What this also means is that the share of child deaths from older or younger children also depends on how much progress countries have made on vaccine coverage and other interventions. There, neonatal deaths account for only 37% of under-5 deaths, whereas in most Asian, European and American countries this share is 50% or higher. This is because many countries across Sub-Saharan Africa still have significant progress to make in the prevention of vaccine-preventable diseases. The ethical issues relevant to dying and death underlie all the topics included in this bibliography.
When a person considers whether to disclose to a child that he or she or a parent or sibling is dying, an ethical decision is being made. When the focus is on relative emphases on maintaining hope at end of life compared to allowing open communication about it , an ethical decision is being made. The area of palliative team care requires confrontation with all these ethical issues, as does bad-news delivery. Making decisions about prolonging and delaying death, even at the cost of more suffering, are obviously inherently ethical decisions, as discussed in White and Fitzpatrick 2006. More controversial are decisions related to euthanasia and physician-assisted suicide.
Defining a "good death" and issues of allowing denial are also ethical concerns. Ethical frameworks that are relevant to an understanding of this area include utilitarianism, deontology, principalist medical ethics , and virtue ethics, as discussed in Jeffrey 2006. The writing in this area is rather consistent, frequently bringing these ethical issues to the attention of health-care providers who might not have received much training in ethics but whose work requires an awareness of the concepts.
Big countries like Brazil and China reduced their child mortality rates 10-fold over the last 4 decades. Other countries – especially in Africa – still have high child mortality rates, but it's not true that these countries are not making progress. In Sub-Saharan Africa, child mortality has been continuously falling for the last 50 years (1 in 4 children died in the early 60s – today it is less than 1 in 10). Over the last decade this improvement has been happening faster than ever before. Rising prosperity, rising education and the spread of health care around the globe are the major drivers of this progress. All individuals have something that they experience as spiritual.
This becomes more relevant as an individual approaches end of life, although Williams 2006 notes that most doctors ignore the spiritual dimension. Ford, et al. 2012 identifies three levels of competence in this regard, with the highest being competence in discussions of spirituality. Providers are encouraged by most authors in this area to be nonjudgmental about individual experiences of spirituality. Religion is a structured frame around which individuals may see spirituality. Concepts of a higher being, the possibility of an afterlife, and communication with the higher power through prayer are central to many religious frameworks; Pevey, et al. 2008–2009 examines the role of prayer at end of life. The separation between religion and spirituality is relatively recent.
Negative experiences with religion sometimes lead individuals to identify instead with spirituality. What is frequently just called "spirituality" is called by some "nonreligious spirituality." All spirituality is related to issues of the sacred and transcendence. Recognition of the role of spirituality in palliative team care is ethically imperative, according to many scholars and practitioners.
Providers who partner with chaplains frequently benefit from this collaboration and provide more fulfilling care for most patients. Different religions, of course, are also intertwined with cultural differences and must be recognized on both levels. Religiosity is also related to death anxiety and, according to Kessler 2007, to anger.
Those who are religious but fear a negative afterlife due to their behavior during their lifetime are likely to experience more death anxiety than those who anticipate a positive afterlife. Much of the research on death anxiety or fear of death reviewed in the section on that topic has important implications for the role of spirituality/religiosity in the dying process. In general, end-of-life care pays little attention to these fundamental issues.
Keeley 2004 studies discussions of spirituality in final conversations. The Second National Consensus Project for Quality Palliative Care placed great emphasis on the role of spirituality in palliative team care, as noted in Puchalski, et al. 2009. Consistent with palliative team care, hospice is a movement toward death with dignity. Hospice can be a place that allows emphasis on relieving suffering and improving quality of life as death approaches—this can be a separate facility or an area of a health-care facility such as a hospital. In many cases, however, hospice care can be provided in the home with appropriate help. Providing full-time care to a family member is not easy, so support staff may be brought in.
Hospice nurses and other care providers are involved in providing care to the patient. The goal is to support both the family and the patient as the end approaches. Most patients indicate a preference for dying at home, although few are able to do so. This is typically because curative treatment extends well beyond the point that it should, and palliative team care begins too late, as evidenced by Csikai 2006 and Casarett and Quill 2007.
Dy, et al. 2011 provides suggestions to help avoid these consequences. Similarly, Hawthorne and Yurkovich 2004 discusses how hope changes during hospice care. Two hundred years ago the child mortality rate was extremely high around the world –more than 40% of all children died. Since then the child mortality rate has declined more than 10-fold. Because we need to further reduce child deaths we are studying the causes of death of children today and how it was possible to improve child health so very substantially in the past in ourentry on child mortality.
Advance directives typically also include a medical or health-care power of attorney, giving the decision-making role to a particular individual, and may also include a DNR order. It is also possible to have a DNR order apart from the other aspects of an advance directive. Broader than just a document or series of documents, ACP also includes familial and/or provider discussions about a person's priorities and beliefs that pertain to end of life. Although Wenger, et al. 2001 finds that few patients have advance directives, Westphal and McKee 2009 finds that even fewer physicians actually read the advance directives.
Black 2007 reports that social workers are more likely to read these. It is generally agreed that preparation of an advance directive should be encouraged, in that they provide some help in the event of patient incapacitation, but are limited in terms of applicability. There is also no assurance that anticipated wishes will correspond with actual desires when a situation occurs.
There are individuals who, while they are healthy, feel that they would not want extraordinary efforts to keep them alive in the event of an accident if they were subsequently likely to be severely disabled, for instance. If such an event actually arrives, the patient sometimes feels differently, as Smith 2004 notes. Song 2004 finds that ACP leads to higher levels of satisfaction, and Waldrop and Meeker 2012 reports that ACP is essential for person-centered end-of-life care. Our concern will then turn towards countries where the chances of child mortality is high, and the number of births increasing.
Countries where children are most likely to die – Somalia, Chad, Central African Republic, Sierra Leone, Nigeria, and Mali – will all have an increasing number of children in the coming decades. Progress on reducing child deaths will here therefore become a race between declining child mortality rates and an increasing number of children. Of course, the death of every child is an enormous tragedy, and in many countries far too many children die because of causes we know how to prevent and treat. As the map here shows, today the highest child mortality rates are in Sub-Saharan Africa, where we still have countries with child mortality rates greater than 10% — this means that one out of 10 children born never reach their 5th birthday. Anne Moody mentioned the Till case in her autobiography, Coming of Age in Mississippi, in which she states she first learned to hate during the fall of 1955.
Audre Lorde's poem "Afterimages" focuses on the perspective of a black woman thinking of Carolyn Bryant 24 years after the murder and trial. Bebe Moore Campbell's 1992 novel Your Blues Ain't Like Mine centers on the events of Till's death. Toni Morrison mentions Till's death in the novel Song of Solomon and later wrote the play Dreaming Emmett , which follows Till's life and the aftermath of his death.
The play is a feminist look at the roles of men and women in black society, which she was inspired to write while considering "time through the eyes of one person who could come back to life and seek vengeance". Emmylou Harris includes a song called "My Name is Emmett Till" on her 2011 album, Hard Bargain. According to scholar Christopher Metress, Till is often reconfigured in literature as a specter that haunts the white people of Mississippi, causing them to question their involvement in evil, or silence about injustice. The 2002 book Mississippi Trials, 1955 is a fictionalized account of Till's death. The 2015 song by Janelle Monáe "Hell You Talmbout" invokes the names of African-American people – including Emmett Till – who died as a result of encounters with law enforcement or racial violence.
In 2016 artist Dana Schutz painted Open Casket, a work based on photographs of Till in his coffin as well as on an account by Till's mother of seeing him after his death. I am looking for support for our amendment today, but we will support a united voice in Parliament. However, the minister's motion lacks acknowledgment of the failure of the Scottish Government to act much earlier when fatalities began to spiral upwards, or to set out a clear course of action. It shows the devastating impact of what can happen when focus is not on critical issues that are allowed to escalate as policies continue on a mistaken path. Lives could have been saved if action had been taken far earlier. This means that as child mortality rates decline across the world, our attention must turn increasingly towards saving babies in the first days of life.
We need to make much faster progress in addressing neonatal causes of death. Schiavo's body was taken to the Office of the District 6 Medical Examiner for Pinellas and Pasco counties, based in Largo, Florida. The autopsy occurred on April 1, 2005, and revealed extensive brain damage. In addition to consultation with a neuropathologist (Stephen J. Nelson), Thogmartin also arranged for specialized cardiac and genetic examinations to be made. In addition to studying Terri Schiavo's remains, Thogmartin scoured court, medical and other records and interviewed her family members, doctors and other relevant parties.
Examination of Schiavo's nervous system by neuropathologist Stephen J. Nelson, revealed extensive injury. The brain itself weighed only 615 g (21.7 oz), only half the weight expected for a female of her age, height, and weight, due to the loss of a massive number of neurons. Microscopic examination revealed extensive damage to nearly all brain regions, including the cerebral cortex, the thalamus, the basal ganglia, the hippocampus, the cerebellum, and the midbrain. The neuropathologic changes in her brain were precisely of the type seen in patients who enter a PVS following cardiac arrest. Throughout the cerebral cortex, the large pyramidal neurons that comprise some 70% of cortical cells – critical to the functioning of the cortex – were completely lost. The pattern of damage to the cortex, with injury tending to worsen from the front of the cortex to the back, was also typical.
There was marked damage to important relay circuits deep in the brain – another common pathologic finding in cases of PVS. The damage was, in the words of Thogmartin, "irreversible, and no amount of therapy or treatment would have regenerated the massive loss of neurons". Several key provider-related issues must be considered within a discussion of dying and death concerns as they relate to communication. These focus on provider communication skills and the training to improve such skills. Within the field of communication, most research uses the term "competence" rather than "skills," but we use the term "skills" here to be consistent with most of the literature published on the topic more broadly.
Nonetheless, researchers seem to assume that providers can be reached for communication training much more easily than can patients. Researchers have, thus, focused almost exclusively on assessment of provider skills and training programs designed to improve such. Within the broader area of health communication, notable researchers such as Don Cegala have done important work on training patients in communication skills, but this work has not focused on the end-of-life context.
We do not include a separate section on patients, as most of the other research discussed within this bibliography focuses on patients. Additionally, it may appear troubling to try to "train" those who are dying regarding communication with providers. Communication training for nonproviders would have to begin well prior to a diagnosis of terminality; one would hope that the skills acquired might then extend into end-of-life applications. The research on provider skills is consistent in indicating inadequacy of both observed and perceived competencies among physicians in communicating with those who are terminally ill.
Although training programs have some impact on these skills, the programs generally do not create enough improvement in competencies. Nurses are typically better than physicians at communicating with terminally ill patients and are more likely to recognize the importance of both skills and training to improve skills. The methods used in the research on dying and death are primarily qualitative, as one would expect considering the nature of the phenomenon. The small amount of experimental research that has been done in the area has involved testing the effectiveness of training programs to impact interaction between health-care providers and dying patients as well as their families. It would not be ethical, of course, to experimentally manipulate treatment of the dying or their families, so no such research has been reported in the literature. A few quantitative studies are also reported; in particular, scale development has become much more common and sophisticated in this area of study.
Due to the detailed nature of the data examination provided by discourse analysis, work in this area has made especially insightful contributions to our understanding of health communication processes. This is particularly true in regard to provider–patient interaction. Ethnography has also been especially interesting, and goes back to early work by symbolic interactionists.
Palliative care journals and those focusing specifically on death issues are the most common outlets for research in this area. Most of these journals focus on empirical research, but some include practical advice and letters to the editor. Omega and Death Studies focus on death issues of all types and have a social scientific emphasis. They include issues such as suicide, which would not be relevant to palliative care. The various palliative care journals take a medical/clinical perspective.
Journal of Palliative Medicine provides a particularly strong emphasis on standard medical issues but also focuses on legal concerns. Journal of Pain and Symptom Management is more interdisciplinary, as is American Journal of Hospice & Palliative Medicine. Palliative Medicine takes a very clinical approach, and Palliative & Supportive Care places more emphasis on psychiatric and spiritual issues than do the other journals. International Journal of Palliative Nursing emphasizes nursing issues and concerns.
The duties and responsibilities of nurses are frequently different from those of other health-care providers, and nurses tend to place more emphasis on communication concerns than do many other health-care professionals. The chances of survival for a newborn today are around 10-times higher than the past. But in some countries mortality rates are still much higher than the world average.
The country with the highest infant mortality rate is the Central African Republic where close to 9% of all infants die. Firstly, health officials are unable to determine the spread of covid-19 infections among different age groups, and therefore are not able to focus attention on the most vulnerable. Secondly, when looking at the death data, for example, it is just not possible to get age-wise or gender-wise numbers. While the government declared 400,000 deaths due to covid-19, some very credible analysts, including the former chief economic advisor, Arvind Subramanian, in July 2021, declared that the deaths could be 10 times that number. The other fallouts are drug stockouts, vaccine supply shocks, overused ventilators and overcrowding at covid centres. Till's body was returned to Chicago where his mother insisted on a public funeral service with an open casket which was held at Roberts Temple Church of God in Christ.
Tens of thousands attended his funeral or viewed his open casket, and images of his mutilated body were published in black-oriented magazines and newspapers, rallying popular black support and white sympathy across the U.S. Intense scrutiny was brought to bear on the lack of black civil rights in Mississippi, with newspapers around the U.S. critical of the state. Although local newspapers and law enforcement officials initially decried the violence against Till and called for justice, they responded to national criticism by defending Mississippians, temporarily giving support to the killers. With the decline of child mortality and fertility over the last couple of centuries this has changed dramatically, and in rich countries like Sweden these tragic events have become very rare.
