Hurricane Case Study Need to support with a minimum of 3 scholarly articles. Proposal should be no longer than 4 pages; 1” margins, 1.5 spacing. image1.emf Module 4 End of Life Decisions & The Funeral Process END OF LIFE DECISIONS: ADVANCED DIRECTIVES Part 1 Advance Directives • Documents that specify the type of health care an individual wishes to receive should that individual not be in a position to express his or her wishes in a critical situation • Living Will (introduced in 1968) • Self-Determination Act (state legislation started in 1976 in California) • Established health care proxies and durable power of attorney clauses Patient Informed Consent • The legal right to refuse treatment • Patients must be given adequate information regarding: • Nature of the proposed treatment • Probabilities of success • Possible side-effects • Other treatment options (and no-treatment option) Living Will • Advantages • First advance directive • Empowered individuals to make their choices known • Brought private, public, and professional awareness to end-of-life issues and decisions • Disadvantages • Can be ambiguous in interpretation • Doesn’t include provisions for assisted death • May not be available to medical care providers when needed The Patient Self Determination Act • Started in California in 1976; now laws passed in every state • Recognizes a mentally competent adult’s right to refuse life support procedures • Patients were given the right to designate a person who would see that the advance directive is respected if they were unable to act in their own behalf • Designated person = a health proxy • Responsibility give the health proxy is durable power of attorney for health care Facts about Advance Directives (Sabatino, 2005) • They are legal in every state • One that is legal in one state is generally legal in all states • Can change the wording of preprinted forms • A lawyer is not required to make it a legal document • It doesn’t restrict treatment efforts within accepted medical standards; allows for pain control and comfort care • Health care providers are legally obligated to follow it A Right Not to Die? The Cryonics Alternative • Available since 1967 • Choosing to have your certified dead body placed in a hypothermic (frozen) condition for the possibility of resuscitation at a later time • No attempts have been made (yet) to resuscitate from a cryonic state • First person to chose a cryonic alternative was a psychologist, Dr. James H. Bedford The Cryonics Alternative: Three Purposes or Visions • Restoring a “dead” person to continue his/her life where it had left off (perhaps with a cure to their terminal illness) • Equipping the reanimated with a body that will be resistant to aging and other forces of mortality • Reanimating the brain so that it may grow a new body in the .

1. Hurricane Case Study
Need to support with a minimum of 3 scholarly articles.
Proposal should be no longer than 4 pages; 1” margins, 1.5
spacing.
image1.emf
Module 4
End of Life Decisions & The Funeral Process
END OF LIFE DECISIONS: ADVANCED
DIRECTIVES
Part 1
Advance Directives
• Documents that specify the type of health
care an individual wishes to receive should
that individual not be in a position to express
his or her wishes in a critical situation
• Living Will (introduced in 1968)
• Self-Determination Act (state legislation started in
1976 in California)
• Established health care proxies and durable power of

2. attorney clauses
Patient Informed Consent
• The legal right to refuse treatment
• Patients must be given adequate information
regarding:
• Nature of the proposed treatment
• Probabilities of success
• Possible side-effects
• Other treatment options (and no-treatment option)
Living Will
• Advantages
• First advance directive
• Empowered individuals to make their choices known
• Brought private, public, and professional awareness
to end-of-life issues and decisions
• Disadvantages
• Can be ambiguous in interpretation
• Doesn’t include provisions for assisted death
• May not be available to medical care providers when
needed

3. The Patient Self Determination Act
• Started in California in 1976; now laws passed in every
state
• Recognizes a mentally competent adult’s right to refuse
life support procedures
• Patients were given the right to designate a person who
would see that the advance directive is respected if they
were unable to act in their own behalf
• Designated person = a health proxy
• Responsibility give the health proxy is durable power of
attorney
for health care
Facts about Advance Directives
(Sabatino, 2005)
• They are legal in every state
• One that is legal in one state is generally legal in all states
• Can change the wording of preprinted forms

4. • A lawyer is not required to make it a legal document
• It doesn’t restrict treatment efforts within accepted medical
standards; allows for pain control and comfort care
• Health care providers are legally obligated to follow it
A Right Not to Die?
The Cryonics Alternative
• Available since 1967
• Choosing to have your certified dead body
placed in a hypothermic (frozen) condition for
the possibility of resuscitation at a later time
• No attempts have been made (yet) to
resuscitate from a cryonic state
• First person to chose a cryonic alternative
was a psychologist, Dr. James H. Bedford
The Cryonics Alternative:
Three Purposes or Visions
• Restoring a “dead” person to continue his/her

5. life where it had left off (perhaps with a cure to
their terminal illness)
• Equipping the reanimated with a body that will
be resistant to aging and other forces of
mortality
• Reanimating the brain so that it may grow a new
body in the future
Cryonics: Radical New Developments
• Neural Preservation (head only) has replaced
whole-body
• Focus is on brain preservation
• A body can be regenerated from neural DNA
• The cooled tissues are vitrified (transformed
to a stone-like substance)
• Replaces water inside cells with antifreeze
compounds
• Temperature is dropped to -130 degrees Celsius
• Flesh turns into a form of glass
Organ Donation

6. • Kidneys and livers are the most needed
• Restraining influences on the number of
successful transplantations:
• Willingness of people to donate
• Condition of the donated organs
• Biological match between donor and recipient
• Overall condition of the recipient
• Expense and timely delivery
Copyright © Allyn & Bacon 2007
Organ Donations
• Approximately 7,000 people donate organs while
they are still alive (such as donating a kidney)
• Victims of fatal motor vehicle accidents are one of
the most available sources
• About 75,000 people are on the waiting list is the
U.S. at any given time
• Demand and short supply creates:
• Discrimination
• Conflict
• Illegal sales of organs to affluent clients

7. Module 4: Part 3
Funeral-Related Decisions
• Funeral homes are required to provide a price
list
• Do thorough comparison shopping
• Be aware of additional charges for additional
services and products
• Do not hesitate to inquire about simple and
immediate burials or about cremation
• The most expensive item in a traditional funeral
is the casket
• Use good judgment to resist services or
products that your family really doesn’t want
From Dead Body to Living Memory:
A Process Approach
• Premortem Preparations may include:
• Financial and employment matters
• Funeral arrangements
• Attention to personal relationships
• Immediate Postdeath Activities

8. • Certification by a physician
• Contact relatives and friends
• Cleanse and wrap the body
From Dead Body to Living Memory:
A Process Approach
• Preparation for Burial or Cremation
• Allows for friends and relatives to gather
• Funeral arrangements must be make
• Insurance companies consulted
• Other financial arrangements made
• Allows time for embalming, mummification, or
whatever means the culture uses to preserve bodies
• Death must by certified by a physician
• Death certificate records are often missing potentially
important information
From Dead Body to Living Memory:
A Process Approach
• The medical examiner (coroner) reviews the case
• Autopsy needed?
• Death investigator (medical specialist) needed?

9. • May involve an Autopsy
• Performed by the coroner or medical examiner
• Requires permission from the next of kin
• Sometimes needed to understand a condition that
poses a threat to the community
• Sometimes there is suspicion of negligence, error, or
homicide
From Dead Body to Living Memory:
A Process Approach
• Settling into the Earth
• Most Americans are placed horizontally on their back
• Most common is fetal position (to sleep or be reborn)
• Cremation
• Preferred by most ancient cultures (except Egyptians)
• Opposed by Christianity until the Reformation by Luther
• Some concern today over toxic gas emissions
• Utilized in the U.S. about 25% of the time, 63% of the time
in Europe, and 95% of the time in Japan
• Rare in Islamic counties, Israel, and sub-Saharan Africa
From Dead Body to Living Memory:
A Process Approach
• The Funeral Service

10. • Held for whole body burials and cremations
• Many decisions to be made in designing the
ceremony
• Serves two purposes
• Final placement of the remains
• Public recognition of the death
• Memorializing the Deceased
• Obituaries
• Grave markers
• Personal rituals, prayers, gifts, sacrifices
What Does the
Funeral Process Accomplish?
• Create or solidify the place of a hero
• Ch’in, 1st Emperor of China, built a palace as a burial
tomb to support his claims to greatness and
immortality, secure succession, confound enemies,
and impress deities
• Queen Victoria created an elaborate funeral for Prince
Albert that symbolically incorporated him into the
British Empire and demonstrated the Victorian
sentiment
• Lenin’s corpse was placed in a grand mausoleum as
a “patron saint,” even though he had no use for
religion

11. What Does the
Funeral Process Accomplish?
• Balance the claims of the living and dead
• In Potamia, northern Greece, villagers (mostly the
women) tend temporary graves for 5 years, then
bones are transferred to the bone house
• The survivors are obligated to tend the graves
• Kotas, southern India, cremate the dead and carry out
two funerals, Green and Dry, for purification
• Orthodox Jews have a special time called Aninut,
devoted to honoring the dead and reflecting on the
loss
Cemeteries in the United States
• Colonial times
• Dead buried in churchyards or city cemeteries
• Quickly became crowded and chaotic
• 1796, New Haven Burying Ground
• Better planned; the first to offer “family plots”
• Mount Auburn Cemetery, Cambridge, MA

12. • Introduced landscaped, park-like atmosphere
• National Cemetery System for veterans
• President Lincoln’s Gettysburg Address (November
11, 1863) was given to dedicate the first national
cemetery
Cemeteries in the United States
• Neighborhood Cemeteries
• Still active though some are in the midst of urban
decay
• Examples of Ethnic Cemeteries
• Afro-American Section, The Common Burying
Ground, Newport, Rhode Island
• Navajo and Mormon companions at the Ramah
Cemetery, Ramah, New Mexico
• Mexican-Americans in San Antonio’s San Fernando
Cemetery
When Are the Dead

13. Important to the Living?
• The dead are more secure in past-oriented societies
• Future-oriented societies may look to technology
rather than wisdom and achievements of the past
• Geographical detachment from the dead will cause
distress to the living, especially in past-oriented societies
• Also disrupts their sense of tradition and culture
• The dead will be remembered and “used” more often in
societies in which children are highly valued as
continuing the family soul over the gap created by death
When Are the Dead
Important to the Living?
• Longer life expectancy and low vested power of the
elderly make the dead less important
• More people are older (not unusual) and have fewer
resources
• A society lacking unifying and transcending themes will
assimilate the funeral and memorialization process into
its utilitarian motives
• Dead may live on through organ donation rather than
memories, tradition, or social identity because of the
emphasis on function
• Societies that live close to nature need the assistance of

14. the dead to promote fertility and regeneration
Recent American Memorials
• Vietnam Veterans Memorial
• Black stone suggests mourning and reflection
• Names are given in order of their deaths while rank,
unit, and home state were ignored
• Many people bring items to leave at the memorial
• World War II Memorial
• Built after the Vietnam Veterans Memorial
• Took many years of advocacy and private fundraising
• Dedicated in 2004
Recent American Memorials
• World Trade Center Memorial
• Memorials have been established at the Pentagon
and in rural Pennsylvania
• Much discussion and controversy of the purpose and
design of the NYC memorial
• Oklahoma City National Memorial
• Includes a chair in remembrance of all who died
• Includes a museum that charts the chain of events

15. and honors each individual who died with a personal
object
• Includes an education and outreach service
The Treatment of Human Remains: The
Vermillion Accord
• Universal respect shall be given to the mortal remains of
the dead
• Disposition of human remains will be made in
accordance with the wishes of the dead themselves
whenever this is known or can be reasonably inferred
• The wishes of the local community will be respected
“whenever possible, reasonable, and lawful”
The Treatment of Human Remains: The
Vermillion Accord
• The scientific value of studying human remains will be
respected whenever such value can be demonstrated to
exist

16. • Negotiations with an attitude of mutual respect shall be
conducted to accommodate both the legitimate concerns
of communities for the proper disposition of their
ancestors and the legitimate concerns of science and
education
Challenges and Developments:
The Funeral Director’s Perspective
• Directors must pass licensure exams and be
knowledgeable in anatomy, chemistry, restorative art,
pathology, business, accounting, and some law
• More women are becoming funeral directors
• Funeral homes must give full price disclosure
• Must get written consents for embalming
• Typical service
• 20 to 40 minutes
• $6,000-$8,000 cost
• Music prelude, opening prayer, introductory remarks,
words from friends and family, clergy remarks, closing
Alternatives to Traditional Funerals

17. • Memorial Service (less formal, more personal in design)
• Green Funerals
• Buried in biodegradable wrap placed in woodlands or
meadows
• Available U.S., more established in Europe
• Virtual Memorials (on the internet)
• Tell the story of the person’s life (add photographs or
videos)
• Guest book that others can sign
• Most common - children who died of illness
Pre-Funeral Preparations
• Autopsy: Procedure to determine how and
under what circumstances a person die by
examining their body, organs, potential of
toxins in blood.
o Performed in suspicious or unexpected causes of
death
o Not accepted by all religious traditions
o Usually performed by a pathologist
Pre-Funeral Preparations
• Embalming:

18. o Process of preserving the body by removing the
blood and replacing it with embalming fluids
o Slows or halts decomposition.
o Written consent from next of kin is required.
o Conducted by certified embalmers in funeral
homes.
o Required for a body to cross state lines.
o Utilized by about 30% of Americans.
Spontaneous Memorials
• A public, spontaneous response to a death, usually a
violent and unanticipated death
• Usually at the site of the death
• Usually occurs quickly after the death is announced in
the media
• Leave candles, mementoes, cards
• People often stay to reflect on the tragedy, and many will
return several times
• No one is left out, all can participate
Examples of Abuse in the
Funeral Process
• Tri-State Crematory in Georgia dumped 334 bodies
while giving families cement dust instead of ashes

19. • Tulane University’s School of Medicine sold bodies to the
U.S. Army for experiments with landmines
• UCLA Medical School sold cadaver parts to a broker
who sold them to commercial biomedical corporations
• Cadavers used as crash dummies in vehicle studies
• Cases of body harvesting to brokers
• Burial insurance industry overcharging and defrauding
black Americans
THE FUNERAL PROCESS
Module 4: Part 2
Christian Views on End of Life and
Funeral Processes
• Euthanasia not allowed in Roman
Catholicism or Orthodox Christians
• Organ donation acceptable to most
denominations
• Most permit cremation
Jewish Views
• Do not believe in Euthanasia
• Orthodox Jews do not permit autopsy or

20. cremation, some allow organ donation
Rituals surround Death in the Jewish
Tradition
• Burial preparation includes ritual washing of
the body, dressing in white clothes or shroud
• Body is never left alone until burial occurs
• Embalming is not permitted
• Usually burial is within 24 hours of death
• Seven days of mourning and attendance of
family members
Buddhist Rituals
• Usually use Cremation
• Death practices vary depending on the
Buddhist tradition
• Body left in place for as long as possible
• Ritually washed by male family member
• Body not left a lone prior to cremation
• Cremation occurs after three days
Muslim Views
• Do not allow cremation, usually not autopsy
unless absolutely necessary

21. • Do not allow euthanasia
Burial Rituals in Islam
• Muslims of the same gender handle the dead
body unless no one is available (usually
direct family members)
• Ritual washing, perfuming and wrapping of
the body
• Burial usually within 24 hours
• Not buried in a coffin unless it is required by
law in the country of burial
• Some prefer unmarked graves
Hindu Rituals
• Family is consulted as to how the body should
be handled
• Ritual washing and anointing, including trimming
hair, clean clothes
• Funeral within 24 hours, body carried to the
funeral pyre where Hindu priests /senior family
members conduct the funeral service
• Cremation performed to allow soul to make

22. journey
Module 4End of Life Decisions: Advanced DirectivesAdvance
DirectivesPatient Informed ConsentLiving WillThe Patient Self
Determination ActFacts about Advance Directives�(Sabatino,
2005)A Right Not to Die? �The Cryonics AlternativeThe
Cryonics Alternative:�Three Purposes or VisionsCryonics:
Radical New DevelopmentsOrgan DonationOrgan
DonationsSlide Number 13Funeral-Related DecisionsFrom Dead
Body to Living Memory:�A Process ApproachFrom Dead Body
to Living Memory:�A Process ApproachFrom Dead Body to
Living Memory:�A Process ApproachFrom Dead Body to
Living Memory:�A Process ApproachFrom Dead Body to
Living Memory:�A Process ApproachWhat Does the �Funeral
Process Accomplish? What Does the �Funeral Process
Accomplish?Cemeteries in the United StatesCemeteries in the
United StatesWhen Are the Dead �Important to the
Living?When Are the Dead �Important to the Living?Recent
American MemorialsRecent American MemorialsThe Treatment
of Human Remains: The Vermillion AccordThe Treatment of
Human Remains: The Vermillion AccordChallenges and
Developments:�The Funeral Director’s PerspectiveAlternatives
to Traditional FuneralsPre-Funeral PreparationsPre-Funeral
PreparationsSpontaneous MemorialsExamples of Abuse in the
�Funeral ProcessThe Funeral ProcessChristian Views on End of
Life and Funeral ProcessesJewish Views Rituals surround Death
in the Jewish TraditionBuddhist RitualsMuslim ViewsBurial
Rituals in IslamHindu Rituals
Death and Dying Psychology
20
15
10
5
Describe an alternative to burial or cremation
Writing shows high degree of attention to logic and reasoning

23. of points well developed thoughts. The writing clearly leads the
reader to the conclusion and stirs thought regarding the topic.
Content indicates synthesis of ideas, in-depth analysis of
original thought and support for the topic.
Writing is coherent and logically organized with transitions
used between ideas and paragraphs to create coherence. The
writing sufficiently expresses coherent ideas from original
thinking supported by firm evidence. Main points well
developed with quality supporting details and reflects.
Writing is coherent and logically organized, but some points are
misplaced or stray from the topic. Some transitions are used
inconsistently. Main ideas reflecting some critical thinking is
presented without detail or development.
Writing lacks logical organization. It shows some coherence but
ideas lack unity. Many or serious errors are present. Main ideas
reflect little critical thinking is presented without detail,
development, or ideas are vaguely presented.
Describe the culture or country where this process is practiced
Writing shows high degree of attention to logic and reasoning
of points well developed thoughts. The writing clearly leads the
reader to the conclusion and stirs thought regarding the topic.
Content indicates synthesis of ideas, in-depth analysis of
original thought and support for the topic.
Writing is coherent and logically organized with transitions
used between ideas and paragraphs to create coherence. The
writing sufficiently expresses coherent ideas from original
thinking supported by firm evidence. Main points well
developed with quality supporting details and reflects.
Writing is coherent and logically organized, but some points are
misplaced or stray from the topic. Some transitions are used
inconsistently. Main ideas reflecting some critical thinking is
presented without detail or development.
Writing lacks logical organization. It shows some coherence but
ideas lack unity. Many or serious errors are present. Main ideas
reflect little critical thinking is presented without detail,
development, or ideas are vaguely presented.

24. Explain the purpose of the practice
Writing shows high degree of attention to logic and reasoning
of points well developed thoughts. The writing clearly leads the
reader to the conclusion and stirs thought regarding the topic.
Content indicates synthesis of ideas, in-depth analysis of
original thought and support for the topic.
Writing is coherent and logically organized with transitions
used between ideas and paragraphs to create coherence. The
writing sufficiently expresses coherent ideas from original
thinking supported by firm evidence. Main points well
developed with quality supporting details and reflects.
Writing is coherent and logically organized, but some points are
misplaced or stray from the topic. Some transitions are used
inconsistently. Main ideas reflecting some critical thinking is
presented without detail or development.
Writing lacks logical organization. It shows some coherence but
ideas lack unity. Many or serious errors are present. Main ideas
reflect little critical thinking is presented without detail,
development, or ideas are vaguely presented.
Includes 2 scholarly references
Includes 2 scholarly references
Includes 2 rereferences but they are not scholarly, peer
reviewed journals
Includes 1 reference
Lacks adequate references
Usage of correct grammar, usage, and mechanics in APA
format.
Essay is free of distracting spelling, punctuation, and
grammatical errors; absent of fragments, comma splices, and
run-ons. Meets most criteria of APA formatting requirements.
Essay has few spelling, punctuation, and grammatical errors
allowing reader to follow ideas clearly. Very few fragments or
run-ons. Meets some of APA formatting requirements.
Essay has several spelling, punctuation, and grammatical errors
allowing reader to follow ideas clearly. Very few fragments or
run-ons. Meets few of APA formatting requirements.

25. Spelling, punctuation, and grammatical errors create distraction,
making reading difficult; fragments, comma splices, run-ons
evident. Errors are frequent. Fails to follow APA formatting
requirements.