1. Chapter 23

2. . © 2012 McGraw-Hill Companies. All Rights Reserved Why Is There Death?  There is no completely satisfying answer to the question of why death exists  Death promotes variety through the evolution of species  The perspective of species survival, the cycle of life and death 2

3. . © 2012 McGraw-Hill Companies. All Rights Reserved Understanding Death and Dying  Defining Death Defined as cessation of the flow of vital bodily fluids. ○ Cessations of the heart beating and breathing ○ Life-support systems ○ Brain death ○ Harvard medical School committee – death involves: 1. Lack of receptivity and response to external stimuli 2. Absence of spontaneous muscular movement and spontaneous breathing 3. Absence of observable reflexes 4. Absence of brain activity Electroencephalogram (EEG) Clinical death Cellular death 3

4. . © 2012 McGraw-Hill Companies. All Rights Reserved Learning About Death  A child’s understanding of death evolves greatly from about age 5 to age 9. Most children cone to understand that death is final, universal, and inevitable  Mature understanding of death  Mark Speece and Sandor Brent – Facts about death includes four components 1. Universality 2. Irreversibility 3. Nonfunctionality 4. Causality 4

5. . © 2012 McGraw-Hill Companies. All Rights Reserved Denying Versus Welcoming Death  Understanding death in a mature fashion does not imply that we never experience anxiety about the deaths of those we love or about the prospect of our own death. 5

6. . © 2012 McGraw-Hill Companies. All Rights Reserved Planning For Death  Making a Will A legal instrument expressing a person’s intentions and wishes for the disposition of his or her property after death. Estate Testator Intestate Testamentary letter ○ Document includes information about your personal affairs (bank statements, credit cards, documents etc.) 6

7. . © 2012 McGraw-Hill Companies. All Rights Reserved Considering Options for End-of- Life Care  Home Care  Hospital-Based Palliative Care Focuses on controlling pain and relieving suffering by caring for the physical, psychological, spiritual, and existential needs of the patient.  Hospice Programs Palliative care 7

8. . © 2012 McGraw-Hill Companies. All Rights Reserved Deciding to Prolong Life or Hasten Death  Withholding or Withdrawing Treatment  Assisted Suicide and Active Euthanasia Physician-assisted suicide (PAS) ○ Physician provides lethal drugs or other interventions Active euthanasia ○ Intentional act of killing someone who would otherwise suffer from an incurable and painful disease 8

9. . © 2012 McGraw-Hill Companies. All Rights Reserved Completing an Advance Directive  Any statement made by a competent person about choices for medical treatment should he or she become unable to make such a decisions.  Two forms: 1. Living will 2. Health care proxy ○ Surrogate (the decision maker) 9

10. . © 2012 McGraw-Hill Companies. All Rights Reserved Figure 23-1 Sample living will 10

11. . © 2012 McGraw-Hill Companies. All Rights Reserved Becoming an Organ Donor  Each day about 77 people receive an organ transplant while another 19 people on the waiting list die because not enough organs are available. 98,000 Americans waiting for organ transplants  Uniform Donor Card First step See “In Focus” Myths About Organ Donation 11

12. . © 2012 McGraw-Hill Companies. All Rights Reserved Figure 23-2 The need for organ donors 12

13. . © 2012 McGraw-Hill Companies. All Rights Reserved Planning a Funeral or Memorial Service  Disposition of the Body Social, cultural, religious, psychological, and interpersonal considerations Burial Cremation Embalming for a viewing or wake  Arranging a Service 13

14. . © 2012 McGraw-Hill Companies. All Rights Reserved Coping With Dying  Awareness of Dying  The Tasks of Coping 1969 book On Death and Dying, Elisabeth Kubler-Ross ○ 5 psychological stages 1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance Charles Corr ○ 4 primary dimensions in coping with dying 1. Physical 2. Psychological 3. Social 4. Spiritual Specific tasks that need to be addressed in coping with dying ○ Prediagnostic ○ Acute ○ Chronic ○ Terminal ○ Recovery 14

15. . © 2012 McGraw-Hill Companies. All Rights Reserved Coping With Dying  The Trajectory of Dying Understanding patients’ experiences as they near death  Supporting a Dying Person  Coping With Loss Experiencing Grief ○ Bereavement ○ Mourning Tasks of Mourning 1. Accepting reality 2. Working through the pain 3. Adjusting to a changed environment 4. Emotionally relocating the deceased and moving on with life The Course of Grief Supporting a Grieving Person Helping Children Cope with Loss 15

16. . © 2012 McGraw-Hill Companies. All Rights Reserved Coping With Dying The Course of Grief Supporting a Grieving Person Helping Children Cope with Loss  Coming To Terms With Death 16

17. © 2012 McGraw-Hill Companies. All Rights Reserved. Chapter 23 17