4 24 2008 1 Defining Death In the past several decades defining death has become more complex 4 24 2008 2 1 Defining Death In the past several decades defining death has become more complex Brain death the neurological definition when all electrical activity of the brain has ceased for a specified period individual whose higher cortical areas have died may continue breathing and have a heartbeat Kendall others 2007 4 24 2008 3 4 24 2008 4 2 4 24 2008 5 4 24 2008 6 3 Advanced Directive Living will document filed while the individual can still think clearly which expresses the person s desires regarding extraordinary medical procedures that may or may not be used to sustain life advance directive All 50 states now accept advance directives as reflecting an individual s wishes 4 24 2008 7 Euthanasia Euthanasia painlessly ending lives of individuals who are suffering from an incurable disease or severe disability mercy killing two types active when death is deliberately induced assisted suicide passive when a person is allowed to die by withholding available treatment 4 24 2008 8 4 Thursday 20 March 2008 French euthanasia seeker Chantal Sebire dies French woman Chantal Sebire who has been recently in the news because of her attempts to get legal permission for doctors to aid her death has died at her home near Dijon aged 52 The cause of Chantal Sebire s death is as yet unknown Former teacher Chantal Sebire had an incurable cancerous growth in the nasal cavity known as an esthesioneuroblastoma and she had failed to get her plea for euthanasia accepted Chantal Sebire had asked a French court to allow doctors to help her die because her tumour had left her blind disfigured and in intense pain however whilst the court agreed that her condition might inspire compassion it ruled that the law did not allow assisted suicide Chantal Sebire had pointed out that she could no longer see properly taste or smell and she described how children ran away from her in the street because of her appearance Only 200 cases of esthesioneuroblastoma have been recorded worldwide in the last 20 years 4 24 2008 9 End of life Care End of life care should include respect for the goals preferences and choices of the patient and his or her family hospice program committed to making the end of life as free from pain anxiety and depression as possible palliative care reducing pain and suffering and helping individuals die with dignity International Work Group on Death Dying and Bereavement others 2006 Rodriquez Rarnato Arnold 2007 4 24 2008 10 5 Circumstances of Death 200 years ago many children and young adults died average life expectancy was 47 years In 1900 most people died at home cared for by family Today death occurs most often among older adults average life expectancy has increased to 78 80 of deaths occur in institutions and hospitals with professional caregivers Lamb 2003 U S Census Bureau 2006 4 24 2008 11 Cultural Variations In most societies death is not viewed as the end of existence the spirit is believed to live on Individuals are more conscious of death in times of war famine and plague Most societies have had philosophical or religious beliefs about death and most have a ritual that deals with death Lobar Youngblut Brooten 2006 Hedayat 2006 4 24 2008 12 6 Kubler Ross Stages of Dying Dr Elisabeth K bler Ross psychiatrist and prolific author of the ground breaking book On Death and Dying coined the now famous 5 Stages of Grief Her work challenged the medical profession to change its view of dying patients This advanced many important concepts such as living wills home health care and helping patients to die with dignity and respect which is now hospice Five stages denial and isolation anger bargaining depression acceptance Kubler Ross 1972 4 24 2008 4 24 2008 13 Denial It can t be happening Anger Why me It s not fair Bargaining Just let me live to see my children graduate Depression I m so sad why bother with anything Acceptance It s going to be OK 14 7 Evaluation of Kubler Ross 5 stage sequence has not been supported by research findings Stages did not account for individual circumstances of patient and support systems However she did much to call attention to the issues of quality of life and coping with dying Kastenbaum 2007 4 24 2008 15 Coping with Death and Loss It is best for dying persons and their family members to know that death is immanent and a reality individuals can close life with their own ideas about proper dying they can complete some projects and plans and can make arrangements for funeral and for survivors can reminisce can experience physical sensations and medical procedures Banja 2005 Kalish 1981 4 24 2008 16 8 Effective Strategies for Communicating with a Dying Person Establish presence at same eye level and don t be afraid to touch the dying person Eliminate distraction including excessive small talk Keep visits short with frail individuals Don t prescribe or deny feelings of acceptance Allow and encourage expressions of feeling 4 24 2008 17 Ask the person what the expected outcome of the illness is discuss alternatives and unfinished business Ask if there is anyone he or she would like to see or have someone contact Encourage reminiscences Talk to the individual when he or she wishes to talk Express your regard for the dying individual don t be afraid to express love 4 24 2008 18 9 Dimensions of Grief Grief emotional numbness disbelief separation anxiety despair sadness and loneliness that accompany the loss of someone we love Many dimensions pining or yearning separation anxiety despair and sadness hopelessness and defeat Maciejewski others 2007 4 24 2008 19 10
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