The Nakedness Of The Dead Body – The Meaning Of Death To Healthcare Professionals Working With The Dying

Authors

  • Christian Schulz-Quach Author

DOI:

https://doi.org/10.65828/kj5k2380

Keywords:

Healthcare professionals, palliative care psychiatry, death, phenomenology, death confrontation

Abstract

In the clinical practice of Palliative and Hospice Care, daily practice and organizational demands often conceal the lack of articulated phenomenological understanding of the significance of frequent death confrontation and its meaning to those who work in the field as healthcare professionals. In this article, I would like to offer an exploration on the experience of actual death encounter and the cardinal phenomenon of being present to the nakedness of a dead body, in line with the overarching theme of our past annual conference of the Society of Existential Analysis. By doing so, I will draw from theory and personal experience alike.

Full text available
Complete access to the full archive of articles is available with SEA membership. Existing members: please log in with your membership password to view full text. Non-members can buy a single article or issue by registering an account on this website, then selecting a padlocked full text button to purchase.

References

Anderson, N. E., Kent, B. & Owens, R. G. (2015). Experiencing patient death in clinical practice: Nurses' recollections of their earliest memorable patient death. International Journal Of Nursing Studies. 52 (3), 695-704. DOI: https://doi.org/10.1016/j.ijnurstu.2014.12.005

Asai M, Morita T, Akechi T, et al. (2007). Burnout and psychiatric morbidity among physicians engaged in end-of-life care for cancer patients: cross-sectional nationwide survey in Japan. Psychooncology. 16, e421-428. DOI: https://doi.org/10.1002/pon.1066

Becker, E. (1973). The Denial of Death. New York: Simon & Schuster.

Black, K. (2007). Healthcare professionals' death attitudes, experiences, and advance directive communication behavior. Death Studies. 31, 563-572. DOI: https://doi.org/10.1080/07481180701356993

Burke, B., Martens, A. & Faucher, E. (2010). Two decades of terror management theory: A meta-analysis of mortality salience research. Personality and Social Psychology Review. 14 (1), 155-195. DOI: https://doi.org/10.1177/1088868309352321

Carnevale, F.A. (2005). The palliation of dying: A Heideggerian analysis of the 'technologization' of death. Indo-Pacific Journal of Phenomenology. 5:1, 1-12,. DOI: https://doi.org/10.1080/20797222.2005.11433896

Cottrell, L., & Duggleby, W. (2016). The 'good death': An integrative literature review. Palliative and Supportive Care. (14) 6, 1-27. DOI: https://doi.org/10.1017/s1478951515001285

Dalton, D. (2012). The Object of Anxiety: Heidegger and Levinas and the phenomenology of the dead. janushead.org. Last accessed 7 April 2018. https://www.academia.edu/1255326/The_Objct_of_Anxiety_Heidegger_and_Levinas_and_the_phenomenology_of_the_Dead DOI: https://doi.org/10.5840/jh201112229

Derrida, J. (1993). Aporias. Stanford: Stanford University Press.

Dierckx de Casterlé, B., Verhaeghe, S.T., Kars, M.C., Coolbrandt, A., Stevens, M., Stubbe, M., Deweirdt, N., Vincke J & Grypdonck M. (2011) Researching lived experience in healthcare: significance for care ethics. Nursing Ethics. 18 (2), 232-42. DOI: https://doi.org/10.1177/0969733010389253

Deurzen, E. van (2010). Everyday Mysteries: A handbook of existential psychotherapy. London: Routledge.

Dunn, K. S., Otten, C. & Stephens, E. (2005). Nursing experience and the care of dying patients. Oncology Nursing Forum. 32 (1), 97-104. DOI: https://doi.org/10.1188/05.onf.97-104

Dunwoodie, D. & Auret, K. (2007). Psychological morbidity and burnout in palliative care doctors in Western Australia. Intern Med J. 37, e693-698. DOI: https://doi.org/10.1111/j.1445-5994.2007.01384.x

Gamino, L. A., & Ritter, R. H. (2012). Death competence: An ethical imperative. Death Studies. 36 (1), 23-40. DOI: https://doi.org/10.1080/07481187.2011.553503

Gannon, M., & Dowling, M. (2011). Nurses' experience of loss on the death of older persons in long-term residential care: Findings from an interpretative phenomenological study. International Journal of Older People Nursing. 7 (4), 243-252. DOI: https://doi.org/10.1111/j.1748-3743.2011.00281.x

Gerow, L., Conejo, P., Alonzo, A., Davis, N., Rodgers, S. & Domian, E. W. (2010). Creating a curtain of protection: Nurses' experiences of grief following patient death. Journal of Nursing Scholarship. 42 (2), 122-129. DOI: https://doi.org/10.1111/j.1547-5069.2010.01343.x

Graham, I.W., Andrewes, T., Clark, L. (2005). Mutual suffering: A nurse's story of caring for the living as they are dying. International Journal of Nursing Practice. 11, 277-285. DOI: https://doi.org/10.1111/j.1440-172x.2005.00535.x

Heidegger, M. (1962/1977). The question concerning technology. The Question Concerning Technology and Other Related Essays. Trans by Lovitt, W. New York: Harper & Row DOI: https://doi.org/10.5040/9798216385448.ch-1

Heidegger, M. (1977). Science and reflection. The Question Concerning Technology and Other Related Essays. Trans by Lovitt, W. New York: Harper & Row.

Heidegger, M. (1962). Being and Time. Trans by Macquarie, J. and Robinson, E. New York: Harper and Row.

Hinderer, K. A. (2012). Reactions to patient death: The lived experience of critical care nurses. Dimensions of Critical Care Nursing. 31 (4), 252-259. DOI: https://doi.org/10.1097/dcc.0b013e318256e0f1

Holland, J.M. & Neimeyer, R.A. (2005). Reducint the risk of burnout in end-of-life care settings: The role of daily spiritual experiences and training. Palliat Suppor Care. 3:173-181. DOI: https://doi.org/10.1017/s1478951505050297

Jackson, V. A., Sullivan, A. M., Gadmer, N.M., Seltzer, D., Mitchell, A. M., Seltzer, D., Mitchell, A. M., Lakoma, M. D., Arnold, R.M. & Block, S.D. (2005). 'It was haunting ...': Physicians' descriptions of emotionally powerful patient deaths. Academic Medicine. 80 (7), 648-656. DOI: https://doi.org/10.1097/00001888-200507000-00007

Jansen, J., Scherg, A., Schulz-Quach, C., & Lindblad, A. (2017). Searching for a good death: A review of medical students' perception. In Beckers, T. & Siegers, P. (eds), Boundaries of Life and Changing Conceptions of Birth and Death: Social and political contexts of assisted reproduction and assisted dying. New York: Springer.

Jonas, E., Greenberg, J., & Frey, D. (2003). Connecting terror management and dissonance theory: Evidence that mortality salience increases the preference for supporting information after decisions. Personality and Social Psychology Bulletin. 29 (9), 1181-1189. DOI: https://doi.org/10.1177/0146167203254599

Karger, A., Scherg, A., Schmitz, A., Wenzel-Meyburg, U., Raski, B., Vogt, H. & Schulz, C. (2015). A pilot study on undergraduate palliative care education: A study on changes in knowledge, attitudes and self-perception. Journal of Palliative Care and Medicine. 5 (6), 236.

Kasket, E. (2006). Death and the doctor: Part II. Journal of the Society for Existential Analysis. 17 (2), 385-396. DOI: https://doi.org/10.65828/0pr8ne69

Kasket, E. (2006). Death and the doctor. Journal of the Society for Existential Analysis. 17 (1), 137-150. DOI: https://doi.org/10.65828/0pr8ne69

Klackl, J., Jonas, E. & Kronbichler, M. (2014). Existential neuroscience: self-esteem moderates neuronal responses to mortality-related stimuli. Social Cognitive and Affective Neuroscience. 9 (11), 1754-1761. DOI: https://doi.org/10.1093/scan/nst167

Klass, P. (2015). Death takes a weekend. New England Journal of Medicine. 372 (5), 402-405. DOI: https://doi.org/10.1056/nejmp1413363

Krumm, N., Schmidlin, E., Schulz, C., & Elsner, F. (2015). Kernkompetenzen in der Palliativversorgung - ein Weißbuch der European Association for Palliative Care zur Lehre in der Palliativversorgung [Core competencies in palliative care: A white paper on palliative care education from the European Association for Palliative Care]. Zeitschrift für Palliativmedizin. 16 (4), 152-167. DOI: https://doi.org/10.1055/s-0035-1552684

Kubler-Ross, E. (1969). On Death and Dying: What the dying have to teach doctors, nurses, clergy and their own families. New York: Macmillan.

Langen, U., & Rosemeier, H-P. (1985). Das Todeskonzept in Abhängigkeit von der Erfahrung, die Personen im Umgang mit Phänomenen haben, die den Tod betreffen. In Howe, J. & Ochsmann, R. (Hrsg.), Tod – Sterben – Trauer. Bericht über die erste Tagung zur Thanato-Psychologie vom 4.-6. November 1982 in Vechta. (2.ed. p. 306-113). Eschborn bei Frankfurt a. M.: Fachbuchhandlung für Psychologie, Verl.-Abt.

Langs, R. (2004). Death anxiety and the emotion processing mind. Psychoanalytic Psychology. 21 (1), 31-53 DOI: https://doi.org/10.1037/0736-9735.21.1.31

Levinas, E. (1998). Otherwise Than Being or Beyond Essence. Trans. Lingis, A. Pittsburgh: Duquesne University Press. DOI: https://doi.org/10.1007/978-94-015-7906-3

Lifton, R.J. (1973). The sense of immortality: On death and the continuity of life. American Journal of Psychoanalysis. 33 (1), 3-15. DOI: https://doi.org/10.1007/bf01872131

Line, D. (2015). Quality of death index. Economist, 6 October, 2015.

Meier, E. A., Gallegos, J. V., Thomas, L. P. M., Depp, C. A., Irwin, S. A. & Jeste, D. V. (2016). Defining a good death (successful dying): Literature review and a call for research and public dialogue. The American Journal of Geriatric Psychiatry. 24 (4), 261-271. DOI: https://doi.org/10.1016/j.jagp.2016.01.135

Okon, T. (2006). 'Nobody understands': On a cardinal phenomenon of palliative care. J Med Philos. 31 (1), 13-46. DOI: https://doi.org/10.1080/03605310500499161

Oliver, D. P., Porock, D. & Oliver, D. B. (2006). Managing the secrets of dying backstage: The voices of nursing home staff. Omega: Journal of Death and Dying. 53 (3), 193-207. DOI: https://doi.org/10.2190/3p8g-5jad-j2nf-bkgk

Papadatou, D., Papazoglou, I., Bellali, T., Petraki, D. (2002). Greek nurse and physician grief as a result of caring for children dying of cancer. Paediatric Nursing. 28 (4), 345-353

Pessagno, R., Foote, C. E. & Aponte, R. (2013). Dealing with death: Medical students' experiences with patient loss. Omega: Journal of Death and Dying. 68 (3): 207-228. DOI: https://doi.org/10.2190/om.68.3.b

Policy Department Economic and Scientific Policy. (2008). Palliative Care in the European Union. Retrieved 31 May, 2017 from http://www.europarl.europa.eu/RegData/etudes/etudes/join/2008/404899/IPOL-ENVI_ET(2008)404899_EN.pdf

Potthoff, P. (1980). Der Tod im medizinischen Denken : Die Entwicklung kognitiver und emotionaler Dimensionen der Todesbedeutung. Stuttgart: Enke.

Quirin, M., Loktyushin, A., Arndt, J., Küstermann, E., Lo, Y.Y., Kuhl, J. & Eggert, L. (2012). Existential neuroscience: a functional magnetic resonance imaging investigation of neural responses to reminders of one's mortality. Social Cognitive and Affective Neuroscience. 7 (2), 193-198 DOI: https://doi.org/10.1093/scan/nsq106

Ramsay, N. (1995). Sitting close to death: Observation on a palliative care unit. Group Analysis. 28 (3), 355-365. DOI: https://doi.org/10.1177/0533316495283011

Redinbaugh, E.M., Sullivan, A.M., Block, S.D., Gadmer, N.M., Lakoma, M., Mitchell, A.M., Seltzer, D., Wolford, J., Arnold, R.M. (2003). Doctors' emotional reactions to recent death of a patient: cross sectional study of hospital doctors. BMJ. 2003. Jul 26. 327 (7408):185. DOI: https://doi.org/10.1136/bmj.327.7408.185

Rhodes-Kropf, J., Carmody, S., Seltzer, D., Redinbaugh, E., Gadmer, N., Block, & & Arnold, R. (2005). 'This is just to awful; I just can't believe I expereenced that...': Medical students' reactions to their most memorable patient death. Academic Medicine. 80 (7). 634-640. DOI: https://doi.org/10.1097/00001888-200507000-00005

Rodin, G., Lo, C., Rydall, A., Nissim, R., Malfitano, C., Shnall, J., Zimmermann, C. & Hales, S. (2017). Managing cancer and living meaningfully (CALM): A randomized controlled trial of a psychological intervention for patients with advanced cancer. Journal of Clinical Oncology. 35, no. 18 suppl - published online before print. DOI: https://doi.org/10.1200/JCO.2017.35.18_suppl.LBA1001

Rodin, G., & Zimmermann, C. (2008). Psychoanalytic reflections on mortality: A reconsideration. Journal of the American Academy of Psychoanalysis and Psychodynamic Psychiatry. 36 (1), 181-196. DOI: https://doi.org/10.1521/jaap.2008.36.1.181

Sansó, N., Galiana, L., Oliver, A., Pascual, A., Sinclair, S. & Benito, E. (2015). Palliative care professionals' inner life: Exploring the relationships among awareness, self-care, and compassion satisfaction and fatigue, burnout, and coping with death. J Pain Symptom Manage. 50:200-207 DOI: https://doi.org/10.1016/j.jpainsymman.2015.02.013

Schnell, M.W. & Schulz, C. (Hrsg.) (2016). 30 Gedanken zum Tod. Berlin: Nicolai DOI: https://doi.org/10.1007/978-3-658-19921-0_3

Schnell, M.W. (2018). Diversity at the end of life – between philosophy and palliative care [GERMAN]. Imago Hominis. 25(2), 97-102

Schnell, M.W. & Schulz, C. (2012). http://30jungemenschen.de/projekt.html

Schnell, M.W., Schneider, W. & Kolbe, H. (Hrsg.) (2014). Sterbewelten-Eine Ethnographie. Wiesbaden: Springer VS

Schulz, C., Moeller, M., Seidler, D., Schnell, M.W. (2013). Evaluating an evidence-based curriculum in undergraduate palliative care education: piloting a phase II exploratory trial for a complex intervention. BMC Med Edu. 2013, 13:18 DOI: https://doi.org/10.1186/1472-6920-13-1

Schulz-Quach, C. (2018). 'What is the meaning of death to you?' – metasynthesis of the lived experience of health care professionals who experience the death of others in a professional context. Master thesis (submitted). New School of Psychotherapy and Counselling (NSPC), London, UK.

Schulz, C. (2007). Just an Ordinary Day. Film Project. Available via https://www.youtube.com/watch?v=v=F_B2qxwFmgo

Schulz, C. (2010). The Encounter Between Dying Patients and Medical Undergraduates During a Course in End-of-life Communication in the Medical Curriculum: a qualitative approach to insights into the patient perspective. (Thesis) Master of Science in Palliative Care (MSc), King's College London.

Schulz, C. (2014). Why do you grief so differently, sister? An essay on loss and the family from a systemic perspective. Module Assignment, New School of Psychotherapy and Counselling (NSPC), London, UK. Available via https://www.researchgate.net/publication/3123280340_Why_do_you_grief_so_differently_sister_-_An_essay_on_loss_and_the_family_from_a_systemic_perspective; last accessed: 08/04/18

Schulz, C., Wenzel-Meyburg, U., Karger, A., Scherg, A., Schmitten, J. in der, Trapp, T., et al. (2015). Implementation of palliative care as a mandatory cross-disciplinary subject (QB13) at the Medical Faculty of the Heinrich-Heine-University Düsseldorf, Germany. GMS Journal for Medical Education. 32 (1), Doc 6.

Seymour, J. E. (2000). Negotiating natural death in intensive care. Social Science & Medicine. 51 (8), 1241-1252. DOI: https://doi.org/10.1016/s0277-9536(00)00042-3

Shen, P. (2017). In Pursuit of Silence. Documentary film project. http://www.pursuitofsilence.com

Shorter, M. & Stayt, L.C. (2010). Critical care nurses' experiences of grief in an adult intensive care unit. Journal of Advanced Nursing. 66 (1), 159-167. DOI: https://doi.org/10.1111/j.1365-2648.2009.05191.x

Sinclair, S. (2011). Impact of death and dying on the personal lives and practices of palliative and hospice care professionals. Canadian Medical Association Journal. 183 (2), 180-187. DOI: https://doi.org/10.1503/cmaj.100511

Smith, A., & Periyakoil, V.S. (2018). Should we bury 'the good death'?. Journal of the American Geriatrics Society (JAGS). DOI: https://doi.org/10.1111/jgs.15321

Smith, L., & Kasser, T. (2014). Mortality salience increases defensive distancing from people with terminal cancer. Death Studies. 38 (1), 44-53. DOI: https://doi.org/10.1080/07481187.2012.725449

Steinhauser, K.E., Christakis, N.A., Clipp, E.C., McNeilly, M., McIntyre, L. & Tulsky, J.A. (2000). Factors considered important at the end of life by patients, family, physicians and other care providers. JAMA. 284, 2476-2482. DOI: https://doi.org/10.1001/jama.284.19.2476

Stephenson, L. & Hale, B. (2017). An exploration into effectiveness of existential-phenomenological therapy as a UK NHS psychological treatment intervention. Journal of Humanistic Psychology. DOI: https://doi.org/10.1177/0022167817719178

Stevens, E. (2009). Extending knowledge of terror management theory to improve nursing care. International Journal of Palliative Nursing. 15 (8), 368-370. DOI: https://doi.org/10.12968/ijpn.2009.15.8.43793

Stiefel, F., Nakamura, K., Terui, T. & Ishitani, K. (2017). Collusions between patients and clinicians in end-of-life care: why clarity matters. Journal of Pain and Symptom Management Journal of Pain and Symptom Management. 53 (4), 776-782 DOI: https://doi.org/10.1016/j.jpainsymman.2016.11.011

Vachon, M., Fillion, L. & Achille, M. (2012). Death confrontation, spiritual-existential experience and caring attitudes in palliative care nurses: An interpretative phenomenological analysis. Qualitative Research In Psychology. 9 (2), 151-172. DOI: https://doi.org/10.1080/14780881003663424

Vos, J., Cooper, M., Correia, E., Craig, M. (2015). Existential therapies: A review of their scientific foundations and efficacy. Journal of the Society for Existential Analysis. 26, 49-69. DOI: https://doi.org/10.65828/92y7cr57

Ware, B. (2012). The Top Five Regrets of the Dying: A life transformed by the dearly departing. Hay House; Reprint edition (20 March, 2012), ISBN-10: 9781401940652

Webber, D., Zhang, R., Schimel, J. & Blatter, J. (2016). Finding death in meaninglessness: Evidence that death-thought accessibility increases in response to meaning threats. British Journal of Social Psychology. 55 (1), 144-161. DOI: https://doi.org/10.1111/bjso.12118

Wein, S. (2012). Heroism and the fear of death. Journal of Palliative Medicine. 15 (7), 731–732. DOI: https://doi.org/10.1089/jpm.2012.0064

Weissmann, D., Quill, T. & Block, S. (2010). Missed opportunities in medical student education. Journal of Palliative Medicine. 13 (5), 489-490. DOI: https://doi.org/10.1089/jpm.2010.9838

Wettreck, K. (2001). 'Am Bett ist alles anders' – Perspektiven professioneller Pflegeethik. Münster: LIT.

Weyers, S., Noack, T., Rehkämper, G., Wenzel-Meyburg, U., Schulz, C. & Schmitz, A. (2017). 'I just realized that something happened to me today' – An innovative educational approach to support students in dealing with the dissection course, death and dying. Annals of Anatomy. 210, 160-163. DOI: https://doi.org/10.1016/j.aanat.2016.11.012

Whitehead, P. R. (2014). The lived experience of physicians in dealing with patient death. BMJ Supportive & Palliative Care. 4, 271-276. DOI: https://doi.org/10.1136/bmjspcare-2012-000326

Wildfeuer, J., Schnell, M. W. & Schulz, C. (2015). Talking about dying and death: On new discourse constructions of a formerly postulated taboo. Discourse & Society. 26 (3), 366-390. DOI: https://doi.org/10.1177/0957926514564739

Wohlgemuth, P. (2013). 'Ich sehe Dich' [German] I see you. Palliative Care Film Project. Co-director: Christian Schulz. Available via: http://mediathek.hhu.de/watch/82df7ebb-1b15-43ac-bee0-7a6c931b69dd

Zambrano, S. C. & Barton, C. A. (2011). On the journey with the dying: how general practitioners experience the death of their patients. Death Studies. 35 (9), 824-851. DOI: https://doi.org/10.1080/07481187.2011.553315

Zust, B.L. (2006). Death as a transformation of wholeness: an 'aha' experience of health as expanding consciousness. Nursing Science Quarterly. 19 (1), 57-60. DOI: https://doi.org/10.1177/0894318405283555

Published

2018-07-01

Cite This Article

The Nakedness Of The Dead Body – The Meaning Of Death To Healthcare Professionals Working With The Dying. (2018). Existential Analysis: Journal of the Society for Existential Analysis, 29(2), 301-323. https://doi.org/10.65828/kj5k2380
Download: RIS · BibTeX

Related articles

Search for similar articles ›