1. Chapter Twenty
Dying and Death

2. Defining Death
Death has been defined as cessation of the flow of vital bodily fluids
This occurs when the heart stops beating and breathing ceases
The concept of cellular ‘brain death’ involves the following:
Lack of receptivity and response to external stimuli
Absence of spontaneous muscular movement and spontaneous breathing
Absence of observable reflexes
Absence of brain activity (EEG)

3. Understanding of Death
Our understanding of death changes as we grow and mature
Based on work by Speece and Brent, the observable facts about death include 4 components:
Universality (all things eventually die)
Irreversibility (organisms that die cannot live again)
Nonfunctionality (death involves cessation of all signs of life)
Causality (there are biological reasons for death)

4. Denying vs. Welcoming Death
Many people seek to avoid any mention of death
The saying, “out of sight, out of mind” appears to be the rule compared to facing death directly
Cartoons and video games give death a ‘two-dimensional’ concept which distorts reality
Problems can arise when the avoidance or denial that death can happen to you
See Box: “Day of the Dead”
See Box: Dimensions of Diversity

5. Planning For Death
Accepting that death will occur allows the ability to plan for this event
Basic tasks may include:
Making a Will
Considering options for ‘End-of-Life’ care
Home Care
Hospital based Care (palliative care)
Hospice Programs
See Box: In Focus

6. Deciding to Prolong Life or Hasten Death
Once someone is given the prognosis that life would end soon, the following decisions would have to be considered
Withholding or Withdrawing Treatment (passive euthanasia)
Assisted Suicide (active euthanasia or physician assisted)
Advanced Directive (document regarding treatment if you become unable to make them)
Living Will
Health Care Proxy
Organ Donation
See Figure 20-1 on a Living Will
See Figure 20-2 on Organ Donating
See Box: “What Can Be Done About the Shortage of Organ Donors?”
See Figure 20-3 on Uniform Donor Card

7. Planning a Funeral
A funeral are rites of passage that commemorate a person’s life and acknowledge their existence
Funerals provide a framework that allows survivors to support one another as they cope with the loss and express grief
The following need to be addressed when planning a funeral
Disposition of the body
Service Arrangement
See Box; Critical Consumer
See Box: ‘Tasks for Survivors”

8. Coping With Dying
Charles Corr distinguishes 4 primary dimensions in coping with dying
Physical (satisfying bodily needs0
Psychological (maximizing sense of security)
Social (sustaining significant relationships)
Spiritual (reaffirming sources of meaning)
Contemplating these dimensions gives us a framework for considering specific tasks that need to be addressed

9. Coping With Dying
Charles Corr distinguishes 4 primary dimensions in coping with dying
Physical (satisfying bodily needs0
Psychological (maximizing sense of security)
Social (sustaining significant relationships)
Spiritual (reaffirming sources of meaning)
Contemplating these dimensions gives us a framework for considering specific tasks that need to be addressed

10. Coping With Loss
Grief is the reaction to loss and encompasses thoughts and feelings, as well as physical and behavioral responses
Mourning is closely related to grief and refers to the process by which a person adjusts to loss and incorporates this into their life
William Worden has identified 4 tasks when mourning
Accepting the reality of loss
Working through the pain
Adjusting to a change environment
Emotionally relocating the deceased and moving on
See Box: “In Search of a Good Death”
See Box: Gender Matters
See Box: “Coping with Grief”
See Box: Take Charge
See Box: “Grief and Gender”

11. Chapter Twenty
Dying and Death