in the Cross-Cultural Perspective Forum. Encyclopedia of Death and Dying. http://www.deathreference.com/A-Bi/Afterlife-in-Cross-Cultural-Perspective.html
[28]	Devries, R.G. (1981) Birth and death: Social construction at the poles of existence. Social Forces, 59, 1074-1093.
[29]	Kierkegaard, S. (1963) Sickness unto death. http://books.google.com/books?id=eeOMT5Sm4dwC&dq=sickness+unto+death&pg=PP1&ots=i_vts3vLt7&source=bn&sig=vmjUSRlpvpwpXCL97Q9e6kvWM6w&hl=en&sa=X&oi=book_result&resnum=4&ct=result#PPP1,M1
[30]	Camus, A. (1942) The myth of Sisyphus. Penguin, New York.
[31]	Maslow, A. (1973) Theory of human motivation. In: Lowry, R.J., Ed., Dominance, Self-Esteem, Self-Actualization: Germinal Papers of A. H. Maslow, Brooks/Cole, Pacific Grove.
[32]	Campbell, J. (1968) The hero with a thousand faces. 2nd Edition, Bollingen, Princeton.
[33]	Kuebler-Ross, E. (1969) On death and dying. Scribner, New York.
[34]	Kuebler-Ross, E. and Kessler, D. (2003) On grief and grieving: Finding the meaning of grief through the five stages of loss. Scribner, New York.
[35]	Curtis, M. (2003) What is a good death?: Death cannot be tamed. BMJ, 327, 1047. doi:10.1136/bmj.327.7422.1047-b
[36]	Hart, B., Sainsbury, P. and Short, S. (1998) A sociological critique of the “good death”. Mortality, 3, 65-77. doi:10.1080/713685884
[37]	Hendin, H. (1995) Selling death and dignity. International Task Force on Euthanasia and Assisted Suicide. http://www.internationaltaskforce.org/selling.htm
[38]	Jones, J. (2003) Letter: In search of a good death: What is a good death? BMJ, 327, 224. doi:10.1136/bmj.327.7408.224
[39]	RADAR (2008) Assisted dying: The facts. www.radar.org.uk
[40]	National Hospice and Palliative Care Organization (2007) NHPCA facts and figures: Hospice in America. www.nhpco.org/research
[41]	Gorer, G. (1965) Death grief and mourning. Cresset, London.
[42]	Clark, D. (2002) Between hope and acceptance: The medicalization of dying. BMJ, 324, 905-907. doi:10.1136/bmj.324.7342.905
[43]	Doorenbos, A.Z., Schim, S.M., Benkert, R. and Borse, N.N. (2005) Psychometric evaluation of the cultural competence assessment instrument among healthcare providers. Nursing Research, 54, 324-331. doi:10.1097/00006199-200509000-00006
[44]	Walzer, P. (2008) Mandatory diversity training may do more harm than good. The Virginian-Pilot. http://hamptonroads.com/node/482963
[45]	Kalev, A., Dobbin, F. and Kelly, E. (2006) Best practices or best guesses? Assessing the efficacy of corporate affirmative action and diversity policies. American Sociological Review, 71, 589-617. doi:10.1177/000312240607100404
[46]	Beliefnet (2008) Transition rituals; death rites for major world religions. http://www.beliefnet.com/story/78/story_7894.html
[47]	Beshai, J.A. (2008) Are cross-cultural comparisons of norms on death anxiety valid? Omega, 57, 299-313.
[48]	Ostaseki, F. (2008) Zen and the good death. Zen Hospice Project. http://www.amitabhahospice.org/public/spiritual_support/zen_and_the_good_death.php
[49]	Mosher, C. and Danoff-Burg S. (2007) Death anxiety and cancer-related stigma: A terror management analysis. Death Studies, 31, 885-907. doi:10.1080/07481180701603360
[50]	Florian, V., Mikulincer, M. and Hirschberger, G. (2001) An existentialist view on mortality salience effects: Personal hardiness, death-thought accessibility, and cultural worldview defense. British Journal of Social Psychology, 40, 437-453. doi:10.1348/014466601164911
[51]	Smith, W. (2008) Unpublished interview. Togus Veterans Administration Medical Center, Augusta.