Insel11e ppt23

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Chapter 23

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Why Is There Death?

There is no completely satisfying answer to the question of why death exists

Death promotes variety through the evolution of speciesFrom the perspective of species survival,

the cycle of life and death makes sense

Death challenges our emotional and intellectual security

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What is Death?

Defining deathDefined 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 stimuli2. Absence of spontaneous muscular movement and spontaneous

breathing3. Absence of observable reflexes4. Absence of brain activity

• Clinical death• Cellular death

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Learning About Death

A child’s understanding of death evolves greatly from about age 5 to age 9Most children cone to understand that death is

final, universal, and inevitable Mature understanding of death Mark Speece and Sandor Brent’s facts

about death, including four components:1. Universality2. Irreversibility3. Nonfunctionality4. Causality

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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

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Planning For Death

Making a willA legal instrument expressing a person’s

intentions and wishes for the disposition of his or her property after death

EstateTestatorIntestateTestamentary letter

○ Document includes information about your personal affairs (bank statements, credit cards, documents etc.)

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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 programsPalliative care

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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

interventionsActive euthanasia

○ Intentional act of killing someone who would otherwise suffer from an incurable and painful disease

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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 decision

Two forms:1. Living will

2. Health care proxy○ Surrogate (the decision maker)

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Figure 23.1 Sample living will

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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 available98,000 Americans wait for an organ

transplant

Uniform donor card

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Figure 23.2 The need for organ donors

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Planning a Funeral or Memorial Service Disposition of the body

Social, cultural, religious, psychological, and interpersonal considerations

BurialCremationEmbalming for a viewing or wake

Arranging a service

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Coping With Dying Awareness of dying The tasks of coping

On Death and Dying by Elisabeth Kubler-Ross○ 5 psychological stages in response to an awareness of imminent

death: 1. Denial2. Anger3. Bargaining4. Depression5. Acceptance

Charles Corr’s four primary dimensions in coping with dying:1. Physical2. Psychological3. Social4. Spiritual

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Coping With Dying The trajectory of dying

Useful for understanding patients’ experiences as they near death

Supporting a dying person

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Coping With Loss Experiencing grief

Bereavement Mourning

Tasks of mourning1. Accepting reality2. Working through the pain3. Adjusting to a changed environment4. Emotionally relocating the deceased and moving

on with life The course of grief Supporting a grieving person Helping children cope with loss

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Chapter 23

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