Ch 12 Death and Dying

Learning Outcomes 12.1 Discuss how attitudes toward death have changed over time. Page 358 12.2 Discuss accepted criteria for determining death. Page 359-360 12.3 Determine the health care professional’s role in caring for the dying. pages 360,361,362 LO 12.1 Discuss how attitudes toward death have changed over time. LO 12.2 Discuss accepted criteria for determining death. LO 12.3 Determine the health care professional’s role in caring for the dying.

12-3 Learning Outcomes 12.4 Discuss benefits to end-of-life health care derived from the right to die movement. Page 364 Look at pages 366,367,368,369,370,371 12.5 Identify the major features of organ donation in the United States. Pages 372,372,373 12.6 Discuss the various stages of grief. Pages 375,376,377,378 LO 12.4 Discuss benefits to end-of-life health care derived from the right to die movement. LO 12.5 Identify the major features of organ donation in the United States. LO 12.6. Discuss the various stages of grief. 3

Attitudes Toward Death and Dying page 358 Will I die alone, in an impersonal, clinical hospital environment? Will my health care providers be so committed to preserving life that they prolong my dying to an irrational degree? Will I suffer in pain? Will I feel a sense of tasks left unfinished and goals left unrealized? Will I experience a peaceful letting go? LO 12.1 Discuss how attitudes toward death have changed over time.

Uniform Determination of Death Act 12-5 Uniform Determination of Death Act Pate 359 Definition of brain death Circulatory and respiratory functions have irreversibly ceased The entire brain, including the brain stem, has irreversibly ceased to function LO 12.2 Discuss accepted criteria for determining death. 5

12-6 Brain Injury page 359 Coma Deep stupor from which the patient cannot be roused by external stimuli Persistent vegetative state Severe mental impairment with irreversible cessation of higher functions of the brain, most often caused by damage to the cerebral cortex suba sub2 LO 12.2 Discuss accepted criteria for determining death. 6

Signs of Death page 359 Cannot breathe without assistance 12-7 Signs of Death page 359 Cannot breathe without assistance Has no coughing or gagging reflex Has no pupil response to light Has no blinking reflex when the cornea is touched Has no grimace reflex when the head is rotated or ears are flushed with ice water Has no response to pain LO 12.2 Discuss accepted criteria for determining death. 7

12-8 Autopsy page 359,360 Postmortem examination determines cause of death and/or obtains physiological evidence when necessary. Autopsies performed in hospitals may confirm or correct clinical diagnoses. Autopsies must be performed in cases in which the death is suspicious or due to homicide. LO 12.2 Discuss accepted criteria for determining death. 8

12-9 Palliative page 360,361 Given when patient’s disease is incurable and death is imminent Directed toward providing relief to terminally ill patients through symptom and pain management Goal is to provide comfort and maintain the highest possible quality of life LO 12.3 Determine the health care professional’s role in caring for the dying. 9

Question Tell whether the following statement is true or false. 12-10 Question Tell whether the following statement is true or false. A patient who has end stage lung cancer would most likely be sent to a facility that provides curative care. True False LO 12.3 Determine the health care professional’s role in caring for the dying. 10

12-11 Answer False A patient who has end stage lung cancer would most likely be sent to a facility that provides hospice care. Hospice care focuses on relieving pain, controlling symptoms, and meeting emotional needs and personal values of the terminally ill, instead of targeting the underlying disease process. LO 12.3 Determine the health care professional’s role in caring for the dying. 11

Right to Die Movement page 365 12-12 Right to Die Movement page 365 First became an issue in Karen Quinlan case (1976) Uniform rights of the Terminally Ill Act A federal statute passed in 1989 to guide state legislatures in constructing laws to address advance directives LO 12.4 Discuss benefits to end-of-life health care derived from the right to die movement. 12

12-13 Euthanasia page 369 LO 12.4 Discuss benefits to end-of-life health care derived from the right to die movement. 13

Physician-Assisted Suicide/Issues page 366,367 12-14 Some believe a person has the right to control his or her own life, including choosing to end it. Others see the question from a quality-of-life perspective. Another group argues that physician-assisted suicide should be permissible only if a person is nearly brain-dead with no chance of recovery. LO 12.4 Discuss benefits to end-of-life health care derived from the right to die movement. 14

Patient Self-Determination Act 1990 pages 369-370 12-15 Patient Self-Determination Act 1990 pages 369-370 Advance directives Living will Durable power of attorney Health care proxy LO 12.4 Discuss benefits to end-of-life health care derived from the right to die movement. 15

Patient Self-Determination Act 1990 page 369 12-16 Health care providers will document in the patient’s medical record whether he or she has executed an advance directive. Providers may not discriminate against an individual based on whether or not he or she has executed an advance directive. LO 12.4 Discuss benefits to end-of-life health care derived from the right to die movement. 16

Patient Self-Determination Act 1990 12-17 Patient Self-Determination Act 1990 Providers must comply with state laws respecting advance directives. Providers must have a policy for educating staff and the community regarding advance directives. LO 12.4 Discuss benefits to end-of-life health care derived from the right to die movement. 17

Question Tell whether the following statement is true or false. 12-18 Question Tell whether the following statement is true or false. A living will directly provides instructions to physicians, hospitals, and other health care providers involved in a patient’s treatment. True False LO 12.4 Discuss benefits to end-of-life health care derived from the right to die movement. 18

12-19 Answer True A living will directly provides instructions to physicians, hospitals, and other health care providers involved in a patient’s treatment. All 50 states accept the validity of living wills, although they also specify various requirements that must be met. LO 12.4 Discuss benefits to end-of-life health care derived from the right to die movement. 19

12-20 Living Will page 370 LO 12.4 Discuss benefits to end-of-life health care derived from the right to die movement. 20

Types of Advance Directives page 369 12-21 Types of Advance Directives page 369 Durable Power of Attorney An advance directive that confers upon a designee the authority to make a variety of legal decisions on behalf of the grantor, usually including health care decisions Health care proxy Durable power of attorney issued for purposes of health care decisions only LO 12.4 Discuss benefits to end-of-life health care derived from the right to die movement. 21

Types of Advance Directives (cont.) page 370 12-22 Do-not-resuscitate order When admitted to a hospital, most patients are allowed by state law to specify that they are not to be revived if their heart stops. LO 12.4 Discuss benefits to end-of-life health care derived from the right to die movement. 22

National Organ Transplant Act page 372 12-23 National Organ Transplant Act page 372 Addresses the severe shortage of organs available for transplantation Provides funds for grants to qualified organ procurement organizations Provides funds for the establishment of an Organ Procurement and Transplantation Network to assist OPOs in the distribution of unused organs outside their geographical area LO 12.5 Identify the major features of organ donation in the United States. 23

12-24 OPTN Goals page 372 Organ Procurement and Transplantation Network Goals Increase the effectiveness and efficiency of organ sharing and equity in the national system of organ allocation Increase the supply of donated organs available for transplantation LO 12.5 Identify the major features of organ donation in the United States. 24

Organ Donor Directives page 373 12-25 Organ Donor Directives page 373 Some states allow licensed drivers to fill out organ donation forms on the back of their licenses. Nondrivers or residents of states where driver’s licenses do not include this information may carry an organ donor card in their wallets, specifying their desire to donate organs. LO 12.5 Identify the major features of organ donation in the United States. 25

Organ Donor Directives 12-26 Organ Donor Directives Organizations such as the National Kidney Foundation, the United Network for Organ Sharing (UNOS), and the Living Bank provide donor registration materials in response to requests. In addition to having an organ donor card, patients should make clear to family members their wishes regarding organ donation in the event of their death. LO 12.5 Identify the major features of organ donation in the United States. 26

Uniform Anatomical Gift Act page 373 12-27 Uniform Anatomical Gift Act page 373 A proposed national statute allowing individuals to donate their bodies or body parts, after death, for use in transplant surgery, tissue banks, or medical research or education. LO 12.5 Identify the major features of organ donation in the United States. 27

Organs/Tissues for Transplantation 12-28 Organs/Tissues for Transplantation Organs Heart, kidney, pancreas, lung, stomach, and small and large intestines Tissues Bone, corneas, skin, heart valves, veins, cartilage, and other connective tissues LO 12.5 Identify the major features of organ donation in the United States. 28

Question Tell whether the following statement is true or false. 12-29 Question Tell whether the following statement is true or false. A person is donating a kidney. It is the responsibility of the person donating an organ to pay the costs of the transplant. True False LO 12.5 Identify the major features of organ donation in the United States. 29

12-30 Answer False A person is donating a kidney. It is the responsibility of the person receiving an organ (or his or her insurance) to pay the costs of the transplant. LO 12.5 Identify the major features of organ donation in the United States. 30

Stage of Grief (Reaction to Loss)p. 377-378 12-31 Stage of Grief (Reaction to Loss)p. 377-378 Stage 1: denial and isolation Stage 2: anger, rage, resentment Stage 3: bargaining and guilt Stage 4: depression or sadness Stage 5: acceptance (Elisabeth Kubler-Ross, MD) LO 12.6. Discuss the various stages of grief. 31

Three Stages of Grief page 377 12-32 Three Stages of Grief page 377 Numbness, characterized by mechanical or rote functioning and social isolation Disorganization, where feelings of loss are so painful and disorienting one can’t make plans or decide what to do next Reorganization, a return to one’s previous, more normal and functional way of life (Roberta Temes, PhD) LO 12.6. Discuss the various stages of grief. Roberta Temes, PhD, also describes her perception of the distinctive behaviors of grief in her book, Solace: Finding Your Way Through Grief and Learning to Live Again (New York: Amacon Books, 2009) 32