Chapter 11-Death and Dying

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Learning Outcomes Discuss accepted criteria for determining death. Determine the health care professional’s role in caring for

the dying. Explain differences between a living will, a health care

proxy, and durable power of attorney. Discuss the various stages of grief. Begin to form a knowledge base for assisting dying

patients and their family members through the grieving process, as well as forming a personal philosophy concerning death and dying.

Identify the major features of organ donation in the United States.

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Most states follow definitions recommended in a proposed Uniform Determination of Death Act.

Brain death occurs when the following functions irreversibly cease: Circulatory and respiratory functions. Entire brain, including brain stem.

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Coma A person is comatose when they are in a deep stupor

and do not respond to external stimuli.

Persistent Vegetative State (PVS) Irreversible cessation of higher functions of brain, but

involuntary bodily functions present. No reasonable expectation of reversal.

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A postmortem examination to determine cause of death and/or to obtain physiological evidence.

Required when foul play is suspected. Not routinely done in most hospitals; exception

would be teaching hospitals associated with a medical school.

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More end-of-life care is being taught to physician and other health care professionals.

Thanatology is the study of death and psychological methods of coping with death.

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Each state’s laws are different. Proposed Uniform Rights of Terminally Ill Act

provided guidelines for states. Important to have Advanced Directives in place. Only Oregon allows physician assisted death.

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Active euthanasia Conscious act that results in death.

Passive euthanasia Allowing patient to die naturally, without medical

interference.

Voluntary euthanasia Requires patient or agent consent.

Involuntary euthanasia Without patient or agent consent.

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Curative Care Treatments and procedures to help cure the patient’s

disease.

Palliative Care Treatments to help provide comfort and maintain

highest quality of life; often called comfort care.

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Facilities and care for dying patients. Care may be in the patient’s home or a hospice

facility. Care focuses on relieving pain, controlling

symptoms and meeting emotional needs, and personal values of both the patient and the family members.

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Patient Self-Determination Act of 1990 Requires that hospitals and other health care facilities

provide written information to patients about: The right to make medical decisions. The right to executive Advanced Directives.

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Detailed instructions regarding a patient’s wishes for end-of-life treatment.

May include any or all of the following: Circumstances under which treatment should be

discontinued. When heroic measures should or should not be taken. Directions for organ donation, autopsy or alternative

treatment.

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Durable Power of Attorney A document designating individual(s) to act on

another’s behalf in all legal matters. Takes effect when the grantor loses ability to make

decisions (unconsciousness or mental incompetence).

Health Care Proxy Health care power of attorney for end-of-life

situations.

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Do-Not-Resuscitate Order Order issued when a patient specifies that no CPR

should be performed if his/her heart stops beating. Different procedure exists in each state.

Organ Donor Directives Patient specifications regarding organ transplantation.

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Federal Law passed in 1984. Established Organ Procurement Organizations

(OPO’s). Established the Organ Procurement and

Transplantation Network (OPTN). The OPTN and OPO work together to provide

organs throughout the United States. Organ shortages remain critical in the United

States.

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States allow organ donation by law, there is no federal law to provide organ donor directives.

Most states allow prospective donors to indicate on their driver’s license their intent to donate.

There are many myths about organ donation; look for the Frequently Asked Questions in Chapter 11 for information.

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Elizabeth Kubler-Ross defines five stages of grief: Denial and isolation Anger, rage, and resentment Bargaining and guilt Depression or sadness Acceptance

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You are one of three siblings. Your 89-year-old mother, who has been in poor health for years, is diagnosed with an irreversible brain cancer and slips into a PVS. Your two sisters are not in agreement about end-of-life care for your mother. They look to you to resolve the issue. What are you going to do?

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