1. Death, Dying, and Grieving
Chapter 20

2. Death, Dying, and Grieving
Defining death has become more complex
Brain death
A neurological definition of death.
A person is brain dead when all electrical activity of the brain has ceased for specified period of time.

3. Death, Dying, and Grieving
Advance Care Planning
The process of patients thinking about and communicating their preferences about end-of-life care
Decreases life-sustaining treatment, increased hospice use, and decreased hospital use
Associated improved quality of care at the end of life
.... Including Less in-hospital death and greater use of hospice care

4. Death, Dying, and Grieving
Living Will
A legal document that reflects the patient's advance care planning
Laws in all 50 states now accept an advance directive, such as a living will

5. Death, Dying, and Grieving
Euthanasia
The act of painlessly ending the lives of persons who are suffering from incurable diseases or severe disabilities
..... sometimes called "mercy killing."

6. Death, Dying, and Grieving
Passive euthanasia
The withholding of available treatments, such as life-sustaining devices, in order to allow a person to die
Active Euthanasia
Death induced deliberately, as by injecting a lethal dose of a drug

7. Death, Dying, and Grieving
In US - there is no official government policy on assisted suicide and leaves the decimation up to each of the states
Currently, three states allow assisted suicide
Oregon, Washington, and Montana
Typically a physician giving the patient an overdose of muscle relaxants or sedatives, which causes a coma and then death

8. Death, Dying, and Grieving
Care of Dying Individuals
Death in America is often lonely, prolonged and painful
Many health care professionals have not been trained to provide adequate end-of-life care or to understand its importance

9. Death, Dying, and Grieving
Good Death for some:
Physical comfort, support from loved ones, acceptance, and appropriate medical care
For others:
Accepting one's impending death and not feeling like a burden to others

10. Death, Dying, and Grieving
Hospice
A program committed to making the end of life as free from pain, anxiety, and depression as possible.
The goals of hospice contrast with those of a hospital....
... Which are to cure disease and prolong life.

11. Death, Dying, and Grieving
Palliative Care
The type of care emphasized in a hospice, which involves reducing pain and suffering and
......helping individuals die with dignity
Hospice goal is to bring pain under control and to help patients face death in a psychologically healthy way
Also makes every effort to include the dying individual's family (assisting with diminishing guilt)

12. Death, Dying, and Grieving
Kubler-Ross Stages of Dying
Elisabeth Kubler-Ross divided the behavior and thinking of dying persons into five stage.
Not all individuals go through the same sequence

13. Death, Dying, and Grieving
Denial and isolation- the dying person denies that she or he is really going to die.
Anger- the dying person's denial gives way to anger, resentment, rage, and envy
Bargaining- the dying person develops the hope that death can somehow be postponed
Depression- the dying person comes to accept the certainty of her or his death. A period of depression or preparatory grief may appear.
Acceptance- The dying person develops a sense of peace, an acceptance of her or his fate, and in many cases, a desire to be left alone

14. Death, Dying, and Grieving
Communicating with a Dying Person
Most psychologists argue that it is best for dying individuals to know that they are dying
... And that significant others know that they are dying so ....
they can interact and communicate with each other on the basis of this mutual knowledge

15. Death, Dying, and Grieving
Advantages:
Dying individuals can close their lives in accord with their own ideas about proper dying
They may be able to complete some plans and projects, can make arrangements for survivors, and can participate in decisions about a funeral and burial
Dying individuals have the opportunity to reminisce and to converse with people who have been important to them
Individuals who know they are dying have more understanding of what is happening within their bodies and what the medical staff is doing for them

16. Death, Dying, and Grieving
Communicating with the dying person
Some experts reason that a conversation should not focus on mental pathology
... Or preparation for death...
But should focus on strengths of the individual and preparation for the remainder of life

17. Death, Dying, and Grieving
Grief
The emotional numbness,
disbelief,
separation anxiety,
despair,
sadness, and
loneliness
that accompany the loss of someone we love

18. Death, Dying, and Grieving
Grief is not a simple emotional state....
But rather a complex, evolving process with multiple dimensions:
Pining for the lost person
Separation anxiety.... Including preoccupation with thoughts of the deceased person
Focuses on places and things associated with the deceased
Crying or sighing
Sense of hopelessness and defeat
Depressive symptoms
Apathy, loss of meaning for activities
Growing desolation

19. Death, Dying, and Grieving
Even six months after:
Some still have difficulty moving on
Feeling numb or detached
Believing their life is empty without the deceased
Feeling that the future has no meaning
Often referred to as Prolonged or complicated grief.

20. Death, Dying, and Grieving
Prolonged grief disorder:
Grief that involves enduring despair and remains unresolved over an extended period of time
Disenfranchised grief
Individual's grief over a deceased person that is a socially ambiguous loss that can't be openly mourned or supported
Loss of an ex-spouse, a hidden loss like an abortion, or a stigmatized death because of AIDS
May intensify an individuals grief because the feelings cannot be publicly acknowledged
May be hidden or repressed for many years, only to be reawakened by later deaths

21. Death, Dying, and Grieving
Losing a Life Partner
Those left behind after the death of an intimate partner often suffer profound grief.
And often endure financial loss,
loneliness,
increased physical illness
and psychological disorders, including depression

22. Death, Dying, and Grieving
Both widow and widowers
Need social support to adjust to the death of a spouse
Support groups often beneficial
organized social activities
Religiosity and coping skills needed

23. Death, Dying, and Grieving
Mourning
In the US 42% of deaths were followed by cremation....
Expected to be 60 percent soon
Trend is away from public funerals and displaying the dead body

24. Death, Dying, and Grieving
Funeral directors
Argue that the funeral provides a form of closure to the relationship, especially when there is an open casket
Others claim that funeral directors are just trying to make money and that embalming is grotesque
One way to avoid being exploited during bereavement is to purchase funeral arrangements in advance
But only 24% of individuals 60 years of age and over had made any funeral arrangements