1. Ch 12
Death and Dying

2. Learning Outcomes
12.1 Discuss how attitudes toward death have changed over time. Page Discuss accepted criteria for determining death. Page Determine the health care professional’s role in caring for the dying. pages 360,361,362
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.

3. 12-3
Learning Outcomes
12.4 Discuss benefits to end-of-life health care derived from the right to die movement. Page 364
Look at pages 366,367,368,369,370,371
12.5 Identify the major features of organ donation in the United States.
Pages 372,372,373
12.6 Discuss the various stages of grief.
Pages 375,376,377,378
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 Discuss the various stages of grief. 3

4. Attitudes Toward Death and Dying page 358
Will I die alone, in an impersonal, clinical hospital environment?
Will my health care providers be so committed to preserving life that they prolong 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.

5. Uniform Determination of Death Act
12-5
Uniform Determination of Death Act
Pate 359
Definition of brain death
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. 5

6. 12-6
Brain Injury page 359
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
suba
sub2
LO 12.2 Discuss accepted criteria for determining death. 6

7. Signs of Death page 359 Cannot breathe without assistance
12-7
Signs of Death page 359
Cannot breathe without assistance
Has no coughing or gagging reflex
Has no pupil response to light
Has no blinking reflex when the cornea is touched
Has no grimace reflex when the head is rotated or ears are flushed with ice water
Has no response to pain
LO 12.2 Discuss accepted criteria for determining death. 7

8. 12-8
Autopsy page 359,360
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. 8

9. 12-9
Palliative page 360,361
Given when patient’s disease is incurable and death is imminent
Directed toward providing relief to terminally ill patients through symptom and pain management
Goal is to provide comfort and maintain the highest possible quality of life
LO 12.3 Determine the health care professional’s role in caring for the dying. 9

10. Question Tell whether the following statement is true or false.
12-10
Question
Tell whether the following statement is true or false.
A patient who has end stage lung cancer would most likely be sent to a facility that provides curative care.
True
False
LO 12.3 Determine the health care professional’s role in caring for the dying. 10

11. 12-11
Answer
False
A patient who has end stage lung cancer would most likely be sent to a facility that provides hospice care. Hospice care focuses on relieving pain, controlling symptoms, and meeting emotional needs and personal values of the terminally ill, instead of targeting the underlying disease process.
LO 12.3 Determine the health care professional’s role in caring for the dying. 11

12. Right to Die Movement page 365
12-12
Right to Die Movement page 365
First became an issue in Karen Quinlan case (1976)
Uniform rights of the Terminally Ill Act
A federal statute passed in 1989 to guide state legislatures in constructing laws to address advance directives
LO 12.4 Discuss benefits to end-of-life health care derived from the right to die movement. 12

13. 12-13
Euthanasia page 369
LO 12.4 Discuss benefits to end-of-life health care derived from the right to die movement. 13

14. Physician-Assisted Suicide/Issues page 366,367
12-14
Some believe a person has the right to control his or her own life, including choosing to end it.
Others see the question from a quality-of-life perspective.
Another group argues that physician-assisted suicide should be permissible only if a person is nearly brain-dead with no chance of recovery.
LO 12.4 Discuss benefits to end-of-life health care derived from the right to die movement. 14

15. Patient Self-Determination Act 1990 pages 369-370
12-15
Patient Self-Determination Act pages
Advance directives
Living will
Durable power of attorney
Health care proxy
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 page 369
12-16
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. 16

17. Patient Self-Determination Act 1990
12-17
Patient Self-Determination Act 1990
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. 17

18. Question Tell whether the following statement is true or false.
12-18
Question
Tell whether the following statement is true or false.
A living will directly provides instructions to physicians, hospitals, and other health care providers involved in a patient’s treatment.
True
False
LO 12.4 Discuss benefits to end-of-life health care derived from the right to die movement. 18

19. 12-19
Answer
True
A living will directly provides instructions to physicians, hospitals, and other health care providers involved in a patient’s treatment. All 50 states accept the validity of living wills, although they also specify various requirements that must be met.
LO 12.4 Discuss benefits to end-of-life health care derived from the right to die movement. 19

20. 12-20
Living Will page 370
LO 12.4 Discuss benefits to end-of-life health care derived from the right to die movement. 20

21. Types of Advance Directives page 369
12-21
Types of Advance Directives page 369
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
Health care proxy
Durable power of attorney issued for purposes of health care decisions only
LO 12.4 Discuss benefits to end-of-life health care derived from the right to die movement. 21

22. Types of Advance Directives (cont.) page 370
12-22
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. 22

23. National Organ Transplant Act page 372
12-23
National Organ Transplant Act page 372
Addresses the severe shortage of organs available for transplantation
Provides funds for grants to qualified organ procurement organizations
Provides funds for the establishment of an Organ Procurement and Transplantation Network to assist OPOs in the distribution of unused organs outside their geographical area
LO 12.5 Identify the major features of organ donation in the United States. 23

24. 12-24
OPTN Goals page 372
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. 24

25. Organ Donor Directives page 373
12-25
Organ Donor Directives page 373
Some states allow licensed drivers to fill out organ donation forms on the back of their licenses.
Nondrivers or residents of states where driver’s licenses do not include this information may carry an organ donor card in their wallets, specifying their desire to donate organs.
LO 12.5 Identify the major features of organ donation in the United States. 25

26. Organ Donor Directives
12-26
Organ Donor Directives
Organizations such as the National Kidney Foundation, the United Network for Organ Sharing (UNOS), and the Living Bank provide donor registration materials in response to requests.
In addition to having an organ donor card, patients should make clear to family members their wishes regarding organ donation in the event of their death.
LO 12.5 Identify the major features of organ donation in the United States. 26

27. Uniform Anatomical Gift Act page 373
12-27
Uniform Anatomical Gift Act page 373
A proposed national statute allowing 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. 27

28. Organs/Tissues for Transplantation
12-28
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. 28

29. Question Tell whether the following statement is true or false.
12-29
Question
Tell whether the following statement is true or false.
A person is donating a kidney. It is the responsibility of the person donating an organ to pay the costs of the transplant.
True
False
LO 12.5 Identify the major features of organ donation in the United States. 29

30. 12-30
Answer
False
A person is donating a kidney. It is the responsibility of the person receiving an organ (or his or her insurance) to pay the costs of the transplant.
LO 12.5 Identify the major features of organ donation in the United States. 30

31. Stage of Grief (Reaction to Loss)p. 377-378
12-31
Stage of Grief (Reaction to Loss)p
Stage 1: denial and isolation
Stage 2: anger, rage, resentment
Stage 3: bargaining and guilt
Stage 4: depression or sadness
Stage 5: acceptance
(Elisabeth Kubler-Ross, MD)
LO Discuss the various stages of grief. 31

32. Three Stages of Grief page 377
12-32
Three Stages of Grief page 377
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
(Roberta Temes, PhD)
LO Discuss the various stages of grief.
Roberta Temes, PhD, also describes her perception of the distinctive behaviors of grief in her book, Solace: Finding Your Way Through Grief and Learning to Live Again (New York: Amacon Books, 2009) 32