1. © 2011 McGraw-Hill Higher Education. All rights reserved. Chapter 21 Accepting Dying and Death

2. © 2011 McGraw-Hill Higher Education. All rights reserved. Definitions of Death Clinical determinants of death Clinical determinants of death Medical death certificate Medical death certificate Criteria to establish death Criteria to establish death –Lack of heartbeat and breathing –Lack of central nervous system function –Presence of rigor mortis

3. © 2011 McGraw-Hill Higher Education. All rights reserved. Psychological Stages of Dying Denial Denial Anger Anger Bargaining Bargaining Depression Depression Acceptance Acceptance

4. © 2011 McGraw-Hill Higher Education. All rights reserved. Near-Death Experiences Realization of death Realization of death Out-of-body experience Out-of-body experience Movement into a blue tunnel Movement into a blue tunnel Encountering love ones who have died Encountering love ones who have died Intense light Intense light Sense of well-being and peace Sense of well-being and peace Reviewing of one’s life Reviewing of one’s life Reaching a boundary or border Reaching a boundary or border Returning to the body Returning to the body Feeling a sense of warmth when returning to the body Feeling a sense of warmth when returning to the body

5. © 2011 McGraw-Hill Higher Education. All rights reserved. Interacting with Dying People Be genuine and honest Be genuine and honest Provide emotional support Provide emotional support Allow people to express their feelings Allow people to express their feelings

6. © 2011 McGraw-Hill Higher Education. All rights reserved. Talking with Children about Death Use straightforward, age- appropriate language Use straightforward, age- appropriate language Avoid shielding Avoid shielding Make certain the child understands Make certain the child understands Provide simple, direct answers Provide simple, direct answers –The person will never come back –The body has been buried or burned to ashes

7. © 2011 McGraw-Hill Higher Education. All rights reserved. End-of-Life Options and Decisions Hospice care for the terminally ill Goal is to maximize quality of life Goal is to maximize quality of life Strategies Strategies –Pain control –Family involvement –Multidisciplinary approach –Patient decisions Follow-up and care for survivors Follow-up and care for survivors

8. © 2011 McGraw-Hill Higher Education. All rights reserved. Euthanasia Indirect or passive euthanasia Indirect or passive euthanasia –Allowing to die (“do not resuscitate”) Direct or active euthanasia Direct or active euthanasia –Giving a patient a lethal dose of drugs Physician-assisted suicide Physician-assisted suicide –Prescribing a patient a lethal dose of drugs Oregon Death with Dignity Act Oregon Death with Dignity Act

9. © 2011 McGraw-Hill Higher Education. All rights reserved. End-of-Life Options and Decisions Advance Healthcare Directives Advance Healthcare Directives –Living will –Durable power of attorney for health care

10. © 2011 McGraw-Hill Higher Education. All rights reserved. Living Will

11. © 2011 McGraw-Hill Higher Education. All rights reserved. Organ Donation Intention to donate can be stated on driver’s license, but next-of-kin must consent at time of death Intention to donate can be stated on driver’s license, but next-of-kin must consent at time of death Significant shortage of donor organs Significant shortage of donor organs Every day: Every day: –77 people receive a transplant –110 people join waiting list for a transplant –19 people die waiting for a transplant

12. © 2011 McGraw-Hill Higher Education. All rights reserved. Planning an Organ Donation

13. © 2011 McGraw-Hill Higher Education. All rights reserved. Grief and Coping: The Experience of Grief Physical discomfort Physical discomfort Sense of numbness Sense of numbness Feeling of detachment from others Feeling of detachment from others Preoccupation with the image of the deceased Preoccupation with the image of the deceased Guilt Guilt Hostility Hostility Disruption in daily schedule Disruption in daily schedule Delayed grief Delayed grief

14. © 2011 McGraw-Hill Higher Education. All rights reserved. Coping with Death from Specific Causes Terminal illness Terminal illness Accidental death Accidental death Natural disasters Natural disasters Terrorism Terrorism Suicide Suicide Murder Murder

15. © 2011 McGraw-Hill Higher Education. All rights reserved. Coping with the Death of a Loved One Child Child –Miscarriage –Lost after birth –Grieving Parent Parent Spouse Spouse Sibling Sibling

16. © 2011 McGraw-Hill Higher Education. All rights reserved. Rituals of Death Cultural differences Cultural differences Full funeral services Full funeral services –Embalming –Calling hours –Funeral service Memorial service Memorial service Disposition of the body Disposition of the body –Ground burial –Entombment –Cremation –Anatomical donation Costs Costs

17. © 2011 McGraw-Hill Higher Education. All rights reserved. Personal Preparation for Death Will Will Life insurance Life insurance Funeral prearrangements Funeral prearrangements Anatomical or organ donation Anatomical or organ donation Eulogy Eulogy Epitaph Epitaph

18. © 2011 McGraw-Hill Higher Education. All rights reserved. Chapter 21Accepting Dying and Death