2. Understanding the Process of Dying: Taking Steps Towa rd Death Choosing the Nature of Death: Is DNR the Way to Go?Caring for the Terminally Ill: The Place of Death

3. Understanding the Process of Dying: Taking Steps Toward Death

4. Are there steps toward death? Kübler-Ross Developed a theory of death and dying Built on extensive interviews with people who were dying Input from those who cared for them

5. Moving Toward the End of Life The steps toward death, according to Ku ̈ bler-Ross (1975). Do you think there are cultural differences in the steps?

6. Evaluating Kübler-Ross’ Theory PROS One of first people to observe systematically how people approach their own deaths Increased public awareness and affected practices and policies related to dying CONS Largely limited to those who are aware that they are dying Less applicable to people who suffer from diseases in which the prognosis is uncertain Stage-like increments questioned Anxiety levels not included

7. Other Theorists Edwin Shneidman “Themes” in people’s reactions to dying that occur—and recur—in any order throughout the dying process Charles Corr People who are dying face a set of psychological tasks

8. Elisabeth Ku ̈ bler-Ross identified five steps toward dying: denial, anger, bargaining, depression, and acceptance. While Ku ̈ bler-Ross has added to our understanding of the process of dying, the steps she identified are not universal. Recently, other theorists have developed alternative ideas.

9. Ku ̈ bler-Ross initially suggested that individuals pass through basic steps or stages as they approach death. The first stage is ______________. a. grief b. acceptance c. anger d. denial

10. What response, if any, should a family member offer to a terminally ill relative in each of the stages that Ku ̈ bler-Ross identified?

11. Choosing the Nature of Death: Is DNR the Way to Go?

12. Should people be free to select the nature of their own death?

13. Choosing the Nature of Death DNR: Issues –Differentiates “extreme” and “extraordinary” measures from those that are simply routine –Determines individual’s current quality of life and whether it will be improved or diminished by a particular medical intervention –Determines decision-maker role

14. Many terminally ill patients choose “DNR,” or “Do Not Resuscitate,” as a way to avoid extraordinary medical interventions.

15. Doctors and Decisions Medical personnel are reluctant to suspend aggressive treatment. Physicians often claim to be unaware of patients’ wishes Physicians and other health care providers may be reluctant to act on DNR requests Trained to save patients Avoid legal liability issues

16. Living Wills Health care proxy Durable power of attorney See figure 10-2 for an example of a living will

17. Euthanasia and Assisted Suicide Euthanasia –Passive –Voluntary active Assisted suicide –Kevorkian

18. What are the arguments? PROSCONS

19. Issues surrounding dying are highly controversial, including the degree of measures that physicians should apply to keep dying patients alive and who should make the decisions about those measures. Assisted suicide and, more generally, euthanasia are highly controversial and are illegal in most of the United States, although many people believe they should be legalized if they are regulated.

20. In the medical community, DNR stands for ______________. a. Do Not Renew b. Daily Notice of Revision c. Do Not Revive d. Do Not Resuscitate

21. Some people designate a specific person, called a ___________ to act as their representative for health care decisions. a. health associate b. health care proxy c. legal aide d. personal care attendant

22. Do you think assisted suicide should be permissible? Other forms of euthanasia? Why or why not?

23. Caring for the Terminally Ill: The Place of Death

24. Caring for the Terminally Ill Place of Death Home careHospice care Hospital care

25. Although most people in the United States die in hospitals, increasing numbers are choosing home care or hospice care for their final days.

26. Some people designate a specific person called a______________ to act as their representative for health care decisions. a. health associate b. health care proxy c. legal aide d. personal care attendant

27. The focus in hospice care is on extending the last stage of life as long as possible. True False

28. Do you think it would be wise to suggest hospice care to a terminally ill family member who is in the bargaining stage of dying? Which of the stages identified by Ku ̈ bler-Ross would be the most appropriate for making such a suggestion?