Powerpoint presentation (pptx file) - California State University, Fresno

John Amson Capitman, PhD.
Nickerson Professor of Health Policy
Central Valley Health Policy Institute
California State University, Fresno
Day 1:
Overview and Individual Goals
Changing Context of Death and Disability
Death and Life Review
“Recipes” for a Good Death
Day 2:
Anticipating Long-term Care Needs
Caring for Caregivers
Living Will: the 5 wishes
Long-term Care Insurance
How often do I think about death, dying,
disability? What feelings come up?
What questions do I have about death, dying,
disability? What do I want to learn from this
How have I been learning about death, dying
and disability? (Who? What sources?) What are
the main issues I have been examining? What
do I feel I have learned enough about and
don’t want to explore anymore
 Epidemiological
Transition--life course change
 Change in nature of death
 Change in place of death
 Change in cost of death
 Increasing costs for healthrelated services
Fear of death: common, overlooked,
rarely addressed
 Fear of death develops over life course
 Fear of death is most often about:
◦ Fear of missed opportunities
◦ Fear for fate of loved ones
◦ Fear of judgment/spiritual doubts
Making the most of life as principal
feature of a good death
Outside observers would probably say that my main achievements have
been ...
For myself, what I am most pleased with and proud of in my life, are ...
One of the most important lessons that I have learnt in my lifetime is
that ...
During my life I have used my ... [list three positive personal
characteristics, for example: imagination, sense of humour and
intelligence] through my ... [list three activities, for example: writing,
running groups and parenting] with the underlying vision, I now realise,
of helping work towards a world in which, one day, ... [describe your
long-term Utopia, for example: 'people are kind and sensitive to each
other, nature is at ease and magic is alive'].
The people I have felt closest to in my life have been ...
One generalisation I could make about the quality of my relationships
with others is that ...
If I regret anything, it is that ...
If I had known how short a time I had left to live, I would probably have
Kubler-Ross famously said, all grief goes
through 5 stages
 Denial
 Anger
 Bargaining
 Depression
 Acceptance
Recent research finds: (1) model is culture
specific, does not apply for many, (2) even
among US/Europe, pattern not upheld
(A Buddhist Perspective)
1) Understanding and transforming
2) Making a connection, healing
relationships and letting go.
3) Preparing spiritually for death.
4) Finding meaning in life.
 Task
 Task
 Task
 Task
 Task
Ask For Forgiveness
Offer Forgiveness
Offer Heartfelt Thanks
Offer Sentiments of Love
Say Goodbye
To know when death is coming, and to
understand what can be expected.
To be able to retain control of what
To be afforded dignity and privacy.
To have control over pain relief and other
symptom control.
To have choice and control over where
death occurs (at home or elsewhere).
To have access to information and expertise
of whatever kind is necessary.
To have access to any spiritual or emotional
support required.
To have access to hospice care in any location,
not only in hospital.
To have control over who is present and who
shares the end.
To be able to issue advance directives which
ensure wishes are respected.
To have time to say goodbye, and control over
other aspects of timing.
To be able to leave when it is time to go, and
not to have life prolonged pointlessly.