Chapter Twenty Dying and Death

Defining Death Death has been defined as cessation of the flow of vital bodily fluids This occurs when the heart stops beating and breathing ceases The concept of cellular ‘brain death’ involves the following: Lack of receptivity and response to external stimuli Absence of spontaneous muscular movement and spontaneous breathing Absence of observable reflexes Absence of brain activity (EEG)

Understanding of Death Our understanding of death changes as we grow and mature Based on work by Speece and Brent, the observable facts about death include 4 components: Universality (all things eventually die) Irreversibility (organisms that die cannot live again) Nonfunctionality (death involves cessation of all signs of life) Causality (there are biological reasons for death)

Denying vs. Welcoming Death Many people seek to avoid any mention of death The saying, “out of sight, out of mind” appears to be the rule compared to facing death directly Cartoons and video games give death a ‘two-dimensional’ concept which distorts reality Problems can arise when the avoidance or denial that death can happen to you See Box: “Day of the Dead” See Box: Dimensions of Diversity

Planning For Death Accepting that death will occur allows the ability to plan for this event Basic tasks may include: Making a Will Considering options for ‘End-of-Life’ care Home Care Hospital based Care (palliative care) Hospice Programs See Box: In Focus

Deciding to Prolong Life or Hasten Death Once someone is given the prognosis that life would end soon, the following decisions would have to be considered Withholding or Withdrawing Treatment (passive euthanasia) Assisted Suicide (active euthanasia or physician assisted) Advanced Directive (document regarding treatment if you become unable to make them) Living Will Health Care Proxy Organ Donation See Figure 20-1 on a Living Will See Figure 20-2 on Organ Donating See Box: “What Can Be Done About the Shortage of Organ Donors?” See Figure 20-3 on Uniform Donor Card

Planning a Funeral A funeral are rites of passage that commemorate a person’s life and acknowledge their existence Funerals provide a framework that allows survivors to support one another as they cope with the loss and express grief The following need to be addressed when planning a funeral Disposition of the body Service Arrangement See Box; Critical Consumer See Box: ‘Tasks for Survivors”

Coping With Dying Charles Corr distinguishes 4 primary dimensions in coping with dying Physical (satisfying bodily needs0 Psychological (maximizing sense of security) Social (sustaining significant relationships) Spiritual (reaffirming sources of meaning) Contemplating these dimensions gives us a framework for considering specific tasks that need to be addressed

Coping With Dying Charles Corr distinguishes 4 primary dimensions in coping with dying Physical (satisfying bodily needs0 Psychological (maximizing sense of security) Social (sustaining significant relationships) Spiritual (reaffirming sources of meaning) Contemplating these dimensions gives us a framework for considering specific tasks that need to be addressed

Coping With Loss Grief is the reaction to loss and encompasses thoughts and feelings, as well as physical and behavioral responses Mourning is closely related to grief and refers to the process by which a person adjusts to loss and incorporates this into their life William Worden has identified 4 tasks when mourning Accepting the reality of loss Working through the pain Adjusting to a change environment Emotionally relocating the deceased and moving on See Box: “In Search of a Good Death” See Box: Gender Matters See Box: “Coping with Grief” See Box: Take Charge See Box: “Grief and Gender”

Chapter Twenty Dying and Death