1. Dying And Death Chapter 20

2. © 2008 McGraw-Hill Companies. All Rights Reserved.2 Why Is There Death? Life span is long enough to allow reproduction and the linage of our species. Challenges our emotions and intellectual security. Religion plays a major role in shaping our attitudes and behaviors toward death We know that everything alive eventually dies.

3. Chapter 20 © 2008 McGraw-Hill Companies. All Rights Reserved.3 Understanding Death and Dying Defining death. –Defined as cessation of the flow of bodily fluids. –Life-support systems. –1968 Harvard Medical School Committee, Brain death involves: 1.Lack of receptivity and response to external stimuli. 2.Absence of spontaneous muscular movement and breathing. 3.Absence of observable reflexes. 4.Absence of brain activity. 1.Electroencephalogram (EEG). 5.Second set of tests after 24 hours 1.Hypothermia (Below 90 degrees F) 2.Central nervous system depressants  Clinical death  Cellular death

4. Chapter 20 © 2008 McGraw-Hill Companies. All Rights Reserved.4 Learning About Death Understanding of death changes as we age. Mature understanding of death. Four components (Mark Speece). 1.Universality.  All living things must die 2.Irreversibility.  Organisms that die cannot be made alive again 3.Nonfunctionality.  Cessation of all physiological functioning, or signs of life. 4.Causality.  Biological reasons for the occurrence of death.

5. Chapter 20 © 2008 McGraw-Hill Companies. All Rights Reserved.5 Dying Versus Welcoming Death Anxiety associated with death. Many seek to avoid any thought or mention of death. –“Out of sight, out or mind” United states attitude is to “death denying”.

6. Chapter 20 © 2008 McGraw-Hill Companies. All Rights Reserved.6 Planning For Death Making a will. –Legal instrument expressing a person’s intentions and wishes for the disposition of his or her property after death. –Estate. Money, property, and other possessions –Testator. The person making the will –Interstate. Without having left a valid will

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8. Chapter 20 © 2008 McGraw-Hill Companies. All Rights Reserved.8 Considering Options for End-of Life Care Spending your last days at home, cared for by relatives and friends? -OR- Access to the sophisticated medical technologies in the hospitals. Home care. Hospital-based palliative care. Hospice programs.

9. Chapter 20 © 2008 McGraw-Hill Companies. All Rights Reserved.9 Deciding to Prolong Life or Hasten Death Would you want aggressive treatment to keep you alive, even if it meant that your were put on life-support? Modern medicine. –Persistent vegetative state. –Ethical questions about the “right to die”. U.S. Supreme Court –1990. Cruzan case –2003. Schiavo case –The right to refuse life sustaining treatment is constitutionally protected. –The importance of expressing one’s wishes about life-sustaining treatment

10. Chapter 20 © 2008 McGraw-Hill Companies. All Rights Reserved.10 Deciding to Prolong Life or Hasten Death Withholding or Withdrawing Treatment. –The right of a competent patient to refuse unwanted treatment. –Passive euthanasia. Assisted Suicide and Active Euthanasia. –Physician-assisted suicide (PAS). 1997. Supreme Court cases –Washington v. Glucksberg –Vacco v. Quill Oregon is the only state permitting PAS –The Death with Dignity Act (1994) –Active euthanasia.

11. Chapter 20 © 2008 McGraw-Hill Companies. All Rights Reserved.11 Completing an Advance Directive 1.Living will. Enables individuals to provide instructions about the kind of medical care they wish to receive. 2.Health care proxy. Durable power of attorney for health care Appoint another person to make decisions about medical treatment Surrogate.

12. Chapter 20 © 2008 McGraw-Hill Companies. All Rights Reserved.12 Becoming an Organ Donor Human body is a valuable resource. Each day 60 people receive an organ transplant. Each day 18 people on the waiting list die because not enough organs to assist. Uniform Donor Card.

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14. Chapter 20 © 2008 McGraw-Hill Companies. All Rights Reserved.14 Planning a Funeral or Memorial Service Disposition of the body. –Considerations: Social Cultural Religious Psychological Interpersonal Arranging a Service. –Choice of last rites Traditional funeral ceremony Simple memorial service Costs between $5,000-$7,000 –Non-profit memorial society.

15. Chapter 20 © 2008 McGraw-Hill Companies. All Rights Reserved.15 Coping With Dying No one right way to live or die of a life- threatening illness. – Doctors treat diseases; people suffer from illness. –Concerns with: Costly medical care. Loss of income. Repeated and lengthy hospitalization. Physical pain.

16. Chapter 20 © 2008 McGraw-Hill Companies. All Rights Reserved.16 Awareness of Dying “Living-dying” experience. Avery Weisman – process of coping –Middle knowledge – patients and family seek a balance between hope and reality. –Maintain a sense of self-worth, setting goals and striving to reach them.

17. Chapter 20 © 2008 McGraw-Hill Companies. All Rights Reserved.17 The Tasks of Coping On Death and Dying (Elisabeth Kubler- Ross). –5 Psychological stages: 1.Denial. 2.Anger. 3.Bargaining. 4.Depression. 5.Acceptance. Charles Corr’s primary dimensions in coping with dying. –Four primary dimensions in coping with dying 1.Physical. 2.Psychological. 3.Social. 4.Spiritual.

18. Chapter 20 © 2008 McGraw-Hill Companies. All Rights Reserved.18 The Trajectory of Dying. Useful for understanding patients’ experiences as they near death. Some involve a steady and fairly predictable decline. Distinguish between different stages in a dying trajectory.

19. Chapter 20 © 2008 McGraw-Hill Companies. All Rights Reserved.19 Coping With Loss Experiencing Grief. –Reaction to loss Thoughts, feelings, physical and mental responses. –Bereavement. –Mourning. Tasks of Mourning. 1.Accepting the reality of the loss. 2.Working through the pain and grief. 3.Adjusting to a changed environment. 4.Emotionally relocating the deceased and moving on. The Course of Grief. –Early phase –Middle phase –Last phase

20. Chapter 20 © 2008 McGraw-Hill Companies. All Rights Reserved.20 Supporting a Grieving Person Give kind and loving support. Be a good listener. Refrain from making judgments about the survivor’s feelings are “good” or “bad”. Social support is critical.

21. Chapter 20 © 2008 McGraw-Hill Companies. All Rights Reserved.21 Helping Children Cope With Loss Children tend to cope with loss healthier fashion. Adults must share the news with the children. –Natural curiosity. –Sudden changes in the family environment. Keep the informational lines open for the child’s questions. Be Honest.

22. Chapter 20 © 2008 McGraw-Hill Companies. All Rights Reserved.22 Coming To Terms With Death Confronted with emotions and thoughts that relate to the immediate loss but also to our own mortality. Teaches us that relationships are more important than things Allow ourselves to make room for death Denying death, it turns out, results in denying life.

23. Dying And Death Chapter 20