Chapter 15 Death and dying

Thanatology The study of death and dying

Death pathways 1. Sudden death Accident Heart attack 2. Steady decline Fatal disease 3. Erratic course (ups and downs) Most common

Stages of death and dying (Elisabeth Kϋbler-Ross) Denial: ”Not me!” Belief diagnosis was a mistake or gets second opinion Anger: “Why me?” outrage defense Bargaining: Make a deal with God for cure Depression: Crash of reality Acceptance: Accepts inevitability of death, often feeling deep inner peace

Aspects of death Middle knowledge: when terminally ill know they’re dying but are not dealing with it emotionally Palliative care: any intervention that promotes dignified dying, not to cure, and to relieve pain and make patient comfortable

Problems dying at home PATIENT No privacy, intimate needs cared for by family (bathing, dressing, etc.) Can be a burden to family members FAMILY On call 24/7 May interfere with work outside the home Financial strain

Dying in a hospital or hospice Better care Less dependent on family Less burden on family More free to vent emotionally

Advance directives Written document specifying instructions on the use of life-prolonging treatment if terminally ill and unable to communicate Four types 1. Living will 2. Durable power of attorney for health care 3. Do Not Resuscitate Order (DNR) 4. Do Not Hospitalize Order (DNH)

Death diagnostics “Brain dead.” Irreversible loss of all brain function. Flat line EEG (but hindbrain may still be active, totally independent of an active brain). Persisent vegetative state: The preferred term. Reflects possibility of automatic reflexes by neural circuits outside the brain.

Euthanasia Passive: Withdrawing potentially life-saving interventions (e.g., feeding tube) Active: Taking action to help a person die. Legal in The Netherlands. Physician assisted suicide: Active euthanasia of physician prescribing lethal medication to a terminally ill person

“Slippery Slope” issues Daniel Callahan, biomedical ethicist, recommends Age-based rationing of care, no expensive life-sustaining treatment on old-old people. Basis: They have lived out the lifespan.