Breaking The Taboo: Briniging Death Into Coaching : Breaking The Taboo: Briniging Death Into Coaching Death as a part of life As presented by Dr. Daniel Leviton and Rose Woodruff, CPCC at the Capital Coaches Conference June 1 2007, Washington, DC


Boldly Coaching Death: Boldly Coaching Death Introduction Death Language Key Concepts Appropriate Death Grief and Bereavement Horrendous Death Conclusion


Language Affects Behavior and Can Arouse Emotion: Language Affects Behavior and Can Arouse Emotion Language affects behavior at the perceptual, autonomic, and central nervous system levels Coaching is about using language to arouse emotion. Some language evokes strong emotions… Ethnic/racial language Political language or 'spin' Propaganda Sex Death


Death Language is Taboo: Death Language is Taboo To coach others on the topic of death, we must be able to easily and matter-of-factly use the language of death. What makes talking about death hard? What emotion swells inside of you at the mention of: Death? Corpse? Burial? Funeral? Afterlife (Heaven or Hell)?


Our Society Has Created Euphemisms to Make Death Less Real: Our Society Has Created Euphemisms to Make Death Less Real What euphemisms do you know for: Dying? Death? Dead Corpse? Burial? Funeral? Grave? Afterlife (Heaven or Hell)? Suicide?


Key Concepts: Key Concepts Fear of Death Working with any client fearing/denying death Working with dying person Working with bereaved person Religion in death Social Distance


Fear of Death: Fear of Death Type and style of death → Fear of death → Denial → Removal of denial → Action Most people say, 'If I die…' They miss the point that for every person it’s not 'if I die' but 'When I die…' When do you expect to die?


Goal of Working With The Client Who Fears or Denies Death: Goal of Working With The Client Who Fears or Denies Death We have been taught to run from death and fear death our whole lives. As people get older/closer to death or are reminded of their mortality, that fear bubbles up to their conscience thought. They feel a need to talk about it, but often don’t articulate what the feeling is. The coach facilitates the exploration of attitudes, fears, beliefs, and perspectives on death.


Goal in working with Dying Person is Appropriate Death: Goal in working with Dying Person is Appropriate Death Communication and Maximum Control When would you like to die? Where would you like to die Doing what? With whom? Under what circumstances? What are your fears? What are your apprehensions ?


Goal of Working With The Bereaved Person: Goal of Working With The Bereaved Person Eventual re-engagement with life and the living (fulfillment)


All Religions and Philosophies Provide an Answer to Death: All Religions and Philosophies Provide an Answer to Death Theology Ritual and ceremony What is your religion’s answer to death? Or what is your answer to death? What are some rituals from your culture or religion . . . or your own? Has your view changed since you were a child? Is death a wall or door?


Social Distance: Would You Date Someone Who Is . . . : Social Distance: Would You Date Someone Who Is . . . A Canadian Democrat or Republican Neo-Nazi, member of Al-Qaeda or the Taliban Sick Has Cancer Dying Terminal Has AIDS Suicidal


Social Distance: Would You Date Someone Who Is . . .: Social Distance: Would You Date Someone Who Is . . . Dead – but attractive, intelligent, and personable?


Lonely Death: Lonely Death Many people report that once they knew they were dying, their friends stopped visiting. Their friends were confronted with their own mortality. Their friends were afraid of saying something to remind them that they were dying. They left their friend lonely because they couldn’t overcome the denial of death. The dying person and their friend both lost. You can’t say the wrong thing to a dying friend, as long as you are with them and loving them.


Appropriate Death: Appropriate Death Appropriate death as defined by the client What can and cannot be controlled about your death? Time Place Circumstance


What Is Death?: What Is Death? What Is Death? What Is Your Death? What Is Dying? When Are You Dead? Is Death a Wall or a Door?


Slide17: Powerful Questions For Coaching Toward an Appropriate Death When do you want to die? Whom do want with you when you die? Where do you want to die? How do you want to die? What do you want to be doing when you die? What do you fear about dying What do you fear about death? What are your concerns? What must you do before you die to feel complete? What do you need to tell your loved ones before you die? Who do you need to forgive? Whose forgiveness do you need? What is most important to you, now?


Culture Affects Communication : Culture Affects Communication A person is diagnosed with metastasized cancer. Percent of Patients who want to be told: 87-88% African andamp; European Americans 65% Mexican Americans 47% Korean Americans Source: Weiss, R. (1995). Giving bad news. The Washington Post Health. Washington: 12+


Doctor believes that the patient will probably die from the disease. : Doctor believes that the patient will probably die from the disease. Percent of patients who want to be told: 63-69% African and European Americans 35-45% Mexican and Korean Americans


Desire of Patients to make personal decisions regarding Life Support Technology : Desire of Patients to make personal decisions regarding Life Support Technology 60-65% African and European Americans 28-41% Mexican and Korean Americans Be sensitive to the person’s culture and current perspective while communicating about severe illness, dying, death, and/or grieving.


Fear of Death 4-Fold Table: What are the related issues re each cell?: Fear of Death 4-Fold Table: What are the related issues re each cell? Lester, D. (1990). The Collett-Lester Fear of Death Scale: The original version and a revision. Death Studies, 14(451), 45-458.


Other Death Fears: Other Death Fears Hereafter Corpses Ghosts andamp; spirits No control Frailty and infirmity Pain and suffering Choking, murder, etc. Aloneness andamp; isolation What else?


Legal Issues(Clients might seek coaching around decisions): Legal Issues (Clients might seek coaching around decisions) Legal Will Advance Directives Living Will Durable power of attorney for health affairs 5 Wishes Physician-assisted death Legal in Oregon, the Netherlands, Belgium, and Switzerland


5 Wishes. My wish . . . : 5 Wishes. My wish . . . For the person to make care decisions for me when I can’t. The kind of medical treatment I want or don’t want. How comfortable I want to be. How I want people to treat me. What I want my loved ones to know. www.AgingWithDignity.org


Palliative Care: Palliative Care Goal is to prevent suffering especially physical pain Hospice versus hospital (acute care) versus chronic care facility (nursing home) Client control


Hospice: Hospice Goal: Care andamp; Comfort Location: Hospital wing, separate facility, home


Actors – care of the dying involves: Actors – care of the dying involves Patient Family Formal and informal caregivers Health providers Friends, Coaches, and Clergy You may be coaching any of these clients about impending death, fears or grief


Other Symptoms or Problems During the Dying Process: Other Symptoms or Problems During the Dying Process Weakness and wasting away (cachexia) Anorexia (loss of appetite) Dypnea (shortness of breath)(Chronic Obstructive Pulmonary Disease -- COPD) Opioids variable; accupuncture, exercise, pursed lips breathing, exercise rehab helpful but need research Constipation Dry mouth (xerolube,salivert) Insomnia Bed sores (decubitus ulcers) Nausea (Bard suppository – benadryl, activan, reglan, decadron)


Where Do You Wish to Die? Means to a Better End Study: Where Do You Wish to Die? Means to a Better End Study Nationally, 25% of deaths occur at home, although more than 70% of Americans say that home is where they would prefer to die. About half of all deaths occur in hospitals, but less than 60% of the hospitals in any given state offer specialized end of life services.


Sources: Sources info@amerpainsoc.org www.cancer.org Permut SR: Advance Directives: Physicians' rights and responsibilities. Hospital Medicine 1998;34:21-22, 24, 29-30. Salerno E, Willens JS: Pain Management Handbook: An Interdisciplinary Approach. St. Louis, Mosby, 1996. Storey P: Primer of Palliative Care; ed 2nd. Gainesville, American Academy of Hospice and Palliative Care, 1996. Sulmasy DP, Lynn J: End-of-life care. Journal of the American Medical Association 1997;277:1854-1855. Barclay L: Voluntary dehydration to hasten death: A newsmaker interview with Linda Ganzini, MD, MPH; Medscape Medical News, Medscape Medical News, 2003, vol 2003. Barclay L: Revised pain management guidelines target: Inadequate pain control: A newsmaker interview with James N. Thompson, MD. Medscape Medical News 2004. Ellershaw J, Ward C: Care of the dying patient: the last hours or days of life. British Journal of Medicine 2003;326:30-34. Lema MJ: A compassionate approach to pain management in the terminally ill patient. Hospital Medicine 1998;35:1-14, 15-16, 18, 20-21.


Types of Euthanasia – Motivation & By Whose Hand?: Types of Euthanasia – Motivation andamp; By Whose Hand?


Men Are High Risk for Suicide; Women are the Attempters: Men Are High Risk for Suicide; Women are the Attempters Unemployed men have a higher suicide rate than employed men. In addition, suicide rates are higher in lower socioeconomic classes, where incomes are lower Women seek help; men die


In The Young, Suicide is : In The Young, Suicide is 3rd leading cause of death among 15-24 year olds. Follows unintentional injuries and homicide Also 3rd for children ages 10-14


Summation: Summation Men in the middle years of life have the highest absolute risk for suicide. This group accounts for the greatest YPLL and the greatest expected value of lost earnings that they would have contributed to society.


Slide35: April 2000— Among age 50+ Americans, 60% have a will, 45% have a durable power of attorney, and 23% have a living trust; but 36% have none of these legal documents and only 17% have all three. Where There is a Will...Legal Documents Among the 50+ Population: Findings from an AARP Survey  / Research Report


Mortality/Lifeline Exercise: Mortality/Lifeline Exercise


Do you have a will, living will, and living trust?: Do you have a will, living will, and living trust? Who pays the emotional and financial cost of your denial of death?


Grief and Bereavement: Grief and Bereavement Definition of grief, bereavement, mourning Where there is a significant loss including the death of a companion animal, expect grieving Demographics of widowhood


Goal in Working With the Bereaved: Goal in Working With the Bereaved Eventual re-engagement with life and living (fulfillment) Most re-engage life, but some, especially elderly widowed (dependent person) almost wither and die – they have lost much of the will to live


Research: Research Adapting to grief is complicated, and individualistic Children and adolescents grieve: Adolescents tend to grieve longer and more intensely than adults Gender/Sex differences – women cry and network, men seek action and stay within themselves Globally, crying is a general part of grief except in one country – Bali. Moral: Ask cultural questions.


Trajectories of Grief: Trajectories of Grief Idealized grief Prolonged or chronic grief (high pre-loss) Delayed grief -- rare Anticipatory grief – before death occurs Complicated grief including unsanctioned grief Absence of grief or 'resilience' (low pre-loss) Source: Boerner, K., Wortman, C. B., andamp; Bonanno, G. A. (2005). Resilient or at Risk? A 4-Year Study of Older Adults Who Initially Showed High or Low Distress Following Conjugal Loss. J Gerontol B Psychol Sci Soc Sci, 60(2), P67-73.


Symptoms or Grief-related Behavior: Symptoms or Grief-related Behavior Sensory focus Anniversary effect


Problem in Living or Pathological Grief?: Problem in Living or Pathological Grief? Adjustment versus medication and therapy or both? What is the DSM definition of 'Pathological Grief' or what clues indicate a grieving client should be referred to a psychotherapist?


Tasks of Grieving: Tasks of Grieving Social Behavioral Emotional


Support Groups: Support Groups Candlelighters – parents of children with cancer Compassionate Friends – bereaved parents, and grandparents Dougy Center for Grieving Children TAPS (Tragedy Assistance Program for Survivors), Inc. for families of military Society of Military Widows Religious Groups like Theos and NAIM


Ratio Over Age 65: Ratio Over Age 65 8 widows per 1 widower


Horrendous Death Defined: Horrendous Death Defined HD is the umbrella term for those deaths caused by people Type 1: Motivation exists to kill others Type 2: Motivation is absent Type 3: Equivocal, or other


HD Type I Examples: HD Type I Examples Deaths resulting from War Terrorism, and other forms of extrajudicial killing such as death squads Genocide Intentional environmental assault (ecocide) Intentional famine and starvation Racism, sexual, and gender assault (e.g., homophobia), e.g., lynching, rape murder Homicide Work, e.g., death in coal mines and commercial fishing, work-place homicide Injuries (intentional – 66.2% - suicide, homicide)


What is the Process?: What is the Process? Making the HD threat salient by removal of the denial of personal vulnerability and mortality Anticipatory grieving of the fantasized beloved with special reference to one’s children or beloved other Removal of barriers to action such as the herd effect, ignorance, either-or thinking, and lack of motivation Organization and mobilization Preventive action


Cost to Eliminate Some World Health Problems: Cost to Eliminate Some World Health Problems Eliminate Starvation and Malnutrition ($19 billion) Provide Shelter ($21 billion) Remove Land mines ($4 billion) Eliminate Nuclear Weapons ($7 billion) Refugee Relief ($5 billion) Eliminate Illiteracy ($5 billion) Provide Clean, Safe Water ($10 billion) Provide Health Care and AIDS Control ($21 billion) Stop Deforestation ($7 billion) Prevent Global Warming ($8 billion) Stabilize Population ($10.5 billion) Prevent Acid Rain ($8 billion) Source: The Borgen Project (2004): http://borgenproject.org/Global_Issues.html


Boldly Coaching Death: Boldly Coaching Death Begins with removing the denial that we will die. Accepts death as a natural part of life. Helps clients of all ages prepare for their deathdays with no regrets, no 'should haves' or 'could haves.' Rejects through social action coaching and other actions those large scale, man-made deaths classified as Horrendous Death.