Dying And Death Chapter 20. © 2008 McGraw-Hill Companies. All Rights Reserved.2 Why Is There Death? Life span is long enough to allow reproduction and.

Dying And Death

Chapter 20

Chapter 20 © 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.

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 hours1. Hypothermia (Below 90 degrees F)2. Central nervous system depressants

Clinical death Cellular death

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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.

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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”.

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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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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.

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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

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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.

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Completing an Advance Directive1. 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.

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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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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.

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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.

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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.

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

dying1. Physical.2. Psychological.3. Social.4. Spiritual.

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.

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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

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.

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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.

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.

Dying And Death

Chapter 20