This document discusses definitions of death, ethical issues surrounding end of life care, and personal aspects of thinking about death. It defines clinical death, whole brain death, and persistent vegetative state from a legal and medical perspective. Ethical issues discussed include euthanasia, assisted suicide laws, advance directives, do not resuscitate orders, and the high costs of life-sustaining care. Case studies on Nancy Cruzan and Terri Schiavo are provided. Developmental views of how people think about death across the lifespan and Kübler-Ross's five stages of grief are also summarized.
This is seminar presented as part of academics in my department. Please comment on the content, so that i can improve myself. If the content is good, kindly like it.
Srinivasa Murthy-Psiquiatría: situación actual y perspectivas de futuroFundación Ramón Areces
'Psiquiatría: situación actual y perspectivas de futuro'. Este es el título del simposio internacional que organizamos el 20 de junio de 2016 en la Fundación Ramón Areces con las fundaciones Juan José López-Ibor y Lilly en homenaje al doctor Juan José López-Ibor, fallecido en enero de 2015. Durante esta jornada, expertos internacionales abordaron la profunda crisis que atraviesa la psiquiatría como disciplina científica y especialidad médica. Además, se presentó el libro con el mismo título del simposio, también en recuerdo del doctor López-Ibor.
This is seminar presented as part of academics in my department. Please comment on the content, so that i can improve myself. If the content is good, kindly like it.
Srinivasa Murthy-Psiquiatría: situación actual y perspectivas de futuroFundación Ramón Areces
'Psiquiatría: situación actual y perspectivas de futuro'. Este es el título del simposio internacional que organizamos el 20 de junio de 2016 en la Fundación Ramón Areces con las fundaciones Juan José López-Ibor y Lilly en homenaje al doctor Juan José López-Ibor, fallecido en enero de 2015. Durante esta jornada, expertos internacionales abordaron la profunda crisis que atraviesa la psiquiatría como disciplina científica y especialidad médica. Además, se presentó el libro con el mismo título del simposio, también en recuerdo del doctor López-Ibor.
1) The Death System and Cultural Contexts
2) Defining Death and Life/Death Issues
3) A Developmental Perspective on Death
4) Facing One's Own Death
5) Coping with the Death of Someone Else
Addiction and Suicide Prevention - December 2012 Dawn Farm
“Addiction and Suicide Prevention” was presented on Tuesday December 18, 2012; by Raymond Dalton, MA; Dawn Farm therapist. There is an alarmingly high prevalence of suicide among people with addiction and people in early recovery. This program will raise awareness of the signs of suicidal thinking and describe ways to offer support and obtain help for people who may be contemplating suicide. Viewers will learn how to recognize suicidal thinking, reach out and offer support to others contemplating suicide, obtain help when suicidal thoughts are present, and access local and national suicide prevention and intervention resources. This program is part of the Dawn Farm Education Series, a FREE, annual workshop series developed to provide accurate, helpful, hopeful, practical, current information about chemical dependency, recovery, family and related issues. The Education Series is organized by Dawn Farm, a non-profit community of programs providing a continuum of chemical dependency services. For information, please see http://www.dawnfarm.org/programs/education-series.
A warm welcome to CRESTBD's webinar slides for "Stigma123 & Bipolar Disorder"! An idea readily accepted in academic literature, the three levels of stigma is not yet a robust part of the mainstream discussion about stigma. We'll share both the lived experience and research perspectives of our team.
Module 5 Euthanasia, Physician Assisted Suicide and The Righ.docxkendalfarrier
Module 5
Euthanasia, Physician Assisted Suicide and The Right to Die
Movement
Key Terms
• Hippocratic Oath – an ancient, optional code of ethical
principles
• Euthanasia – intentional shortening of the life of a person
or animal to spare further suffering
• Active Euthanasia – taking some action to cause
death
• Passive Euthanasia – withholding treatment that
might prolong life (generally tolerated by society)
• Key question: Should actions be introduced,
continued, done, or discontinued?
Key Terms
• Terminal Sedation – relieving dying patients’ distress by
keeping them in a deep sedation or coma until death
• An alternative to active euthanasia
• Called “slow euthanasia”
• Liberty Principle – individuals can make their own
decisions
• Informed Consent – patients must be fully informed
before proceeding with treatments
• Competence – the mental ability to understand the
information and make a rational decision
Key Terms
• Nazi “euthanasia” – the false name given to the murder
of innocent people and associated genocide
• Black Stork – The movement in the U.S. in the early
1900s to allow “defective” infants to die
• Eugenics – The movement aimed at sterilizing people
with “defective genes”
• Led to other ideas, such as letting “defective” infants die and
ending the lives of “incurable” patients
• Slippery Slope Argument – Opposing any instance of
assisted death because it could contribute to widespread
abuse in other instances
Assisted Suicide and Euthanasia
• In both, at least two individuals are involved.
• In Assisted Suicide, permission and
cooperation is obtained from individual
wishing to end life. Not always the case in
euthanasia.
Euthanasia and Religion
Various Religions have commented on Euthanasia
and other forms of assisted Suicide:
Judaism: God created a person and therefore
owns the body, a person is just the caretaker
Duty to preserve life – Orthodox & Conservative
Jews find euthanasia morally unacceptable
Active Euthanasia is condemned by all Jewish
groups
Euthanasia in Christianity & Islam
Christianity: suffering is part of God’s plan for
all humans
Typically oppose any intentional killing of
oneself or others
Islam: Suicide, Euthanasia and Physician
Assisted Suicide is generally disapproved of
“Do not destroy yourselves”
Euthanasia Hinduism & Buddhism
Hinduism: assisted suicide and euthanasia may
interfere with karmic processes and is undesirable,
but is not forbidden
Extending human life through medical interventions
may also interfere with karma
Ahimsa: avoidance of causing pain or killing any life
Gandhi: “Should my child be attacked with rabies and
there was no helpful remedy to relieve his agony, I
should consider ot my duty to end his life”
Buddhism: intentionally ending a life is unacceptable
Easing suffering is inappropriate
Right-To-Die Cases
• Estimated that 10,000 to 35.
Ethical Issues in Professional Nursing PracticeCha.docxelbanglis
Ethical Issues in
Professional
Nursing Practice
Chapter 14
Relationships and
Professional Ethics
• Nurse–physician relationships
• Nurse–patient–family relationships
– Unavoidable trust
– Boundaries
– Dignity
– Patient advocacy
• Nurse–nurse relationships
The National Council of State Boards
of Nursing’s Professional Boundaries
in Nursing Video
https://www.ncsbn.org/464.htm
https://www.ncsbn.org/464.htm
Moral Rights and Autonomy (1 of 2)
• Moral rights are defined as rights to perform
certain activities
– Because they conform to accepted standards or
ideas of a community
– Because they will not harm, coerce, restrain, or
infringe on the interests of others
– Because there are good rational arguments in
support of the value of such activities
Moral Rights and Autonomy (2 of 2)
• Two types of moral rights
– Welfare rights
– Liberty rights
• Informed consent
• Patient Self-Determination Act
• Advance directives
– Living will
– Durable power of attorney
Social Justice
• Sicilian priest first used term in 1840; in 1848,
popularized by Antonio Rosmini-Serbati
• Center for Economic and Social Justice
definition
• John Rawls’ concept of veil of ignorance
• Robert Nozick’s concepts of entitlement
system
Allocation and Rationing of
Healthcare Resources
• Does every person have a right to health care?
• How should resources be distributed so
everyone receives a fair and equitable share of
health care?
• Should healthcare rationing ever be considered
as an option in the face of scarce healthcare
resources? If so, how?
Organ Transplant Ethical Issues
• Moral acceptability of transplanting an
organ from one person to another
• Procurement of organs
• Allocation of organs
– Justice
– Medical utility
Balanced Caring and Fairness
Approach for Nurses (1 of 2)
• Encourage patients and families to express
their feelings and attitudes about ethical issues
involving end-of-life, organ donation, and
organ transplantation
• Support, listen, and maintain confidentiality
with patients and families
• Assist in monitoring patients for organ needs
Balanced Caring and Fairness
Approach for Nurses (2 of 2)
• Be continually mindful of inequalities and
injustices in the healthcare system and how the
nurse might help balance the care
• Assist in the care of patients undergoing surgery
for organ transplant and donation patients and
their families
• Provide educational programs for particular
target populations at a broader community level
Definitions of Death
• Uniform Determination of Death Act definition of
death: “An individual who has sustained either (1)
irreversible cessation of circulatory and respiratory
functions or (2) irreversible cessation of all functions
of the entire brain, including the brain stem is dead.
A determination of death must be made in
accordance with accepted medical standards.”
• Traditional, whole-brain, hig ...
Reply 1Peer review is when professionals working the same field .docxWilheminaRossi174
Reply 1
Peer review is when professionals working the same field evaluate ones work and then being able to put their input on the review. It is important to have peer reviewed information in evidenced based practice because it gives patients assurance that the practice their professional is giving them is reassuring. They are able to show that the best knowledge and care is being used. Peer review can be facilitated by allowing a group of nurses or doctors give a certain input and be able to test it and get it approved rather than further information form others be needed to have it as peer reviewed.
Kharasch, E. D., Avram, M. J., Clark, J. D., Davidson, A. J., Houle, T. T., Levy, J. H., London, M. J., Sessler, D. I., & Vutskits, L. (2021, January 1).
Peer Review Matters: Research Quality and the Public Trust. American Society of Anesthesiologists. Retrieved October 18, 2022, from https://pubs.asahq.org/anesthesiology/article/134/1/1/114542/Peer-Review-Matters-Research-Quality-and-the
Reply 2
Peer review can be defined as a system of an assessment made based on the quality, of a professional expert that is in the same field (National Institutes of Health, n.d.). In a peer reviewed, an article submitted to an expert in the field to analyze. The assessment will help the professional expert to whether published it or not. Peer review helps prevent made up findings that are not well supported by evidenced based practice. Peer review can be facilitated by teaching students the importance of it. At times, it can be difficult for students, due to the lack of knowledge. By facilitating peer review students can have a general idea of other models work and can used these approaches of evidenced base practice. Overall, peer review is great way for constructive criticism of your work. As a result, this will ensure accurate evidenced based practice are been followed by the author.
National Institutes of Health. (n.d.). Peer-reviewed literature. U.S. National Library of Medicine. Retrieved October 18, 2022, from
https://www.nlm.nih.gov/nichsr/stats_tutorial/section3/mod6_peer.html
Links to an external site.
Libguides: Research process: Scholarly and peer-reviewed journals. Banner. (n.d.). Retrieved October 18, 2022, from https://library.ncu.edu/researchprocess/scholarlyjournals
Module 1
Introduction to Death & Dying
INTRODUCTION
Module 1: Part 1
What is this course about?
• If you don’t want to talk about death, dying, grief,
and beliefs, rituals, or practices surrounding
death for the next three months, this may not be
the course for you.
• This course will involve reading, discussion, and
both research and reflective writing.
This course, continued..
• This course deals with some heavy stuff, stuff
that we don’t normally talk about in society.
Some topics (and readings or videos) may make
you feel uncomfortable – feel free to vocalize
this to me
Some Facts ab.
Chapter 15
End-of-Life Issues
LEARNING OBJECTIVES
• Discuss the human struggle to survive and the
right to autonomous decision-making.
• Describe how patient autonomy has been
impacted by case law and legislative enactments.
• Discuss the following concepts: preservation of
life with limits, euthanasia, advance directives,
futility of treatment, withholding and withdrawal
of treatment, and do-not-resuscitate orders.
LEARNING OBJECTIVES – II
• Discuss the purpose of an ethics committee
and its consultative role in the delivery of
patient care.
• Explain end-of-life issues as they relate to
autopsy, organ donations, research
experimentation, and clinical trials.
• Describe how human genetics and stem cell
research can have an impact on end-of-life
issues.
Dreams of Immortality
• Human struggle to survive
• Desire to prevent & cure illness
• Advances in medicine & power to prolong life
• Process of dying can be prolonged
• Ethical & legal issues have increased
– involving entire life span, from right to be
born to right to die
Scope of Ethical Issues
• Entire Life Span
• The Right to be Born
• The Right to Die, &
• Everything in between, e.g.,
– to choose treatment
– to refuse treatment for oneself
– to refuse treatment for another
– to limit the suffering one would endure
Ethical Dilemmas Arise
When values,
rights,
duties
& loyalties conflict.
Autonomy
• Right of a person to make one’s own decisions.
• Patient has right to accept or refuse care even
if it is beneficial to saving his or her life.
• Autonomy may be inapplicable in certain
cases
– affected by one’s disabilities, mental status,
maturity, or capacity to make decisions.
Quinlan court
Relying on: Roe v. Wade
• Announced the constitutional right to privacy
protects a patient’s right to self-
determination.
• State’s interest did not justify interference
with her right to refuse treatment.
• Quinlan’s father was appointed her legal
guardian
Cruzan Case
• Supreme Court held that right-to-die should be
decided pursuant to state law, subject to a due-
process liberty interest, and in keeping with state
constitutional law.
• Cruzans returned to Missouri probate court:
– Judge Charles Teel authorized physicians to
remove the feeding tubes from Nancy.
– testimony presented demonstrated clear &
convincing evidence Nancy would not have
wanted to live in a persistent vegetative state.
Legislative Response: Patient Self-
Determination Act of 1990
• Requires healthcare organizations to explain
to patients their legal right to direct their own
care
• Right to refuse medical treatment
• Right to formulate advance directives
• Right to appoint surrogate decision-maker
• Federal reimbursement requires compliance
with Act
Preservation of Life
• Medical ethics does not require patient’s life
be preserved at all cost under all
circumstances.
• Ethical integrity
– of a profession is not compromis.
Hurricane Case StudyNeed to support with a minimum of 3 scho.docxsalmonpybus
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 .
Chapter 2
Contemporary
Ethical Dilemmas
No right is held more sacred, or is more carefully
guarded, by the common law, than the right of
every individual to the possession and control of
his own person, free from all restraint or
interference of others, unless by clear and
unquestioned authority of law.
—Union Pac. Ry. Co. v. Botsford
Learning Objectives (1 of 2)
• Describe various historical events that have had
an impact on the resolution of ethical dilemmas.
• Describe common ethical dilemmas and the
various ethical issues that have in many
instances divided many segments of the
population. Topics include:
– Abortion
– Sterilization
– Artificial insemination
Learning Objectives (2 of 2)
• Topics include:
– Surrogacy
– Organ donations
– Research, experimentation, and clinical
trials
– Human genetics
– Stem cell research
– AIDS
Ethical Dilemmas
• Ethical dilemmas arise in situations where a
choice must be made between unpleasant
alternatives.
• Occur when a choice involves giving up
something good and suffering some bad.
– Should I choose life knowing an unborn child
will be born with severe disabilities?
Noteworthy Historical Events (1 of 11)
58,000–68,000 BC: Neanderthal burial sites
(evidence of belief in an afterlife)
1932–1972: Tuskegee Study of Syphilis
1933–1945: Holocaust
1946: Military Tribunal for War Crimes
1949: International Code of Medical Ethics
1954: Guidelines on Human Experimentation
First kidney transplant
Noteworthy Historical Events (2 of 11)
1960s: Cardiopulmonary resuscitation
1964: WHO guidelines for biomedical research
1968: Harvard Ad Hoc Committee on Brain Death
1970: Patient as a Person
1971: Kennedy Institute of Ethics established
1972: Informed consent (Canterbury v. Spence)
1973: Women’s right to abortion (Roe v. Wade)
Noteworthy Historical Events (4 of 11)
1974: National Research Act
1975: First successful cloning of frogs
1976: Substitute judgment (Karen Ann Quinlan)
First living will legislation enacted
1978: Commission for the Study of Ethical
Problems in Medicine
Noteworthy Historical Events (5 of 11)
1980: Hemlock Society formed to advocate for
physician-assisted dying.
1983: First durable power of attorney legislation
Compassion and Choices
1987: Unethical experiments on children
Noteworthy Historical Events (6 of 11)
1990: Patient Self-Determination Act
Cruzan could have feeding tube removed
Kevorkian assists terminally ill patients in
suicide
Timothy Quill and prescription for death
Derek Humphry’s book Final Exit
Radiation experiments on unknowing
human
subjects
Noteworthy Historical Events (7 of 11)
1993: Patient’s wishes honored
1994: Oregon’s Death with Dignity Act
Michigan makes physician-assisted suicide
illegal
1996: HIPAA
Cloning of Dolly
Fourteenth Amendment and the terminally ill
Noteworthy Historical Events (8 of 11)
1997: Physician-assisted suicide
Kevorki ...
1. To understand the circumstances and consequences of terminal illness and death.
2. To understand grief in the context of impending death- both in the aware patient, the caregiver and loved ones
3. To explore the understanding of death across cultures
4. To develop relevant skills in dealing with death in clinical situations, with specific reference to dementia
The PBHP DYC ~ Reflections on The Dhamma (English).pptxOH TEIK BIN
A PowerPoint Presentation based on the Dhamma Reflections for the PBHP DYC for the years 1993 – 2012. To motivate and inspire DYC members to keep on practicing the Dhamma and to do the meritorious deed of Dhammaduta work.
The texts are in English.
For the Video with audio narration, comments and texts in English, please check out the Link:
https://www.youtube.com/watch?v=zF2g_43NEa0
The Book of Joshua is the sixth book in the Hebrew Bible and the Old Testament, and is the first book of the Deuteronomistic history, the story of Israel from the conquest of Canaan to the Babylonian exile.
The Good News, newsletter for June 2024 is hereNoHo FUMC
Our monthly newsletter is available to read online. We hope you will join us each Sunday in person for our worship service. Make sure to subscribe and follow us on YouTube and social media.
Exploring the Mindfulness Understanding Its Benefits.pptxMartaLoveguard
Slide 1: Title: Exploring the Mindfulness: Understanding Its Benefits
Slide 2: Introduction to Mindfulness
Mindfulness, defined as the conscious, non-judgmental observation of the present moment, has deep roots in Buddhist meditation practice but has gained significant popularity in the Western world in recent years. In today's society, filled with distractions and constant stimuli, mindfulness offers a valuable tool for regaining inner peace and reconnecting with our true selves. By cultivating mindfulness, we can develop a heightened awareness of our thoughts, feelings, and surroundings, leading to a greater sense of clarity and presence in our daily lives.
Slide 3: Benefits of Mindfulness for Mental Well-being
Practicing mindfulness can help reduce stress and anxiety levels, improving overall quality of life.
Mindfulness increases awareness of our emotions and teaches us to manage them better, leading to improved mood.
Regular mindfulness practice can improve our ability to concentrate and focus our attention on the present moment.
Slide 4: Benefits of Mindfulness for Physical Health
Research has shown that practicing mindfulness can contribute to lowering blood pressure, which is beneficial for heart health.
Regular meditation and mindfulness practice can strengthen the immune system, aiding the body in fighting infections.
Mindfulness may help reduce the risk of chronic diseases such as type 2 diabetes and obesity by reducing stress and improving overall lifestyle habits.
Slide 5: Impact of Mindfulness on Relationships
Mindfulness can help us better understand others and improve communication, leading to healthier relationships.
By focusing on the present moment and being fully attentive, mindfulness helps build stronger and more authentic connections with others.
Mindfulness teaches us how to be present for others in difficult times, leading to increased compassion and understanding.
Slide 6: Mindfulness Techniques and Practices
Focusing on the breath and mindful breathing can be a simple way to enter a state of mindfulness.
Body scan meditation involves focusing on different parts of the body, paying attention to any sensations and feelings.
Practicing mindful walking and eating involves consciously focusing on each step or bite, with full attention to sensory experiences.
Slide 7: Incorporating Mindfulness into Daily Life
You can practice mindfulness in everyday activities such as washing dishes or taking a walk in the park.
Adding mindfulness practice to daily routines can help increase awareness and presence.
Mindfulness helps us become more aware of our needs and better manage our time, leading to balance and harmony in life.
Slide 8: Summary: Embracing Mindfulness for Full Living
Mindfulness can bring numerous benefits for physical and mental health.
Regular mindfulness practice can help achieve a fuller and more satisfying life.
Mindfulness has the power to change our perspective and way of perceiving the world, leading to deeper se
What Should be the Christian View of Anime?Joe Muraguri
We will learn what Anime is and see what a Christian should consider before watching anime movies? We will also learn a little bit of Shintoism religion and hentai (the craze of internet pornography today).
Lesson 9 - Resisting Temptation Along the Way.pptxCelso Napoleon
Lesson 9 - Resisting Temptation Along the Way
SBs – Sunday Bible School
Adult Bible Lessons 2nd quarter 2024 CPAD
MAGAZINE: THE CAREER THAT IS PROPOSED TO US: The Path of Salvation, Holiness and Perseverance to Reach Heaven
Commentator: Pastor Osiel Gomes
Presentation: Missionary Celso Napoleon
Renewed in Grace
HANUMAN STORIES: TIMELESS TEACHINGS FOR TODAY’S WORLDLearnyoga
Hanuman Stories: Timeless Teachings for Today’s World" delves into the inspiring tales of Hanuman, highlighting lessons of devotion, strength, and selfless service that resonate in modern life. These stories illustrate how Hanuman's unwavering faith and courage can guide us through challenges and foster resilience. Through these timeless narratives, readers can find profound wisdom to apply in their daily lives.
In Jude 17-23 Jude shifts from piling up examples of false teachers from the Old Testament to a series of practical exhortations that flow from apostolic instruction. He preserves for us what may well have been part of the apostolic catechism for the first generation of Christ-followers. In these instructions Jude exhorts the believer to deal with 3 different groups of people: scoffers who are "devoid of the Spirit", believers who have come under the influence of scoffers and believers who are so entrenched in false teaching that they need rescue and pose some real spiritual risk for the rescuer. In all of this Jude emphasizes Jesus' call to rescue straying sheep, leaving the 99 safely behind and pursuing the 1.
The Chakra System in our body - A Portal to Interdimensional Consciousness.pptxBharat Technology
each chakra is studied in greater detail, several steps have been included to
strengthen your personal intention to open each chakra more fully. These are designed
to draw forth the highest benefit for your spiritual growth.
2. Definitions and Ethical Issues
Learning Objectives
• How is death defined?
• What legal and medical criteria are used to determine
when death occurs?
• What are the ethical dilemmas surrounding
euthanasia?
• What issues surround the costs of life-sustaining
interventions?
2 of 36
3. Definitions and Ethical Issues
Sociocultural Definitions of Death
• All cultures have their own views.
– Melanesians
– Other South Pacific cultures
– Ghana
• Mourning rituals and states of bereavement
– Orthodox Jews
– Muscogee Creek Indians
– Japanese culture and Buddhism in Japan
– Toraja of Indonesia
3 of 36
4. Definitions and Ethical Issues
Definitions of Death
In Western culture, death has several meanings:
An image or object Death as a mystery
tombstone What is it like to die?
Death as a statistic Death as a boundary
mortality rates You can’t come back.
Death as an event Death as a thief of meaning
funeral I feel so cheated.
Death as a state of being Death as fear and anxiety
nothingness I’m afraid to die. Will it hurt?
Death as an analogy Death as a reward or punishment
dead-end street Heaven awaits the just
4 of 36
5. Definitions and Ethical Issues
Legal and Medical Definitions
• Clinical death accepted for hundreds of years
– Lack of heart beat and respiration
• Whole-Brain Death-most widely accepted today
– Includes eight specific criteria, all of which must be met
• No spontaneous responses to any stimuli
• No spontaneous respiration for at least 1 hour
• Total lack of responsiveness to even the most painful stimuli
• No eye movements, blinking, or pupil responsiveness
• No postural activity, swallowing, yawning, or vocalizing
• No motor reflexes
• A flat EEG for at least 10 minutes
• No change in any of these when tested again 24 hours later
• Persistent Vegetative State (PVS) from which a person does
not recover following:
– Disruption of the blood flow to the brain
– Severe head injury
– Drug overdose
5 of 36
6. Persistent Vegetative State
Has severe brain damage and coma, but also show signs of “sleep-wakefulness” cycle without any
detectable evidence of awareness.
•Look normal; eyes open and move about; spontaneous movement of limbs;
•Appear to smile, grimace, laugh, moan, and groan;
•No visual tracking; no visual fixation
•Absence of any expression of self-awareness, specific recognition of external stimuli
•No consistent evidence of attention, intention, or learned response
6 of 36
7. Definitions and Ethical Issues
Decisions regarding healthcare: advance directives
– Living Will
tells how, when, and under what circumstances life-sustaining
treatments are provided or withheld
– Advanced Directives
same as Living Will
– Durable Power of Attorney (DPOA)
allows a surrogate to make decisions for the patient
– Health Care Proxy
person given the legal right to make health care decisions
7 of 36
8. Definitions and Ethical Issues
DNR Orders
–When patients are transferred from one facility to another, orders
may be lost
–Without orders, physicians may try to resuscitate patient before
learning of DNR
– Most want compassionate care that is pain-free
and emotionally supportive end of life (EOL) treatment
– Found mainly in 75+ years nursing home residents
Organ Donation
– Nearly 95,000 Americans wait for transplants
– Kidney is most common organ for transplant
– Donor card, family discussions on religion, philosophy, etc.
8 of 36
9. Definitions and Ethical Issues
Ethical Issues
Bioethics
– Examines the interaction between human values and
technological advances
– The most important bioethical issue is euthanasia.
Euthanasia
– The practice of ending life for reasons of mercy
Active euthanasia
• Deliberately ending someone’s life through some sort of
intervention or action
Passive euthanasia
• Ending someone’s life by withholding treatment or food
• Controversial depending on the reasons and motives
9 of 36
10. Definitions and Ethical Issues
Ethical Issues
• Oregon Death with Dignity Law – 1994
– Provides for people to obtain prescriptions for self-
administered lethal doses of medication (Fig. 13.1)
• Reasons patients choose assisted suicide
– Loss of autonomy (96%)
– Decreasing ability to enjoy life activities (96%)
– Loss of dignity (76%)
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11. Ethical Issues – Case Study
• Case Studies
Nancy Cruzan (July 20, 1957–December 26, 1990)
After an automobile accident left her in a persistent vegetative state, her family
petitioned in courts for three years, as far as the U.S. Supreme Court, to have her
feeding tube removed. The Court initially denied the family's request, citing lack of
evidence of Cruzan's wishes. The family's request was ultimately granted by providing
additional evidence. On December 15, 1990, the tube was removed and she died 12
days later.
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12. Ethical Issues – Case Study
Terri Shiavo
• The Schiavo case was a legal battle between the husband and the parents of Terri Schiavo
that lasted from 1998 to 2005. At issue was whether the equipment that had been used to
sustain her life since 1990 – specifically a feeding tube – should have been disconnected,
thereby allowing her to die.
• Terri Schiavo collapsed in her St. Petersburg, Florida home in full cardiac arrest on February
25, 1990. She suffered massive brain damage due to lack of oxygen and, after two and a
half months in a coma, her diagnosis was elevated to vegetative state. For the next few
years doctors attempted physical therapy and other experimental therapy, hoping to return
Terri to a state of awareness.
• In 1998 Terri's husband, Michael, petitioned the court to remove her feeding tube. He was
opposed by Terri's parents, who argued that Terri was conscious. The court determined that
Terri would not wish to continue life-prolonging measures, and on April 24, 2001 Terri's
feeding tube was removed for the first time, only to be reinserted several days later.
• On February 25, 2005, a Pinellas County judge ordered the removal of Terri's feeding tube.
Several appeals and federal government intervention followed, which included U.S.
President George W. Bush returning to Washington D.C. from a vacation to sign legislation
designed to keep Terri alive. After all attempts at appeals through the federal court system
were unsuccessful, Terri's feeding tube was disconnected on March 18, 2005. Terri died at a
Pinellas Park hospice on March 31.
• In all, the Schiavo case involved 14 appeals and numerous motions, petitions, and hearings
in the Florida courts; five suits in federal district court
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14. Definitions and Ethical Issues
The Price of Life-Sustaining Care
• A growing debate concerns the costs for keeping
someone alive through technology and includes
financial, personal, and moral costs.
• The most obvious are financial costs which are
usually staggering.
– Personal emotional costs are often underestimated, but can
be devastating and long-lasting.
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15. Thinking About Death: Personal Aspects
Learning Objectives
• How do feelings about death change over adulthood?
• How do people deal with their own death?
• What is death anxiety, and how do people show and
cope with it?
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16. Thinking About Death: Personal Aspects
A Developmental View of Death
• Young children, 2-3 years, view death as a
permanent sleep and may blame themselves for
causing it
• Children before 7-8 years do not appreciate the
universality, inevitability, and irrevocability of death
• Children age 9-10 years, recognize that they and all
living things will die
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17. Thinking About Death: Personal Aspects
A Developmental View of Death
• Adolescents and young adults most fearful of death;
they want to achieve so many things in their lives
• Older adults show more acceptance and less fear of
death but focus on the process of dying rather than
death itself
• Many elderly face a “bereavement overload” from losing
so many friends
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18. Thinking About Death: Personal Aspects
Dealing with One’s Own Death
• Kübler-Ross’s theory includes five stages:
– Denial
– Anger
– Bargaining
– Depression
– Acceptance
• The first reaction is likely to be shock and disbelief.
– Denial is a normal part of getting ready to die.
• At some point people express anger as hostility, resentment,
frustration, and envy.
• In the bargaining phase, people look for a way out or a person
sets a timetable.
• When one can no longer deny the illness, feelings of depression
become common.
• In the acceptance stage, the person accepts the inevitability of
death and often seems detached from the world and at peace.
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19. Thinking About Death: Personal Aspects
Kübler-Ross’s Stages of Loss
It is important to note that:
– Some people do not progress through all of these stages,
and some people move through them at different rates.
– People may be in more than one stage at a time and do not
necessarily go through them in order.
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20. Thinking About Death: Personal Aspects
A Contextual Theory of Dying
• Stage theories assume some sort of underlying process for
moving from one stage to another but do not clearly state what a
person must do to move from one to the other.
• A contextual theory of dying
– Emphasizes the tasks and issues that a dying person must
face, and although there may be no right way to die, there
are better or worse ways of coping with death
• Corr identified four dimension of tasks that must be faced.
– Bodily needs, psychological security, interpersonal
attachments, and spiritual energy and hope
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21. Thinking About Death: Personal Aspects
Death Anxiety
• Death anxiety is essentially universal in Western culture.
– However, defining and measuring it is difficult.
• Several components have been identified, including:
– Anxiety about pain
– Body malfunction
– Humiliation
– Rejection
– Nonbeing
– Punishment
– Interruption of goals
– Negative impact on survivors
• These components can be expressed at public, private,
and unconscious levels.
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22. Thinking About Death: Personal Aspects
Learning to Deal with Death Anxiety?
• Demonstrated in many different ways, including:
– Avoidance of things connected with death
• Such as refusing to go to funerals
– Directly challenging death
• Such as engaging in dangerous sports
• Less common ways to express death anxiety include:
– Daydreaming
– Changing one’s lifestyle
– Using humor
– Displacing anxiety onto work
– Becoming a professional who deals with death
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23. Thinking About Death: Personal Aspects
Learning to Deal With Death Anxiety
• Several ways to deal with anxiety exist.
– Living life to the fullest
– Personal reflection
– Death Education
• Koestenbaum (1976) proposed several exercises.
– Write your own obituary
– Plan your death and funeral services
– Consider that death could happen now
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24. End-of-Life Issues
Learning Objectives
• What is a personal final scenario?
• What are hospices, and what options do they
provide?
• How do people make their end-of-life intentions
known?
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25. End-of-Life Issues
Creating a Final Scenario
• End-of-life issues
– Managing the final aspects of life
– After-death disposition of the body and how one is
memorialized—cremation or burial?
– Distribution of assets
• Making choices: what people do and do not want done
– A crucial aspect of the final scenario is the process of
separation from family and friends.
• Bringing closure to relationships
• Affirm love
• Resolve conflicts
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26. End-of-Life Issues
The Hospice Option
Hospice
An approach to assisting dying people that emphasizes pain
management (palliative care) and death with dignity
• Hospice care emphasizes quality of life rather than quantity of life.
– The goal is a de-emphasis on the prolongation of death for terminally
ill patients.
– Both inpatient and outpatient hospices exist.
• The role of the staff is to be with patients, not to do things for
patients.
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27. End-of-Life Issues
The Hospice Option
• How do people decide to explore the hospice option?
– Kastenbaum lists six key considerations:
2. Is the person completely informed about the nature and
prognosis of his or her condition?
3. What options are available at this point in the progress of
the person’s disease?
4. What are the person’s expectations, fears, and hopes?
5. How well do the people in the person’s social network
communicate with each other?
6. Are family members available to participate actively in
terminal care?
7. Is a high-quality hospice care program available?
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28. End-of-Life Issues
The Hospice Option
• How well do the people in the person’s social network
communicate with each other?
– Are family members available to participate actively in terminal
care?
– Is a high-quality hospice care program available?
• Hospice provides an important end-of-life option for
many terminally ill people and their families.
– Moreover, the supportive follow-up services they provide are
used by many surviving family and friends.
– However, adults cannot benefit from hospice care unless:
• Family reluctance to face the reality of terminal illness and
participate in the decision-making process is changed.
• Physician reluctance to approve hospice care for patients until
the very end is changed.
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29. Survivors: The Grieving Process
Learning Objectives
• How do people experience the grief process?
• What feelings do grieving people have?
• What is the difference between normal and prolonged
grief?
• How do adults of different ages deal with loss?
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30. Survivors: The Grieving Process
• Bereavement
The state or condition caused by loss through death
• Grief
The sorrow, hurt, anger, guilt, confusion, or other
feelings that arise after a loss
• Mourning
The way we express our grief
• Mourning is heavily influenced by cultural norms.
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31. Survivors: The Grieving Process
The Grief Process
• A complicated and personal process
– Described as reflecting on many themes and issues that
people confront
• Unlike bereavement, over which we have no control,
grief is a process that involves choices.
• A person must:
– Acknowledge the reality of the loss
– Work through the emotional turmoil
– Adjust to the environment where the deceased is absent
– Loosen ties to the deceased
• Grief is an active coping process.
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32. Survivors: The Grieving Process
The Grief Process
• Risk Factors in Grief
– That may make bereavement much more difficult
• Sudden death vs. prolonged death
– Anticipatory grief
• People tend to disengage from the dying person.
– Strength of attachment makes a difference
• Strong attachment and sudden death causes greater grief.
• Secure attachment results in less depression due to less guilt
over unresolved issues.
• Two interpersonal risk factors
– Level of social support
– Kinship: child most difficult, then spouse, then parent
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33. Survivors: The Grieving Process
Two Types of Grief Reactions
• Uncomplicated (normal)
– Sad, but able to resume daily functions
• Complicated (prolonged)
– Unable to cope and adapt to the death
– Common manifestations
a. Excessive guilt
b. Self-blame
– Three criteria
1. Yearnings and longing for the deceased
2. Number of overwhelming feelings
3. Marked dysfunction in social, occupational, & other important
situations. (judgment errors, agitated depression, sleep & appetite
problems. Intense recurring thoughts about the deceased)
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34. Normal Grief Reactions
• Disbelief • Confusion
• Denial • Helplessness
• Shock • Emptiness
• Sadness • Loneliness
• Anger • Acceptance
• Hatred • Relief
• Guilt • Happiness
• Fear • Lack of enthusiasm
• Anxiety • Absence of emotion
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35. Survivors: The Grieving Process
Normal Grief Reactions
• Anniversary reaction
– Grief that often returns around the anniversary of the death
• Grief Over Time
– Grief tends to peak within the first six months.
– People can grieve many years after the loss.
• Relationship between health and stress
– Interventions may be more effective before the death.
• Effects of normal grief on adults’ health
– In general, experiencing the death of a loved one does not
directly influence physical health.
– Religiosity is thought to provide a support mechanism.
• People who have a hard time coping tend to have low
self-esteem before losing a loved one.
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36. The Grieving Process:
Deaths that are Difficult to resolve
• Death of a young child
– Death of a young child produces intense grief and/or guilt, especially
if unexpected
• Death of a parent
– Death of a parent has persistent long-term effects reduction in
love, affection, and attention they could receive
– Early parental loss has life-long effects with children assuming adult
roles, and possible financial strain
• Death of an adult child
– Un-timeliness of the death and destruction of the parents’ worldview
– Loss of the child/parent bond
– Survivor guilt
– Strain in the parents’ marital relationship
– Change in meaning for the future
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37. The Grieving Process:
Deaths that are Difficult to resolve
• Death of a sibling
– Death of a sibling can be difficult since it is the family bond of
longest duration
– Siblings may feel responsible for the death due to feelings of
survivor guilt
• Suicide
– Intense, overwhelming grief, hostility and feelings of rejection
– Guilt - “I should have been able to recognize / prevent”
– Females x2 more likely to attempt; males x2 as likely to succeed
– Females – passive forms – pills, carbon dioxide, etc
– Males – more violent forms, guns, hanging, knives, etc.
– Survivors need social support and opportunity to share their grief
– Because suicide carries negative social stigma, survivors are
likely to become closed to discussion about death and their own
reactions.
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39. Survivors: The Grieving Process
• Funerals
– Funeral costs have skyrocketed
– Increasing numbers choose cremation
– Many elderly pre-pay their own funeral expenses
• The Grieving Process
– Affects all aspects of survivors: emotional, physical, and
behavioral reaction
– Four phases: numbness, yearning, disorganization/despair,
reorganization
– Grief work has as its goal, the resolution of grief, which can be
arrested if survivors do not go through the process successfully
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40. Survivors: The Grieving Process
Coping with Grief
• Numerous theories have been proposed to account
for the grieving process.
– General life event theories
– Psychodynamic theories
– Attachment theories
– Cognitive process theories
• The Dual Process Model
1. Loss-orientated stressors
2. Restoration-orientated stressors
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41. The Dual Process Model
Stressors of the Moving on with
loss its-self one’s life
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42. Survivors: The Grieving Process
Adult Developmental Aspects of Grief
• Death of One’s Child in Young and Middle Adulthood
– Sudden Infant Death Syndrome (SIDS)
– Loss of sons or daughters in war
– Death in traffic accidents
• Death of one’s Parent
– Perceived as very significant regardless of age of parent
• Death of One’s Child or Grandchild in Late Life
– Loss of a child has profound, lifelong effects
– Loss of a grand-child results in similar feelings, intense
emotional, upset, survivor guilt, regrets about
relationship, need to restructure with surviving children
• Death of One’s Partner in Late Life
– Older bereaved spouses may grieve a great deal.
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Editor's Notes
Figure 13.1 Number of Oregon Death with Dignity Act (DWDA) prescription recipients and deaths 1998-2007
Figure 13.7 The dual process model of coping with bereavement . . .