Death and the Dying Process

1
Death and the Dying Process

• Types of Death
• Basic Statistics
• Social Aspects of Death
• Do Not Resuscitate
• Euthanasia

2
Types of Death

• Thanatologists People who study death and dying.
• Two types of death
• Functional Death
• Absence of a heart-beat and breathing.
• Brain Death
• Diagnosis of death based on the cessation of all
  signs of brain activity.
• Measured by electrical brain waves.

3
Basic Statistics

• America has a very high infant mortality rate
• Ranks behind 35 other countries
• Why is this?
• Accurate statistics on our part
• More drug use than almost any other country
• In early adulthood the leading cause of death is
  accidents
• This is followed by Suicide, Homicide, AIDS, and
  Cancer

4
Basic Statistics

• 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

5
Basic Statistics

• 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

6
Social Aspects of Death

• 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 childs awareness of separation and loss
• Those in middle and late childhood have more
  realistic perceptions of death that it is a
  finality

7
Social Aspects of Death

• 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
• Ones 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

8
Social Aspects of Death

• Elisabeth Kubler-Ross
• Made many observations and interviews with people
  who were dying and with those who cared for them.
  Based on her observations, she suggested that
  people pass through five basic steps as they move
  toward death.

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Social Aspects of Death

• 1. Denial People resist the idea that they are
  going to die.
• They may argue that their test results have been
  mixed up, that an X-ray has been read
  incorrectly, or that their physician does not
  know what he or she is talking about.
• A patient can flatly reject the diagnosis
• Sometimes memories of weeks in the hospital are
  forgotten.

10
Social Aspects of Death

• 2. Anger A dying person may be angry at everyone
• They may be angry at people who are in good
  health, their spouses and other family, those who
  are caring for them, and their children.
• They can lash out at others and get loud.
• Many become very angry with God.
• Questions Asked Why are the bad people not
  dieing and why am I? This can lead to the next
  stage.

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Social Aspects of Death

• 3. Bargaining Dying people try to negotiate
  their way out of death.
• They may declare that they will dedicate their
  lives to the poor if God saves them.
• Maybe if they can live just long enough to see a
  son married, or a child born, they will willingly
  accept death.
• If you are good, you will be rewarded
• The reward for being good is to live

12
Social Aspects of Death

• 4. Depression Realizing that the issue is set in
  stone and that bargaining will not stop this,
  they become overwhelmed with a huge sense of
  loss.
• Reactive depression Feelings of sadness are
  based on events that have already occurred
• Loss of dignity that may accompany medical
  procedures
• End of a job
• Knowledge that one will never return from the
  hospital.
• Preparatory depression Sadness over future
  losses.
• Death will bring an end to their relationships
  with others and that they will never see future
  generations.

13
Social Aspects of Death

• 5. Acceptance Final stage of dying is
  acceptance.
• Once acceptance has arrived they are fully aware
  that death is impending.
• They will have virtually no feelings, positive or
  negative, about the present or future.
• In essence, they have made peace with themselves
  and may wish to be left alone.

14
Social Aspects of Death

• Denial and isolation It cant be!
• Anger Why me?
• Bargaining Just let me do this first!
• Depression withdrawal, crying, and grieving
• Acceptance a sense of peace comes

15
Social Aspects of Death

• The quality of ones 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 (80),
  and fewer die in nursing homes or a hospice.

16
Social Aspects of Death

• Women feel the loss of a life partner more than
  men because
• They live longer than men
• A widowed man is more likely to remarry
• They usually marry older men
• Cross-culturally, many widows fall into poverty
  after the loss of a life partner
• Impact on ones physical and psychological health
  is linked to how long one grieves and remains
  widowed

17
Do Not Resuscitate

• Written order from a doctor that resuscitation
  should not be attempted if a person suffers
  cardiac or respiratory arrest.
• Sometimes known as a no-code order.
• Such an order may be instituted on the basis of
  an advance directive from a person.
• Or from someone entitled to make decisions on
  their behalf, such as a health care proxy.
• In some jurisdictions, such orders can also be
  instituted on the basis of a physician's own
  initiative, usually when resuscitation would not
  alter the ultimate outcome of a disease.
• DNR is more commonly done when a person who has
  an inevitably fatal illness wishes to have a more
  natural death without painful or invasive medical
  procedures.
• DNR order came into being in the U.S. in the
  1960s when defibrillation allowed the reversal of
  cardiac arrest, but this may prolong the life of
  the patient for only a short time.

18
Euthanasia

• Defined The practice of assisting people who are
  terminally ill to die more quickly.
• There are three types of euthanasia
• 1. Passive Euthanasia
• Withholding common treatments (Antibiotics,
  drugs, or surgery) or giving a medication
  (Morphine) to relieve pain, knowing that it may
  also result in death.
• Passive euthanasia is currently the most accepted
  form as it is currently common practice in most
  hospitals.
• 2. Non-aggressive Euthanasia The practice of
  withdrawing life support
• Quite controversial
• 3. Aggressive Euthanasia Using lethal substances
  or force to kill
• Extremely controversial
• Physician-Assisted Suicide Term for aggressive
  voluntary euthanasia.