1. Ch 12
Death and Dying

2. 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 Identify the major features of organ donation in the United States.
LO 12.6 Discuss the various stages of grief.

3. 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 Identify the major features of organ donation in the United States.
LO 12.6 Discuss the various stages of grief.

4. Learning Outcomes
12.1 Discuss how attitudes toward death have changed over time Discuss accepted criteria for determining death 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.

5. 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 Identify the major features of organ donation in the United States.
LO 12.6 Discuss the various stages of grief. 5

6. 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.

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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.

13. 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

14. 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.

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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 Identify the major features of organ donation in the United States. 21

22. 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 Identify the major features of organ donation in the United States. 22

23. 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 Identify the major features of organ donation in the United States. 23

24. 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 Identify the major features of organ donation in the United States. 24

25. 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

26. 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