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Death and Dying

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Death and Dying

  1. 1. Chapter Seventeen Accepting Dying and Death
  2. 2. Definitions of Death <ul><li>Clinical determinants of death </li></ul><ul><li>Medical death certificate </li></ul><ul><li>Criteria to establish death </li></ul><ul><ul><li>Lack of heartbeat and breathing </li></ul></ul><ul><ul><li>Lack of central nervous system function </li></ul></ul><ul><ul><li>Presence of rigor mortis </li></ul></ul>
  3. 3. Psychological Stages of Dying <ul><li>Denial </li></ul><ul><li>Anger </li></ul><ul><li>Bargaining </li></ul><ul><li>Depression </li></ul><ul><li>Acceptance </li></ul>
  4. 4. Near-Death Experiences <ul><li>Acknowledgement of death </li></ul><ul><li>Out-of-body experience </li></ul><ul><li>Extreme blackness </li></ul><ul><li>Encountering love ones who have died </li></ul><ul><li>Intense light </li></ul><ul><li>Sense of well-being and peace </li></ul><ul><li>Decision whether to enter into the light </li></ul><ul><li>Return to the body </li></ul>
  5. 5. Interacting with Dying People <ul><li>Be genuine and honest </li></ul><ul><li>Provide emotional support </li></ul><ul><li>Allow people to express their feelings </li></ul>
  6. 6. Talking with Children about Death <ul><li>Use straightforward, age-appropriate language </li></ul><ul><li>Avoid shielding </li></ul><ul><li>Make certain the child understands </li></ul><ul><li>Provide simple, direct answers </li></ul><ul><ul><li>The person will never come back </li></ul></ul><ul><ul><li>The body has been buried or burned to ashes </li></ul></ul>
  7. 7. End-of-Life Options and Decisions <ul><li>Hospice care for the terminally ill </li></ul><ul><li>Goal is to maximize quality of life </li></ul><ul><li>Strategies </li></ul><ul><ul><li>Pain control </li></ul></ul><ul><ul><li>Family involvement </li></ul></ul><ul><ul><li>Multidisciplinary approach </li></ul></ul><ul><ul><li>Patient decisions </li></ul></ul><ul><li>Follow-up and care for survivors </li></ul>
  8. 8. Euthanasia <ul><li>Indirect or passive euthanasia </li></ul><ul><ul><li>Allowing to die (“do not resuscitate”) </li></ul></ul><ul><li>Direct or active euthanasia </li></ul><ul><ul><li>Giving a patient a lethal dose of drugs </li></ul></ul><ul><li>Physician-assisted suicide </li></ul><ul><ul><li>Prescribing a patient a lethal dose of drugs </li></ul></ul><ul><li>Oregon Death with Dignity Act </li></ul>
  9. 9. End-of-Life Options and Decisions <ul><li>Advance Healthcare Directives </li></ul><ul><ul><li>Living will </li></ul></ul><ul><ul><li>Durable power of attorney for health care </li></ul></ul>
  10. 10. Living Will
  11. 11. Organ Donation <ul><li>Intention to donate can be stated on driver’s license, but next-of-kin must consent at time of death </li></ul><ul><li>Significant shortage of donor organs </li></ul><ul><li>Every day: </li></ul><ul><ul><li>77 people receive a transplant </li></ul></ul><ul><ul><li>110 people join waiting list for a transplant </li></ul></ul><ul><ul><li>19 people die waiting for a transplant </li></ul></ul>
  12. 12. Planning an Organ Donation
  13. 13. Grief and Coping: The Experience of Grief <ul><li>Physical discomfort </li></ul><ul><li>Sense of numbness </li></ul><ul><li>Feeling of detachment from others </li></ul><ul><li>Preoccupation with the image of the deceased </li></ul><ul><li>Guilt </li></ul><ul><li>Hostility </li></ul><ul><li>Disruption in daily schedule </li></ul><ul><li>Delayed grief </li></ul>
  14. 14. Coping with Death from Specific Causes <ul><li>Terminal illness </li></ul><ul><li>Accidental death </li></ul><ul><li>Natural disasters </li></ul><ul><li>Terrorism </li></ul><ul><li>Suicide </li></ul><ul><li>Murder </li></ul>
  15. 15. Coping with the Death of a Loved One <ul><li>Child </li></ul><ul><ul><li>Miscarriage </li></ul></ul><ul><ul><li>Lost after birth </li></ul></ul><ul><ul><li>Grieving </li></ul></ul><ul><li>Parent </li></ul><ul><li>Spouse </li></ul><ul><li>Sibling </li></ul>
  16. 16. Rituals of Death <ul><li>Cultural differences </li></ul><ul><li>Full funeral services </li></ul><ul><ul><li>Embalming </li></ul></ul><ul><ul><li>Calling hours </li></ul></ul><ul><ul><li>Funeral service </li></ul></ul><ul><li>Memorial service </li></ul><ul><li>Disposition of the body </li></ul><ul><ul><li>Ground burial </li></ul></ul><ul><ul><li>Entombment </li></ul></ul><ul><ul><li>Cremation </li></ul></ul><ul><ul><li>Anatomical donation </li></ul></ul><ul><li>Costs </li></ul>
  17. 17. Personal Preparation for Death <ul><li>Will </li></ul><ul><li>Life insurance </li></ul><ul><li>Funeral prearrangements </li></ul><ul><li>Anatomical or organ donation </li></ul><ul><li>Eulogy </li></ul><ul><li>Epitaph </li></ul>
  18. 18. Chapter Seventeen Accepting Dying and Death

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