epilogue death and dying

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Epilogue Death and Dying. Historical and Cultural Contexts of Death and Dying. Morality rates, in developed countries, began to decline in 20 th century. Leading causes of death shifted from acute, infectious disease to chronic, degenerative disease - PowerPoint PPT Presentation



  • Historical and Cultural Contexts of Death and DyingMorality rates, in developed countries, began to decline in 20th century.Leading causes of death shifted from acute, infectious disease to chronic, degenerative diseaseMedical advances in end-of-life health care Process of death and dying examined from a Western societal perspective

  • Figure EP.1: Death Rates by Age in the United States, 2006

  • Defining DeathAt one time death happened quickly, as there were no life-support medical advancesPersistent vegetative stateHigher cortical functioning has ceased while brain stem functioningBrain deathAll signs of brain activity have ceased for a specific period of time

  • Choices and Decisions at the End of LifeDetermining Medical Care at the End of Life: Advanced DirectivesAdvance directives, a legal documents specifying the life-sustaining medical treatments people wish to receive, gives some personal control over decisions at end of life.Living will provides directions about life-sustaining treatments the person does or does not wantDurable power of attorney authorizes a specific person to make health care decisionsFew Americans have these documents, partly due to misconceptions about the documents or discomfort with death

  • Figure EP.2: A Sample Living Will

  • Choices and Decisions at the End of LifeDetermining the Timing of Death: The Rights to DieDesire to have control over timing of death often arises when a terminally ill patients pain and suffering can not be alleviatedPassive euthanasia withholding treatment that would prolong lifeActive euthanasia actions that deliberately induce deathPhysician-assisted dying legal in several European countries and several states in the United States

  • Table EP.1

  • The Experience of DyingKubler-Ross identified five stages experienced by dying personsDenialAngerBargainingDepressionAcceptanceExperience of dying is affected by characteristics of the illness and the individual

  • Caring for Dying PersonsAlthough Americans prefer to die at home only 25% will do soWhen needs of dying patients and their families are met, they are more likely to consider the death a good death.

  • Caring for Dying Persons in Hospitals50 % of Americans die in hospitals and 25 % in nursing homeHospitals are not equipped to meet the needs of dying individuals and family membersStaff experience demands on their time and need to maintain emotional distancePatient pain may not be adequately managed

  • Caring for the Dying in Hospice ProgramsPalliative care designed to improve quality of life for patients with life threatening illnessesHospice care care for terminally ill with less than 6 months to liveEmphasizes managing pain, showing respect for patient needs, supporting family members, and helping the patient prepare for impending deathStudies support distinct benefits for patientsBarriers to adequate end of life care, particularly for ethnic minorities

  • Video: Death and Dying

  • Losing a Loved OneBereavement objective experience of having lost a loved oneGrief painful emotional responses to loss of a loved oneCan vary over time and from one person to the nextCan be difficult for some to overcome, particularly if the death is unexpected

  • Adjusting to the Loss of a Loved OneDual process model of coping with bereavementCoping with their feelings of lossCoping with the changed realties of daily livesMourning manner in which a person expresses griefShaped by cultural practicesIncludes rituals, manner of dress, memorial eventsDesigned to facilitate transition to a new identity

  • Helping the BereavedIt is helpful to show interest in bereaved persons experiences and feelings.Bereaved children have special needs.By age 9 or 10 most children realize that death is permanent stateChildren have less well-developed coping skillsMay experience feelings of guilt or responsibility