Post on 24-Dec-2015
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• Brain death occurs when all electrical activity in the brain ceases.
• Higher portions of the brain die sooner than the lower portions.
• There is controversy over what medical experts should use as criteria for death.
• When does intelligence and personality end?
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• Termination of medical treatments is controversial:– Dying patients in comas need living wills.
– Physicians have concerns over malpractice suits in the absence of a living will or defining laws.
– Euthanasia is often called mercy killing:
• Passive euthanasia—treatment is withheld.
• Active euthanasia—death deliberately induced.
– Euthanasia evokes a variety of emotions among health-care professionals and family members.
©2008 The McGraw-Hill Companies, Inc. All rights reserved.
• Active euthanasia was made famous by Dr. Jack Kevorkian in the U.S. as “assisted suicide.”
• Active euthanasia is a crime in most countries and in the U.S.
• Oregon has a law allowing doctors to prescribe enough medication for a person to end his/her own life, but the doctor cannot aid in any way, and it must be certified that the patient is terminally ill.
• Most physicians surveyed oppose active euthanasia.
• Better care is needed for dying persons, as death is often lonely, prolonged, and painful.
©2008 The McGraw-Hill Companies, Inc. All rights reserved.
• The hospice movement: – Is a new kind of medical institution.
– Began in London at the end of the 1960s.
– Is dedicated to reducing pain and helping patients die with dignity, known as palliative care.
– Makes every effort to include the dying patient’s family members.
– Includes home-based programs today, supplemented with care for medical needs and staff.
©2008 The McGraw-Hill Companies, Inc. All rights reserved.
• Death has changed historically:– 200 years ago, 1 out of every 2 children died
before age 10, and one parent usually died before a child grew up.
– Today, death occurs mostly among the elderly.
– Life expectancy has increased from 47 years for a person born in 1900 to 77 years for a person born today
– Over 80% of all U.S. deaths occur in hospitals.
©2008 The McGraw-Hill Companies, Inc. All rights reserved.
• Culture affects how death is experienced:– Americans live as if they were immortal.
– India and Africa have many young children and infants dying of malnutrition and disease.
– Most societies throughout history have had religious or philosophical beliefs about death, and rituals surrounding it.
– Some societies welcome death while others fear it.
– In most societies, death is not an end to existence.
©2008 The McGraw-Hill Companies, Inc. All rights reserved.
• Causes of death vary across the life span:– Prenatal death through miscarriage.
– Death during birth or shortly afterwards.
– Accidents or illness cause most childhood deaths.
– Most adolescent deaths result from suicide, homicide, or motor vehicle accident.
– Deaths among young adults are increasing due to AIDS.
– Middle-age and older adult deaths usually
– result from chronic diseases.
©2008 The McGraw-Hill Companies, Inc. All rights reserved.
• Attitudes toward death vary at different points in the life span:– Young children use illogical reasoning
to explain death, believing magic or treatment can return life.
– Others claim separation anxiety is an indicator of a child’s awareness of separation and loss.
– Those in middle and late childhood have more realistic perceptions of death—that it is a finality.
©2008 The McGraw-Hill Companies, Inc. All rights reserved.
• Children and youth can reexperience grief as they age, and it may affect future relationships.
• Many strategies, including honesty, should be adopted when discussing death with children: – Extent of explanations will vary
according to a child’s age.
• Most adolescents: – Avoid the subject of death until a loved
one or close friend dies.
– Describe death in abstract terms and have religious or philosophical views about it.
©2008 The McGraw-Hill Companies, Inc. All rights reserved.
• Concerns about death increase as one ages:– Awareness usually intensifies in middle age.
– Older adults are more often preoccupied by it and want to talk about it more.
– One’s own death usually seems more appropriate in old age, possibly a welcomed event, and there is an increased sense of urgency to attend to unfinished business.
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• Knowledge of death’s approach forces the dying person to change their attitudes and behaviors.
• Kübler-Ross identified 5 stages in dying:– Denial and isolation – “It can’t be!”
– Anger – “Why me?”
– Bargaining – “Just let me do this first!”
– Depression – withdrawal, crying, and grieving.
– Acceptance – a sense of peace comes.
• In facing their own deaths, some people struggle desperately until the end.
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• The quality of one’s life is linked to how death will be approached:– Meaning and purpose bring peaceful acceptance.
– An unfulfilled life brings distress and despair.
• Perceived control and denial may be adaptive strategies for remaining alert and cheerful.
• Denial insulates and allows one to avoid coping with intense feelings of anger and hurt.
• In the U.S., most people die in hospitals, and fewer die in nursing homes or a hospice.
©2008 The McGraw-Hill Companies, Inc. All rights reserved.
• No loss is greater than that of a loved one.• Open communication with a dying
person is very important because it gives them:– A chance to plan activities for the time left.
– An opportunity to reminisce.
– A chance to examine what is happening to them.
• Effective strategies for open communication vary and should be directed toward internal growth.
©2008 The McGraw-Hill Companies, Inc. All rights reserved.
• Grief is not a simple emotional process and may not end anytime soon after the loss.
• A variety of cognitive factors influence the severity of the grief process.
• Good family communications and grief counselors can help grievers cope with feelings of separation and loss.
• Cross-culturally, people in some societies forget the deceased as quickly as possible, while in other societies they try to hold on.
©2008 The McGraw-Hill Companies, Inc. All rights reserved.
• Grieving forces one to try and make sense of the world—reliving one or more events over and over.
• Finding meaning may enhance or ease the ability to cope.
• Researchers have identified 3 types of meaning-making coping:– Personal – cognitive acceptance is sought.
– Family – members search for common factors.
– Community – a broader level of loss.
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• Women feel the loss of a life partner more than men because:– Widows outnumber widowers 5 to 1, because
they live longer than men.
– A widowed man is more likely to remarry.
– Widows usually marry older men.
• Cross-culturally, many widows fall into poverty after the loss of a life partner.
• Impact on one’s physical and psychological health is linked to how long one grieves and remains widowed.
©2008 The McGraw-Hill Companies, Inc. All rights reserved.
• Funerals are an important aspect of mourning and a source of closure in many cultures.
• Forms of mourning include:– Making some type of funeral arrangement.
– Deciding on burial or cremation for the body.
– Holding ceremonies after the funeral—in some cultures.
– Being supported as a family by the community.
– Dividing the mourning into time periods.
– Designating one time frame for mourning.