1. Death and Dying

2. Objectives 1. Describe the 5 stages terminally ill people generally pass through. 2. List 3 reasons why many people choose hospice care when they are terminally ill. 3. Describe the functions of a living will. 4. Learn how to be of help to someone who is dying.

3. When does death occur? In the Past In the Past  When the heart and lungs ceased to function In the Present In the Present  CPR  Life-Support Machines

4. Stages in the Acceptance of Death 1. Denial 1. Denial  Initial shock  Allows time to think about situation  Patients should get 2 nd opinion  Just listen to them at this stage

5. Stages in the Acceptance of Death 2. Anger 2. Anger  After they realize they are going to die  Feel as though they’re being treated unfairly  Anger often directed at medical staff and loved ones  Let them know it’s ok to be angry and accept their feelings

6. Stages in the Acceptance of Death 3. Bargaining 3. Bargaining  This is a final attempt to avoid the inevitable  They may pray to God and promise to reform life  Continue to offer emotion support and encourage to get a second opinion if they haven’t already.

7. Stages in the Acceptance of Death 4. Depression 4. Depression  Sad and worried about their affairs  Can feel they are losing everything  Just be with them, often times silently

8. Stages in the Acceptance of Death 5. Acceptance 5. Acceptance  Its hard to imagine, but most people get to this stage  Have taken care of their affairs, final arrangements and said their goodbyes  At this stage, try and help them with any last requests or arrangements that they think they need.

9. Death with Dignity What dying people need What dying people need Hospices Hospices Palliative Care Palliative Care Living Wills Living Wills

10. What Dying People Need Try and allow them to have as much control as possible Try and allow them to have as much control as possible They need to be able to express their feelings They need to be able to express their feelings Should be able to choose their doctor, visitors, funeral arrangements and will Should be able to choose their doctor, visitors, funeral arrangements and will Just listen and be honest to maintain trust Just listen and be honest to maintain trust

11. Hospices Allows you to die at home or in a home-like environment Allows you to die at home or in a home-like environment Provides medical care, but no extensive equipment Provides medical care, but no extensive equipment Provides emotional and legal support for family and patient Provides emotional and legal support for family and patient Has unique features Has unique features In home hospice teaches family patient care In home hospice teaches family patient care

12. Palliative Care Type of care for people who have illnesses that do not go away and often get worse Type of care for people who have illnesses that do not go away and often get worse It focuses on improving quality of life, not jut in ones body, but also in ones mind and spirit It focuses on improving quality of life, not jut in ones body, but also in ones mind and spirit Type of care provided depends on the patients needs and what is important to them Type of care provided depends on the patients needs and what is important to them

13. Palliative Care (continued) It includes setting goals for body, mind and spirit It includes setting goals for body, mind and spirit Often helps patient make future plans around health and medical care Often helps patient make future plans around health and medical care Includes education about understanding ones illness and how it affects not just the patient, but also loved ones Includes education about understanding ones illness and how it affects not just the patient, but also loved ones

14. Living Will Helps with ethical issues, e.g. life-support Helps with ethical issues, e.g. life-support A statement people can sign that instructs their doctors to not use medical equipment just to keep them breathing and their hearts beating A statement people can sign that instructs their doctors to not use medical equipment just to keep them breathing and their hearts beating Takes the burden off the family Takes the burden off the family

15. Medical Power of Attorney Legal document that lets you appoint someone you trust to make decisions about your medical care if you cannot make them yourself Legal document that lets you appoint someone you trust to make decisions about your medical care if you cannot make them yourself Also called a “Healthcare Proxy” or “Durable power of attorney for healthcare” Also called a “Healthcare Proxy” or “Durable power of attorney for healthcare” The person appointed usually is authorized to deal with all medical situations and end-of-life decisions The person appointed usually is authorized to deal with all medical situations and end-of-life decisions

16. Medical Power of Attorney (continued) To help the agent make these decisions, the following should be discussed: To help the agent make these decisions, the following should be discussed:  Values about quality of life that are important  Types of decisions that might have to be made