Death and Dying

Objectives Describe dying, the phases of dying, and death. Explain do-not-resuscitate orders. Differentiate between medical power of attorney and legal power of attorney. List who can be an organ donor and what parts of the body can be donated. Explain various spiritual perspectives on death. Compare Kubler-Ross’ stages with Temes’ stages of death. Explain how people cope with death.

Death and Dying In 1980, the National Conference of Commissioners on Uniform State Laws formulated the Uniform Determination of Death Act to help define death. Dying is the complete and permanent cessation of all vital functions.

Do-Not-Resuscitate Order Instructions written by a doctor telling other health care providers not to try to restart a patient's heart Usually written after a discussion between a doctor and the patient or family members Written for people who are very unlikely to have a successful result from CPR—those who are terminally ill or elderly and frail

Medical and Legal Powers of Attorney Medical power of attorney: Gives the person named the authority to make decisions about whether to follow a dying person’s advance directive, or living will. Legal power of attorney: Gives the person named the control of a person’s financial responsibilities and assets.

Phases of Dying Preactive phase Active phase Patients are more aware they’re dying. They stop recovering from wounds or infections. They often want to put affairs in order. Active phase Body dies from extremities inward. Hands and feet become cold and blue. Patient sleeps a lot. Patient isn’t hungry or thirsty.

Managing End of Life With Hospice Care Cares for dying person and, often, their families. Provides palliative care. Nurses, social workers, and spiritual counselors make up hospice teams.

Organ Donors Organs from people of any age can be donated. Doctors decide which organs are viable for transplantation. Organs from people who are HIV positive, have active cancer, or have a systemic infection can’t be used for donation.

Organs That Can Be Donated Organs that must be transplanted immediately: Kidneys Heart Liver Lungs Pancreas Intestines (continued)

Organs That Can Be Donated (continued) Organs that can be stored for later transplantation: Corneas Middle ears Skin Heart valves Bone Veins Cartilage Tendons Ligaments

Burial Purposes Places Cremation Dispose of the body. Commemorate the person’s life. Places Varies culturally. Often churchyards and cemeteries. Cremation Costs less than traditional burial. Remains of cremated person are portable.

Spiritual Side of Death Cultures differ in the way they deal with death. Cultures differ in their beliefs about the afterlife. Reincarnation Heaven and hell

Kubler-Ross’ Stages of Grief Denial (This isn't happening to me!) Anger (Why is this happening to me?) Bargaining (I’ll be a better person if . . .) Depression (I don't care anymore.) Acceptance (I'm ready for whatever comes.)

Five Stages of Grief

Temes’ Stages of Grief Numbness (mechanical functioning and social insulation) Disorganization (intensely painful feelings of loss) Reorganization (reentry into a more normal social life)