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Chapter SeventeenChapter Seventeen

Accepting Dying and Accepting Dying and DeathDeath

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Definitions of DeathDefinitions of Death

• Clinical determinants of deathClinical determinants of death

• Medical death certificateMedical death certificate

• Criteria to establish deathCriteria to establish death– Lack of heartbeat and breathingLack of heartbeat and breathing– Lack of central nervous system functionLack of central nervous system function– Presence of rigor mortisPresence of rigor mortis

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Psychological Stages of Psychological Stages of DyingDying

• DenialDenial

• AngerAnger

• BargainingBargaining

• DepressionDepression

• AcceptanceAcceptance

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Near-Death ExperiencesNear-Death Experiences

• Acknowledgement of deathAcknowledgement of death

• Out-of-body experienceOut-of-body experience

• Extreme blackness Extreme blackness

• Encountering love ones who have diedEncountering love ones who have died

• Intense lightIntense light

• Sense of well-being and peaceSense of well-being and peace

• Decision whether to enter into the lightDecision whether to enter into the light

• Return to the bodyReturn to the body

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Interacting with Dying Interacting with Dying PeoplePeople

• Be genuine and honestBe genuine and honest

• Provide emotional supportProvide emotional support

• Allow people to express their Allow people to express their feelingsfeelings

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Talking with Children about Talking with Children about DeathDeath

• Use straightforward, age-Use straightforward, age-appropriate languageappropriate language

• Avoid shielding Avoid shielding • Make certain the child Make certain the child

understandsunderstands• Provide simple, direct answersProvide simple, direct answers

– The person will never come The person will never come backback

– The body has been buried or The body has been buried or burned to ashesburned to ashes

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End-of-Life Options and End-of-Life Options and DecisionsDecisions

Hospice care for the terminally Hospice care for the terminally illill

• Goal is to maximize quality of lifeGoal is to maximize quality of life

• StrategiesStrategies– Pain controlPain control– Family involvementFamily involvement– Multidisciplinary approachMultidisciplinary approach– Patient decisionsPatient decisions

• Follow-up and care for survivorsFollow-up and care for survivors

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EuthanasiaEuthanasia

• Indirect or passive euthanasiaIndirect or passive euthanasia– Allowing to die (“do not resuscitate”)Allowing to die (“do not resuscitate”)

• Direct or active euthanasiaDirect or active euthanasia– Giving a patient a lethal dose of drugsGiving a patient a lethal dose of drugs

• Physician-assisted suicidePhysician-assisted suicide– Prescribing a patient a lethal dose of Prescribing a patient a lethal dose of

drugsdrugs

• Oregon Death with Dignity ActOregon Death with Dignity Act

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End-of-Life Options and End-of-Life Options and DecisionsDecisions

• Advance Healthcare DirectivesAdvance Healthcare Directives– Living willLiving will– Durable power of attorney for health Durable power of attorney for health

carecare

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Living WillLiving Will

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Organ DonationOrgan Donation

• Intention to donate can be stated on Intention to donate can be stated on driver’s license, but next-of-kin must driver’s license, but next-of-kin must consent at time of deathconsent at time of death

• Significant shortage of donor organsSignificant shortage of donor organs

• Every day:Every day:– 77 people receive a transplant77 people receive a transplant– 110 people join waiting list for a 110 people join waiting list for a

transplanttransplant– 19 people die waiting for a transplant19 people die waiting for a transplant

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Planning an Organ DonationPlanning an Organ Donation

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Grief and Coping: The Grief and Coping: The Experience of GriefExperience of Grief

• Physical discomfortPhysical discomfort

• Sense of numbnessSense of numbness

• Feeling of detachment from Feeling of detachment from othersothers

• Preoccupation with the image of Preoccupation with the image of the deceasedthe deceased

• GuiltGuilt

• HostilityHostility

• Disruption in daily scheduleDisruption in daily schedule

• Delayed griefDelayed grief

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Coping with Death from Coping with Death from Specific CausesSpecific Causes

• Terminal illnessTerminal illness

• Accidental deathAccidental death

• Natural disastersNatural disasters

• TerrorismTerrorism

• SuicideSuicide

• MurderMurder

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Coping with the Death Coping with the Death of a Loved Oneof a Loved One

• ChildChild– MiscarriageMiscarriage– Lost after birthLost after birth– Grieving Grieving

• ParentParent

• SpouseSpouse

• SiblingSibling

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Rituals of DeathRituals of Death• Cultural differencesCultural differences• Full funeral servicesFull funeral services

– EmbalmingEmbalming– Calling hoursCalling hours– Funeral serviceFuneral service

• Memorial serviceMemorial service• Disposition of the bodyDisposition of the body

– Ground burialGround burial– EntombmentEntombment– CremationCremation– Anatomical donationAnatomical donation

• CostsCosts

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Personal Preparation for Personal Preparation for DeathDeath

• WillWill

• Life insuranceLife insurance

• Funeral prearrangementsFuneral prearrangements

• Anatomical or organ Anatomical or organ donationdonation

• EulogyEulogy

• EpitaphEpitaph

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Chapter SeventeenChapter SeventeenAccepting Dying and DeathAccepting Dying and Death