Ch 12 Death and Dying

Key Terms active euthanasia brain death coma curative care do-not-resuscitate (DNR) order durable power of attorney health care proxy hospice involuntary euthanasia living will National Organ Transplant Act palliative care passive euthanasia LO 12.1 Discuss how attitudes toward death have changed over time. LO 12.2 Discuss accepted criteria for determining death. LO 12.3 Determine the health care professional’s role in caring for the dying. LO 12.4 Discuss benefits to end-of-life health care derived from the right to die movement. LO 12.5 Identify the major features of organ donation in the United States. LO 12.6 Discuss the various stages of grief.

Key Terms (cont.) Patient Self-Determination Act persistent vegetative state (PVS) terminally ill thanatology Uniform Anatomical Gift Act Uniform Determination of Death Act Uniform Rights of the Terminally Ill Act voluntary euthanasia LO 12.1 Discuss how attitudes toward death have changed over time. LO 12.2 Discuss accepted criteria for determining death. LO 12.3 Determine the health care professional’s role in caring for the dying. LO 12.4 Discuss benefits to end-of-life health care derived from the right to die movement. LO 12.5 Identify the major features of organ donation in the United States. LO 12.6 Discuss the various stages of grief.

Learning Outcomes 12.1 Discuss how attitudes toward death have changed over time. 12.2 Discuss accepted criteria for determining death. 12.3 Determine the health care professional’s role in caring for the dying. LO 12.1 Discuss how attitudes toward death have changed over time. LO 12.2 Discuss accepted criteria for determining death. LO 12.3 Determine the health care professional’s role in caring for the dying.

Learning Outcomes (cont.) 12-5 Learning Outcomes (cont.) 12.4 Discuss benefits to end-of-life health care derived from the right to die movement. 12.5 Identify the major features of organ donation in the United States. 12.6 Discuss the various stages of grief. LO 12.4 Discuss benefits to end-of-life health care derived from the right to die movement. LO 12.5 Identify the major features of organ donation in the United States. LO 12.6 Discuss the various stages of grief. 5

Concerns About Death and Dying Will I die alone, in an impersonal, clinical hospital environment? Will my health care providers be so committed to preserving life that they delay my dying to an irrational degree? Will I suffer in pain? Will I feel a sense of tasks left unfinished and goals left unrealized? Will I experience a peaceful letting go? LO 12.1 Discuss how attitudes toward death have changed over time.

Determination of Death 12-7 Determination of Death Uniform Determination of Death Act Proposed by the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical Research in 1981 Each state has its own criteria Definition of brain death (generally accepted): Circulatory and respiratory functions have irreversibly ceased The entire brain, including the brain stem, has irreversibly ceased to function LO 12.2 Discuss accepted criteria for determining death. 7

Brain Injury Coma Persistent vegetative state 12-8 Brain Injury Coma Deep stupor from which the patient cannot be roused by external stimuli Persistent vegetative state Severe mental impairment with irreversible cessation of higher functions of the brain, most often caused by damage to the cerebral cortex LO 12.2 Discuss accepted criteria for determining death. 8

Signs of Death Cannot breathe without assistance 12-9 Signs of Death Cannot breathe without assistance No coughing or gagging reflex No pupil response to light No blinking reflex when the cornea is touched No grimace reflex when the head is rotated or ears are flushed with ice water No response to pain LO 12.2 Discuss accepted criteria for determining death. 9

12-10 Autopsy Postmortem examination determines cause of death and/or obtains physiological evidence when necessary Autopsies performed in hospitals may confirm or correct clinical diagnoses Autopsies must be performed in cases in which the death is suspicious or due to homicide LO 12.2 Discuss accepted criteria for determining death. 10

Palliative and Curative Care 12-11 Palliative and Curative Care Palliative care Treatment of a terminally ill patient’s symptoms to make dying more comfortable Curative care Treatment directed towards curing a patient’s disease LO 12.3 Determine the health care professional’s role in caring for the dying. 11

Hospice Services for dying patients and their families In patient’s home, nursing home, or hospital Special facilities for only hospice patients Multi-disciplinary team of caregivers Physicians Nurses and home health aides Social workers Physical therapists Others LO 12.3 Determine the health care professional’s role in caring for the dying.

12-13 Right to Die Movement First became an issue in Karen Quinlan case (1976) Uniform Rights of the Terminally Ill Act Guidelines for state legislatures to construct laws addressing advance directives LO 12.4 Discuss benefits to end-of-life health care derived from the right to die movement. 13

Right to Die Movement (cont.) Variety of state laws passed over last 60 years Currently, four states have Death with Dignity type legislation Oregon Washington Montana Vermont LO 12.4 Discuss benefits to end-of-life health care derived from the right to die movement.

Euthanasia and Physician-Assisted Suicide 12-15 Euthanasia and Physician-Assisted Suicide Active euthanasia Passive euthanasia Voluntary euthanasia Involuntary euthanasia LO 12.4 Discuss benefits to end-of-life health care derived from the right to die movement. 15

Patient Self-Determination Act (1990) 12-16 Patient Self-Determination Act (1990) PSDA requires providers to ask patients if they have advance directives Advance directives include: Living will Durable power of attorney Health care proxy DNR LO 12.4 Discuss benefits to end-of-life health care derived from the right to die movement. 16

Patient Self-Determination Act (1990) (cont.) 12-17 Patient Self-Determination Act (1990) (cont.) Health care providers will document in the patient’s medical record whether he or she has executed an advance directive Providers may not discriminate against an individual based on whether or not he or she has executed an advance directive LO 12.4 Discuss benefits to end-of-life health care derived from the right to die movement. 17

Patient Self-Determination Act (1990) (cont.) 12-18 Patient Self-Determination Act (1990) (cont.) Providers must comply with state laws respecting advance directives Providers must have a policy for educating staff and the community regarding advance directives LO 12.4 Discuss benefits to end-of-life health care derived from the right to die movement. 18

Types of Advance Directives 12-19 Types of Advance Directives Living will An advance directive that specifies an individual’s end-of-life wishes Durable power of attorney An advance directive that confers upon a designee the authority to make a variety of legal decisions on behalf of the grantor, usually including health care decisions LO 12.4 Discuss benefits to end-of-life health care derived from the right to die movement. 19

Types of Advance Directives (cont.) 12-20 Types of Advance Directives (cont.) Health care proxy Durable power of attorney issued for purposes of health care decisions only Do-not-resuscitate order When admitted to a hospital, most patients are allowed by state law to specify that they are not to be revived if their heart stops LO 12.4 Discuss benefits to end-of-life health care derived from the right to die movement. 20

National Organ Transplant Act 12-21 National Organ Transplant Act Passed in 1984, a federal law that provides grants to qualified organ procurement organizations and established an Organ Procurement and Transplantation Network (OPTN) LO 12.5 Identify the major features of organ donation in the United States. 21

OPTN Goals Organ Procurement and Transplantation Network Goals 12-22 OPTN Goals Organ Procurement and Transplantation Network Goals Increase the effectiveness and efficiency of organ sharing and equity in the national system of organ allocation Increase the supply of donated organs available for transplantation LO 12.5 Identify the major features of organ donation in the United States. 22

Uniform Anatomical Gift Act 12-23 Uniform Anatomical Gift Act Recommendation of the National Conference of Commissioners on Uniform State Laws that all states accepted Allows individuals to donate their bodies or body parts, after death, for use in transplant surgery, tissue banks, or medical research or education LO 12.5 Identify the major features of organ donation in the United States. 23

Organs/Tissues for Transplantation 12-24 Organs/Tissues for Transplantation Organs Heart, kidney, pancreas, lung, stomach, and small and large intestines Tissues Bone, corneas, skin, heart valves, veins, cartilage, and other connective tissues LO 12.5 Identify the major features of organ donation in the United States. 24

Stages of Grief—Kübler-Ross 12-25 Stages of Grief—Kübler-Ross Stage 1: denial and isolation Stage 2: anger, rage, and resentment Stage 3: bargaining and guilt Stage 4: depression and sadness Stage 5: acceptance Not in any specific order LO 12.6 Discuss the various stages of grief. 25

Three Stages of Grief—Temes 12-26 Three Stages of Grief—Temes Numbness, characterized by mechanical or rote functioning and social isolation Disorganization, where feelings of loss are so painful and disorienting one can’t make plans or decide what to do next Reorganization, a return to one’s previous, more normal and functional way of life LO 12.6 Discuss the various stages of grief. 26