Le Workshop Les rites funéraires de Méditerranée : actualisation des découvertes et perspectives d'analyses croisées s'est déroulé à l'Université de Corse les 3 et 4 Avril 2019. Il s'agit de mettre en place un réseau de chercheurs permettant d'échanger et de réactualiser les connaissances autour de l'anthropologie de la Méditerranée. De fait, l'étude du patrimoine archéologique de l'île permet de mettre en évidence des pratiques communes à la fois aux territoires insulaires et à cette zone particulière liant Orient et Occident.
Les dernières découvertes archéologiques ouvrent de nouvelles perspectives de recherches et demandent une analyse croisée actant une réactualisation des connaissances relatives aux rites funéraires. De même, le rapport à la mort, exprimé notamment dans la gestion des défunts et le deuil, évolue tout en conservant des traces évidentes d'un fonctionnement archaïque. Il a donc paru nécessaire de provoquer une confrontation de ces données nouvelles.
Perdre un proche marque une rupture dans nos vies. Cette rupture interagit avec un collectif, les lieux où nous vivons ou encore les structures sociales et politiques qui norment nos existences. Face à l'apparente solitude du deuil, la mort de l’autre interroge notre identité en tant qu’êtres fondamentalement relationnels. Traverser un deuil, c’est se retrouver confronté à la violence et au non-sens de la perte sur lesquels aucun mot, de prime abord, ne peut être posé. C’est pourtant à partir de cet indicible et incommunicable du deuil que peut émerger la question du sens et d’un rapport à soi, aux autres et au monde redéfini par la perte.
Dans la continuité de l’expérience, les savoirs et les discours sur le deuil et la perte influencent nos représentations de la mort et de l’accompagnement de la fin de vie. Ils interrogent plus largement le lien social : en quoi la réflexion sur le deuil nous engage en tant que citoyen.ne ? L’expression « faire son deuil » est alors à questionner : loin d’un impératif, il est question d’ouvrir des pistes de réflexion autour de la créativité humaine – parfois inattendue – face à l’expérience de souffrance et de rupture que constitue la mort de l’autre.
INTRODUCTION: Talking about death and dying is evoking discomfort in many persons, resulting in avoidance of this topic. However, end-of-life discussions can alleviate distress and uncertainties in both old and young adults, but only a minority uses this option in palliative care. Even in healthy populations, talking about death is often seen as alleviative and worthwhile, but rarely initiated.
OBJECTIVE: To investigate different psychological interventions (a) encouraging the readiness for end-of-life discussions and (b) changing death attitudes in healthy adults of different ages.
METHODS: 168 participants were randomized to four different interventions (IG1: value-based intervention with end-of-life perspective, IG2: motivation-based intervention with end-of-life perspective, IG3: combination of IG1 and IG2, CG: control group). Primary outcome was the readiness to engage in end-of-life topics. Secondary outcomes were fear of death, fear of dying and death acceptance. Assessments took place before, directly after the intervention and at 2 weeks of follow up.
RESULTS: IG2 and IG3 reported significantly more changes in the readiness to engage in end-of-life discussions than the CG (F[5.61, 307] = 4.83, p < 0.001, ηp2 = 0.081) directly after the intervention. The effect of IG3 remained stable at the follow-up. There were no significant effects of the interventions on end-of-life fears or death acceptance. Acceptability of the interventions was very high.
CONCLUSIONS: Short interventions can be useful to encourage end-of-life discussions and could be integrated in health care programs. The efficacy and effectiveness of these short interventions in palliative patients are currently examined.
PURPOSE: To have more in-depth understanding of death acceptance among patients with terminal cancer in Thailand.
METHODS: A qualitative descriptive research approach was used to capture the perspectives of patients with terminal cancer about death acceptance. Purposive sampling was used to recruit the participants. A semi-structured interview guide was used during data collection to obtain in-depth interviews with 12 patients diagnosed with terminal cancer. An interpretive descriptive method was used for analyzing data. Analysis of the data for this study was conducted by the analytic team beginning at initial data collection.
RESULTS: The findings of this study revealed six major themes relating to death acceptance: 1) perceiving death as a natural part of life; 2) perceiving that death cannot be controlled; 3) thinking that death can come at any time; 4) letting everything go before dying: finding a calmness; 5) additional Buddhist practices: clean living and making merit; and 6) additional means for attaining a peaceful death and peaceful life before death.
CONCLUSION: Understanding death acceptance is important for nurses providing care for patients with terminal cancer in order to find strategies and support for patients to accept death and live peacefully with their family in the time they have left.
Premature discussions of patients' rights or duties to death must be put aside to focus first on whether death injures the patient who dies. Comparativism argues that dying does have impact on this individual, then it may alter our arguments on duties or rights to die, as well as on how and whether we should make end of life decisions for others. If Comparativism is correct, then there are large ramifications for ethics, medicine, and public health. Unfortunately for Comparativism, its incorporation of intuitions and possible worlds gives it the same undermining biased world problem encountered by Moore's isolation test for intrinsic value. Imagining/referring to a possible world whilst in this one merely creates the illusion that a decedent's death can benefit or injure her. When we select possible worlds or fill in their missing states of affairs, we can often impose our own biases into the thought experiment. Thinking about fictions is useful in figuring out what we should do and be, as well as evaluating what others did and were, but medical practice and policy affecting end of life issues in bioethics should always be based on reality and not subjective partiality.
In Western society, the topic of death has been removed from everyday life and replaced with medical language. Such censorship does not reduce individuals' fear of death, but rather limits their ability to elaborate their experiences of death, thus generating negative effects. The objective of this follow-up qualitative study was to detect how and if death education can help to improve individuals' relationship with death and enhance care environments like hospices. Semi-structured interviews were conducted with palliative care professionals and teachers who had taken part in a death education initiative three years earlier. The results confirmed the initiative's positive effect on both palliative care professionals and teachers. The participants reported that the education initiative helped them to positively modify their perspective on death, end-of-life care, and their own relationship to life, as well as their perception of community attitudes towards the hospice, which seemed to become less discriminatory. This study confirmed that school education initiatives can usefully create continuity between hospices and local communities. This project provided an educational space wherein it was possible for participants to elaborate their experiences in relation to death and to re-evaluate and appreciate hospices.
BACKGROUND: Conversations about death are often associated with fear, anxiety, avoidance and misunderstandings. Many adults feel that these discussions are inappropriate and confusing for young people. In this project, two fourth-year nursing students partnered with a local palliative care team to examine death education for children. The nursing students focused on children's understandings of death and their coping abilities, the lack of appropriate discussions about death with children, and the implementation of death education in public schools. Three online death education resources were identified and evaluated for use in public schools. This project fueled preliminary local discussions and advocacy efforts in the provision of death education for children. In the future, death education will need to be incorporated into education plans at local schools, and could be done in collaboration with the local palliative care team.
Nursing students may feel unprepared to manage the care of dying individuals and may experience anxiety and fear related to death and dying. Preparing nursing students for this situation can help them provide quality care to dying patients. This study aimed to examine the end-of-life care values and behaviors and death attitudes of senior nursing students. In examining these variables, the Values and Behaviors of Intensive Care Nurses for End-of-Life Instrument and the Death Attitude Profile-Revised Scale were used. It was found that the students developed positive attitudes and behavior towards end-of-life care, and that they believed death to be a natural part of life and there is life after death. Students who felt that the information they received during their education was partially sufficient were more likely to have negative death attitudes. It can be recommended that teaching strategies in the education of the nursing students be developed.
This study aimed to determine the relationship between death and DNR attitudes among ICNs. This descriptive-analytical study was performed on 156 ICNs in 2018. All nurses were enrolled in the study; data collection instruments included Death Attitude Profile-Revised (DAP-R) and the DNR attitude questionnaires. The mean scores of DAP-R and DNR items were 150.89/ ± 23.59 and 91.82 ± 11.41, respectively. There was a significant relationship between death attitude and DNR attitude Famong ICNs. All dimensions of DAP-R significantly predicted attitude toward DNR (P < 0.05). Among those, “neutral acceptance” (1.17 [95% CI (0.68--1.65)] was the strongest predictor and “death avoidance” was the weakest predictor (0.36 [95% CI (0.09--0.62)]. There was a significant relationship between the ICNs' work experience and attitude toward DNR (p = 0.03). The findings can be used in formulation of the national guideline for DNR order.
L’objectif de ce travail de réflexion est de mieux appréhender ce que vivent ces personnes qui ont foi en cette continuité de la vie dans leur deuil, et de porter un regard ouvert sur les expériences autour de la mort qui sont parfois difficiles à livrer. Le but étant d’appréhender au mieux la problématique que génère la croyance en l’au-delà sur le processus et le travail de deuil :
N’est-il pas contraire à l’objectif d’acceptation de la séparation avec l’être cher, que de croire qu’il persiste ailleurs dans l’au-delà ?
[Extrait de l'introduction]
Background: One of the most difficult and stressful tasks faced by health science students is having to cope with death and dying due to the emotional burden of the same. Furthermore, the moral, ethical and professional values of future health professionals are influenced by the cultures where they live.
Purpose: This study sought to compare and analyze the perception on end of life among a sample of health science students in Spain and Bolivia.
Methods: A descriptive, cross-sectional and multi-centric study. The total sample (548 students) was comprised of three groups: medical, nursing and physiotherapy students, of whom 245 were from Bolivia, and 303 were Spanish students. The measurement instruments used were the Bugen’s Coping with Death Scale and the Death Self-Efficacy Scale by Robbins.
Results: No statistically significant differences were observed between Spanish and Bolivian students (t (546) = - 0.248, p = 0.804) using the Bugen scale. This implies that there are no differences between the perception of both groups of students and that both groups use similar strategies to cope with death. Additionally, the beliefs and attitudes of both groups were similar, with Bolivian students presenting a trend towards improved scores. No differences were found between Spain and Bolivia in the results obtained on the Robbins scale, with students from both countries displaying similar skills and capabilities for facing death.
Conclusions: The beliefs on death of health science students from Spain and Bolivia were not affected by the respective cultures, type of degree studied, students’ age, or the country of origin, however, we found that students in Bolivia value death as something more natural than their Spanish counterparts.
To appropriately prepare students for this topic, education on coping with death and dying must be included within the university curriculum.
CONTEXT: Evaluation of end-of-life care is a key element in quality improvement, and population-based mortality follow-back designs have been used in several countries. This design was adapted to evaluate a Good Death in Japan.
OBJECTIVES: This study aimed to explain the scientific background and rationale for assessing the feasibility of a mortality follow-back survey using a randomized design.
DESIGN: We utilized a cross-sectional, questionnaire survey to assess feasibility using response rate, sample representativeness, effect on response rate with two methods, and survey acceptability.
SETTING/PARTICIPANTS: The subjects were 4,812 bereaved family members of patients who died from the major five causes of death: cancer, heart disease, cerebrovascular disease, pneumonia, or kidney failure, using mortality data.
RESULTS: Overall, 682 (14.2%) questionnaires could not be delivered, and 2,294 (55.5%) family members agreed to participate in the survey. There was little difference in the distribution of characteristics between the study subjects and the full population, and sample representativeness was acceptable. Sending the questionnaire with a pen achieved a higher response rate than without (weighted: 48.2% vs. 40.8%; p<0.001). In follow-up contact, there was no difference in response rate between resending the questionnaire and a reminder letter alone (weighted: 32.9% vs. 32.4%; p=0.803). In total, 84.8% (weighted) of the participants agreed with improving quality of care through this kind of survey.
CONCLUSIONS: This study demonstrated the feasibility of conducting a population-based mortality follow-back survey using a randomized design. An attached pen with the questionnaire was effective in improving the response rate.
Theories of good death focused on acceptance, control, and meaning-making inform adult palliative care in high-resource settings. As children's palliative and hospice care (CPHC) develops in resource-limited settings, critical conceptualisations of a good death for children across these diverse settings are unknown. Assessed against high-resource setting tenets of good death from carer perspectives, results suggest: carer agency is limited; advanced discussion of death does not occur; distress results from multiple burdens; basic survival is prioritised; physical pain is not an emphasised experience; and carers publicly accept death quickly while private grief continues. Hegemonic conceptions of 'good death' for children do not occur in contexts where agency is constrained and discussing death is taboo, limiting open discussion, acceptance, and control of dying experiences. Alternate forms of discourse and good death could still occur. Critical, grounded conceptualisations of good death in individual resource-limited settings should occur in advance of CPHC development to effectively relieve expansive suffering in these contexts.
This study was conducted to examine the importance of the concept of a good death and the contributing factors from the perspectives of family caregivers of advanced cancer patients. This descriptive and cross-sectional study, conducted with 182 family caregivers, were collected using a questionnaire form and the “Good Death Scale”. The number and percentage distribution, multiple linear regression were used evaluation of data. The total score of the Good Death Scale was 62.65 ± 4.60. The factors contributing to the importance of the concept of a good death were determined as the presence of chronic disease; the type of treatment given to the patient; the presence of another family member who was previously diagnosed with cancer; the presence of a family member who has died of cancer and previously caregiving to a terminally ill family member. This study revealed that the concept of a good death is seen as very important.
As they age, many people are afraid that they might become a burden to their families and friends. In fact, fear of being a burden is one of the most frequently cited reasons for individuals who request physician aid in dying. Why is this fear so prevalent, and what are the issues underlying this concern? I argue that perceptions of individual autonomy, dependency, and dignity all contribute to the fear of becoming a burden. However, this fear is misplaced; common conceptions of these values should be re-framed and re-examined. Practices that support a more community-centered type of autonomy can be found in dependency and dignity. This paper offers some practical examples of how to address common end-of-life situations that may cause anxiety to patients who are worried about being a burden. These practices include discussing expectations, both for care and how the relationship among the participants might change, and modeling respectful caregiving behaviors. Most difficult of all, though, includes cultural and societal attitude changes so that people recognize the good in receiving care and get used to the idea that they do not need to do anything to be valuable.
Death, bereavement, and grief are part of everyone's life experience. In the last few decades, media and social network platforms gradually began to influence people's ways of perceiving and coping with death and dying, and the research on the phenomenon of digital death is growing. Facebook is one of the most known and used social networks, and one of the few that developed specific measures to manage the profile pages of the deceased users. Based on these premises, this survey aimed to investigate how 1281 Italian participants, aged 14-77 years old, approach death on Facebook with respect to their opinions, attitudes, and emotional reactions, through an ad-hoc online survey. The results highlight how the participants seem to have different attitudes and emotions toward death, grief and mourning on the social network platform. The age of the participants seems to influence the use of the social network and the attitudes and the emotions toward the topic of investigation. Moreover, for this Italian sample, the custom of grieving and commemorating on social media is starting to spread along with the usual cultural practices without replacing them.
Both non-rapid eye movements and rapid eye movements sleep facilitate the strengthening of newly encoded memory traces, and dream content reflects this process. Numerous studies evaluated the impact of diseases on dream content, with particular reference to cancer, and reported the presence of issues related to death, negative emotions, pain and illness. This study investigates death and illness experiences in 13 consecutive patients with sarcoma compared to paired controls, early after diagnosis, evaluating dream contents, fear of death, mood and anxiety, distress, and severity of disease perception (perceived and communicated). Ten patients and 10 controls completed the study. Dream contents were significantly different between patients and normative data (DreamSat) and patients and controls (higher presence of negative emotions, low familiar settings and characters and no success involving the dreamer). Illness and death were present in 57% of patients' dreams (0% among controls), but no differences emerged between patients and controls in regard to anxiety and depression, distress and fear of death, even if the severity of illness was correctly perceived. The appearance of emotional elements in dreams and the absence of conscious verbalization of distress and/or depressive or anxious symptoms by patients could be ascribed to the time required for mnestic elaboration (construction/elaboration phase) during sleep.
The concept of death anxiety is expected of older persons as they age and are nearing their end-of-life. This study examined the relationship between religiosity, spirituality, and death anxiety among Filipino older adults. A convenience sample of 125 Filipino older adults were recruited in the study. Data were collected using the Spirituality Scale, Revised Death Anxiety Scale, and Dimensions of Religiosity Scale. Results of the study revealed that spirituality (r=-0.168, p = 0.061) and religiosity (r=-0.044, p = 0.623) had an inverse relationship with death anxiety. However, even with the inverse relationship, spirituality and religiosity were not significantly correlated with death anxiety, although participants were well aware of the importance of these concepts on their lives. It is suggested that assessing spirituality and religiosity of this age group can inform nurses to engage in quality nursing practice, by affirming the vulnerability, and preserving the personhood of older persons as they near their end-of-life.
The COVID-19 pandemic has disproportionately affected older adults, not only through greater risk of illness and death but also by exacerbating underlying distress related to aging and mortality. Older adults' struggles with loneliness, fear of dying, and the sequelae of untreated medical conditions are viewed through the lens of anticipatory grief, and coping and treatment strategies are offered.