Chapter 23

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Why Is There Death?

There is no completely satisfying answer to the question of why death exists Death promotes variety through the evolution of species The perspective of species survival, the cycle of life and death

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Chapter Twenty-three

Understanding Death and Dying

Defining Death
Defined as cessation of the flow of vital bodily fluids. Cessations of the heart beating and breathing Life-support systems Brain death Harvard medical School committee death involves:
Lack of receptivity and response to external stimuli Absence of spontaneous muscular movement and spontaneous breathing 3. Absence of observable reflexes 4. Absence of brain activity Electroencephalogram (EEG)
1. 2.

Clinical death Cellular death

Chapter Twenty-three 3

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Learning About Death

A childs understanding of death evolves greatly from about age 5 to age 9.

Most children cone to understand that death is

final, universal, and inevitable

Mature understanding of death Mark Speece and Sandor Brent Facts about death includes four components

1. 2. 3. 4.

Universality Irreversibility Nonfunctionality Causality

Chapter Twenty-three 4

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Denying Versus Welcoming Death

Understanding death in a mature fashion does not imply that we never experience anxiety about the deaths of those we love or about the prospect of our own death.

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Chapter Twenty-three

Planning For Death

Making a Will
A legal instrument expressing a persons

intentions and wishes for the disposition of his or her property after death. Estate Testator Intestate Testamentary letter
Document includes information about your

personal affairs (bank statements, credit cards, documents etc.)

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Chapter Twenty-three 6

Considering Options for End-ofLife Care

Home Care Hospital-Based Palliative Care

Focuses on controlling pain and relieving

suffering by caring for the physical, psychological, spiritual, and existential needs of the patient.

Hospice Programs
Palliative care

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Chapter Twenty-three

Deciding to Prolong Life or Hasten Death

Withholding or Withdrawing Treatment Assisted Suicide and Active Euthanasia

Physician-assisted suicide (PAS) Physician provides lethal drugs or other interventions Active euthanasia Intentional act of killing someone who would otherwise suffer from an incurable and painful disease

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Chapter Twenty-three

Completing an Advance Directive

Any statement made by a competent person about choices for medical treatment should he or she become unable to make such a decisions. Two forms:

1. Living will 2. Health care proxy Surrogate (the decision maker)

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Chapter Twenty-three

Figure 23-1 Sample living will

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Chapter Twenty-three

10

Becoming an Organ Donor

Each day about 77 people receive an organ transplant while another 19 people on the waiting list die because not enough organs are available.
98,000 Americans waiting for organ

transplants

Uniform Donor Card

First step
See In Focus Myths About Organ Donation

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Chapter Twenty-three

11

Figure 23-2 The need for organ donors

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Chapter Twenty-three

12

Planning a Funeral or Memorial Service

Disposition of the Body

Social, cultural, religious, psychological, and

interpersonal considerations Burial Cremation Embalming for a viewing or wake

Arranging a Service

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Chapter Twenty-three

13

Coping With Dying

Awareness of Dying The Tasks of Coping

1969 book On Death and Dying, Elisabeth Kubler-Ross 5 psychological stages
1. 2. 3. 4. 5.

Denial Anger Bargaining Depression Acceptance

Charles Corr
4 primary dimensions in coping with dying
1. 2. 3. 4.

Physical Psychological Social Spiritual

Specific tasks that need to be addressed in coping with dying Prediagnostic Acute Chronic Terminal Recovery

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Chapter Twenty-three

14

Coping With Dying

The Trajectory of Dying

Understanding patients experiences as they near death

Supporting a Dying Person Coping With Loss

Experiencing Grief Bereavement Mourning Tasks of Mourning 1. Accepting reality 2. Working through the pain 3. Adjusting to a changed environment 4. Emotionally relocating the deceased and moving on with life The Course of Grief Supporting a Grieving Person Helping Children Cope with Loss

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Chapter Twenty-three

15

Coping With Dying

The Course of Grief

Supporting a Grieving Person

Helping Children Cope with Loss

Coming To Terms With Death

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Chapter Twenty-three

16

Chapter 23

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Chapter Twenty-three

17