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Chapter 11-Death and Dying
McGraw-Hill © 2010 by The McGraw-Hill Companies, Inc. All rights reserved
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Learning Outcomes Discuss accepted criteria for determining death. Determine the health care professional’s role in caring for
the dying. Explain differences between a living will, a health care
proxy, and durable power of attorney. Discuss the various stages of grief. Begin to form a knowledge base for assisting dying
patients and their family members through the grieving process, as well as forming a personal philosophy concerning death and dying.
Identify the major features of organ donation in the United States.
McGraw-Hill © 2010 by The McGraw-Hill Companies, Inc. All rights reserved
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Most states follow definitions recommended in a proposed Uniform Determination of Death Act.
Brain death occurs when the following functions irreversibly cease: Circulatory and respiratory functions. Entire brain, including brain stem.
McGraw-Hill © 2010 by The McGraw-Hill Companies, Inc. All rights reserved
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Coma A person is comatose when they are in a deep stupor
and do not respond to external stimuli.
Persistent Vegetative State (PVS) Irreversible cessation of higher functions of brain, but
involuntary bodily functions present. No reasonable expectation of reversal.
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A postmortem examination to determine cause of death and/or to obtain physiological evidence.
Required when foul play is suspected. Not routinely done in most hospitals; exception
would be teaching hospitals associated with a medical school.
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More end-of-life care is being taught to physician and other health care professionals.
Thanatology is the study of death and psychological methods of coping with death.
McGraw-Hill © 2010 by The McGraw-Hill Companies, Inc. All rights reserved
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Each state’s laws are different. Proposed Uniform Rights of Terminally Ill Act
provided guidelines for states. Important to have Advanced Directives in place. Only Oregon allows physician assisted death.
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Active euthanasia Conscious act that results in death.
Passive euthanasia Allowing patient to die naturally, without medical
interference.
Voluntary euthanasia Requires patient or agent consent.
Involuntary euthanasia Without patient or agent consent.
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Curative Care Treatments and procedures to help cure the patient’s
disease.
Palliative Care Treatments to help provide comfort and maintain
highest quality of life; often called comfort care.
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Facilities and care for dying patients. Care may be in the patient’s home or a hospice
facility. Care focuses on relieving pain, controlling
symptoms and meeting emotional needs, and personal values of both the patient and the family members.
McGraw-Hill © 2010 by The McGraw-Hill Companies, Inc. All rights reserved
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Patient Self-Determination Act of 1990 Requires that hospitals and other health care facilities
provide written information to patients about: The right to make medical decisions. The right to executive Advanced Directives.
McGraw-Hill © 2010 by The McGraw-Hill Companies, Inc. All rights reserved
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Detailed instructions regarding a patient’s wishes for end-of-life treatment.
May include any or all of the following: Circumstances under which treatment should be
discontinued. When heroic measures should or should not be taken. Directions for organ donation, autopsy or alternative
treatment.
McGraw-Hill © 2010 by The McGraw-Hill Companies, Inc. All rights reserved
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Durable Power of Attorney A document designating individual(s) to act on
another’s behalf in all legal matters. Takes effect when the grantor loses ability to make
decisions (unconsciousness or mental incompetence).
Health Care Proxy Health care power of attorney for end-of-life
situations.
McGraw-Hill © 2010 by The McGraw-Hill Companies, Inc. All rights reserved
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Do-Not-Resuscitate Order Order issued when a patient specifies that no CPR
should be performed if his/her heart stops beating. Different procedure exists in each state.
Organ Donor Directives Patient specifications regarding organ transplantation.
McGraw-Hill © 2010 by The McGraw-Hill Companies, Inc. All rights reserved
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Federal Law passed in 1984. Established Organ Procurement Organizations
(OPO’s). Established the Organ Procurement and
Transplantation Network (OPTN). The OPTN and OPO work together to provide
organs throughout the United States. Organ shortages remain critical in the United
States.
McGraw-Hill © 2010 by The McGraw-Hill Companies, Inc. All rights reserved
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States allow organ donation by law, there is no federal law to provide organ donor directives.
Most states allow prospective donors to indicate on their driver’s license their intent to donate.
There are many myths about organ donation; look for the Frequently Asked Questions in Chapter 11 for information.
McGraw-Hill © 2010 by The McGraw-Hill Companies, Inc. All rights reserved
11-16
Elizabeth Kubler-Ross defines five stages of grief: Denial and isolation Anger, rage, and resentment Bargaining and guilt Depression or sadness Acceptance
McGraw-Hill © 2010 by The McGraw-Hill Companies, Inc. All rights reserved
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You are one of three siblings. Your 89-year-old mother, who has been in poor health for years, is diagnosed with an irreversible brain cancer and slips into a PVS. Your two sisters are not in agreement about end-of-life care for your mother. They look to you to resolve the issue. What are you going to do?
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