1. Chapter 11-Death and Dying
PowerPoint to accompany Law & Ethics For Medical Careers Fifth Edition Judson · Harrison
Chapter 11-Death and Dying
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2. Death and Dying Learning Outcomes
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Learning Outcomes
Discuss accepted criteria for determining death.
Determine the health care professional’s role in caring for the dying.
Explain differences between a living will, a health care proxy, and durable power of attorney.
Discuss the various stages of grief.
Begin to form a knowledge base for assisting dying patients and their family members through the grieving process, as well as forming a personal philosophy concerning death and dying.
Identify the major features of organ donation in the United States.
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3. Determination of Death
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Most states follow definitions recommended in a proposed Uniform Determination of Death Act.
Brain death occurs when the following functions irreversibly cease:
Circulatory and respiratory functions.
Entire brain, including brain stem.
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4. Other Important Definitions
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Coma
A person is comatose when they are in a deep stupor and do not respond to external stimuli.
Persistent Vegetative State (PVS)
Irreversible cessation of higher functions of brain, but involuntary bodily functions present.
No reasonable expectation of reversal.
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5. Autopsies
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A postmortem examination to determine cause of death and/or to obtain physiological evidence.
Required when foul play is suspected.
Not routinely done in most hospitals; exception would be teaching hospitals associated with a medical school.
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6. Teaching Health Care Providers to Care for Dying Patients
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Teaching Health Care Providers to Care for Dying Patients
More end-of-life care is being taught to physician and other health care professionals.
Thanatology is the study of death and psychological methods of coping with death.
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7. The Right to Die Each state’s laws are different.
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The Right to Die
Each state’s laws are different.
Proposed Uniform Rights of Terminally Ill Act provided guidelines for states.
Important to have Advanced Directives in place.
Only Oregon allows physician assisted death.
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8. Euthanasia Active euthanasia Passive euthanasia Voluntary euthanasia
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Active euthanasia
Conscious act that results in death.
Passive euthanasia
Allowing patient to die naturally, without medical interference.
Voluntary euthanasia
Requires patient or agent consent.
Involuntary euthanasia
Without patient or agent consent.
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9. Caring for Dying Patient
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Caring for Dying Patient
Curative Care
Treatments and procedures to help cure the patient’s disease.
Palliative Care
Treatments to help provide comfort and maintain highest quality of life; often called comfort care.
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10. Hospice Facilities and care for dying patients.
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Hospice
Facilities and care for dying patients.
Care may be in the patient’s home or a hospice facility.
Care focuses on relieving pain, controlling symptoms and meeting emotional needs, and personal values of both the patient and the family members.
McGraw-Hill © 2010 by The McGraw-Hill Companies, Inc. All rights reserved

11. Planning Ahead Patient Self-Determination Act of 1990
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Patient Self-Determination Act of 1990
Requires that hospitals and other health care facilities provide written information to patients about:
The right to make medical decisions.
The right to executive Advanced Directives.
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12. Advanced Directives-Living Will
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Detailed instructions regarding a patient’s wishes for end-of-life treatment.
May include any or all of the following:
Circumstances under which treatment should be discontinued.
When heroic measures should or should not be taken.
Directions for organ donation, autopsy or alternative treatment.
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13. Advanced Directives— Power of Attorney
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Advanced Directives— Power of Attorney
Durable Power of Attorney
A document designating individual(s) to act on another’s behalf in all legal matters.
Takes effect when the grantor loses ability to make decisions (unconsciousness or mental incompetence).
Health Care Proxy
Health care power of attorney for end-of-life situations.
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14. Other Advanced Directives
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Other Advanced Directives
Do-Not-Resuscitate Order
Order issued when a patient specifies that no CPR should be performed if his/her heart stops beating.
Different procedure exists in each state.
Organ Donor Directives
Patient specifications regarding organ transplantation.
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15. National Organ Transplant Act
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National Organ Transplant Act
Federal Law passed in 1984.
Established Organ Procurement Organizations (OPO’s).
Established the Organ Procurement and Transplantation Network (OPTN).
The OPTN and OPO work together to provide organs throughout the United States.
Organ shortages remain critical in the United States.
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16. Uniform Anatomical Gift Act
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Uniform Anatomical Gift Act
States allow organ donation by law, there is no federal law to provide organ donor directives.
Most states allow prospective donors to indicate on their driver’s license their intent to donate.
There are many myths about organ donation; look for the Frequently Asked Questions in Chapter 11 for information.
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17. 11-17
The Grieving Process
Elizabeth Kubler-Ross defines five stages of grief:
Denial and isolation
Anger, rage, and resentment
Bargaining and guilt
Depression or sadness
Acceptance
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18. Ethics Guide Discussion
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Ethics Guide Discussion
You are one of three siblings. Your 89-year-old mother, who has been in poor health for years, is diagnosed with an irreversible brain cancer and slips into a PVS. Your two sisters are not in agreement about end-of-life care for your mother. They look to you to resolve the issue. What are you going to do?
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