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© 2010 McGraw-Hill Companies. All Rights Reserved.
Chapter 23
© 2010 McGraw-Hill Companies. All Rights Reserved.
Why Is There Death?
There is no completely satisfying answer to the question of why death exists
Death promotes variety through the evolution of speciesFrom the perspective of species survival,
the cycle of life and death makes sense
Death challenges our emotional and intellectual security
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© 2010 McGraw-Hill Companies. All Rights Reserved.
What is Death?
Defining deathDefined 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:
1. Lack of receptivity and response to external stimuli2. Absence of spontaneous muscular movement and spontaneous
breathing3. Absence of observable reflexes4. Absence of brain activity
• Clinical death• Cellular death
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© 2010 McGraw-Hill Companies. All Rights Reserved.
Learning About Death
A child’s understanding of death evolves greatly from about age 5 to age 9Most children cone to understand that death is
final, universal, and inevitable Mature understanding of death Mark Speece and Sandor Brent’s facts
about death, including four components:1. Universality2. Irreversibility3. Nonfunctionality4. Causality
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© 2010 McGraw-Hill Companies. All Rights Reserved.
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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© 2010 McGraw-Hill Companies. All Rights Reserved.
Planning For Death
Making a willA legal instrument expressing a person’s
intentions and wishes for the disposition of his or her property after death
EstateTestatorIntestateTestamentary letter
○ Document includes information about your personal affairs (bank statements, credit cards, documents etc.)
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© 2010 McGraw-Hill Companies. All Rights Reserved.
Considering Options for End-of-Life 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 programsPalliative care
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© 2010 McGraw-Hill Companies. All Rights Reserved.
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
interventionsActive euthanasia
○ Intentional act of killing someone who would otherwise suffer from an incurable and painful disease
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© 2010 McGraw-Hill Companies. All Rights Reserved.
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 decision
Two forms:1. Living will
2. Health care proxy○ Surrogate (the decision maker)
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© 2010 McGraw-Hill Companies. All Rights Reserved.
Figure 23.1 Sample living will
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© 2010 McGraw-Hill Companies. All Rights Reserved.
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 available98,000 Americans wait for an organ
transplant
Uniform donor card
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Figure 23.2 The need for organ donors
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© 2010 McGraw-Hill Companies. All Rights Reserved.
Planning a Funeral or Memorial Service Disposition of the body
Social, cultural, religious, psychological, and interpersonal considerations
BurialCremationEmbalming for a viewing or wake
Arranging a service
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© 2010 McGraw-Hill Companies. All Rights Reserved.
Coping With Dying Awareness of dying The tasks of coping
On Death and Dying by Elisabeth Kubler-Ross○ 5 psychological stages in response to an awareness of imminent
death: 1. Denial2. Anger3. Bargaining4. Depression5. Acceptance
Charles Corr’s four primary dimensions in coping with dying:1. Physical2. Psychological3. Social4. Spiritual
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Coping With Dying The trajectory of dying
Useful for understanding patients’ experiences as they near death
Supporting a dying person
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© 2010 McGraw-Hill Companies. All Rights Reserved.
Coping With Loss Experiencing grief
Bereavement Mourning
Tasks of mourning1. Accepting reality2. Working through the pain3. Adjusting to a changed environment4. 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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© 2010 McGraw-Hill Companies. All Rights Reserved.
Chapter 23
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