1. Chapter 23 Dying and Death

2. 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 Chapter Twenty-three

3. 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: • Lack of receptivity and response to external stimuli • Absence of spontaneous muscular movement and spontaneous breathing • Absence of observable reflexes • Absence of brain activity • Electroencephalogram (EEG) • Clinical death • Cellular death Chapter Twenty-three

4. 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 • Universality • Irreversibility • Nonfunctionality • Causality Chapter Twenty-three

5. 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. Chapter Twenty-three

6. 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.) Chapter Twenty-three

7. 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 Chapter Twenty-three

8. 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 Chapter Twenty-three

9. 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: • Living will • Health care proxy • Surrogate (the decision maker) Chapter Twenty-three

10. Figure 23-1 Sample living will Chapter Twenty-three

11. 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 Chapter Twenty-three

12. Figure 23-2 The need for organ donors Chapter Twenty-three

13. 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 Chapter Twenty-three

14. Coping With Dying • Awareness of Dying • The Tasks of Coping • 1969 book On Death and Dying, Elisabeth Kubler-Ross • 5 psychological stages • Denial • Anger • Bargaining • Depression • Acceptance • Charles Corr • 4 primary dimensions in coping with dying • Physical • Psychological • Social • Spiritual Specific tasks that need to be addressed in coping with dying • Prediagnostic • Acute • Chronic • Terminal • Recovery Chapter Twenty-three

15. 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 • Accepting reality • Working through the pain • Adjusting to a changed environment • Emotionally relocating the deceased and moving on with life • The Course of Grief • Supporting a Grieving Person • Helping Children Cope with Loss Chapter Twenty-three

16. Coping With Dying • The Course of Grief • Supporting a Grieving Person • Helping Children Cope with Loss • Coming To Terms With Death Chapter Twenty-three

17. Chapter 23 Dying and Death Chapter Twenty-three