Chapter 21 - Accepting Dying and Death

Principles of Personal Health

I. Dying in Today’s Society

A. Today about 70% of people die in hospitals, nursing homes, and extended care facilities

B. Frequently, frantic efforts are made to keep a person alive

C. Many times, families are forced to deal with death unexpectedly

II. Definitions of Death

A. With technological advances in medicine, some patients who appear dead can be resuscitated

B. Clinical determinants of death measure bodily functions:

1. Lack of heartbeat and breathing

2. Lack of central nervous system function

3. The presence of rigor mortis

C. A person is not legally dead until a physician, coroner, or health department officer has signed a death certificate

III. Euthanasia

A. Direct Euthanasia- The process of inducing death

B. Indirect Euthanasia- Allowing a person to die by disconnecting life support systems

C. Direct euthanasia is illegal for humans in the U.S., Canada, and other developed nations

IV. Advance Medical Directives

A. The living will is a document that confirms a dying person’s desire to be allowed to die peacefully

V. Emotional Stages of Dying

A. People who have a terminal illness progress through self-adjustment:

1. Denial- disbelief

2. Anger- at being "cheated"

3. Bargaining- Often with God or a church leader

4. Depression

5. Acceptance- Patients fully realize that they will die

B. Family members or friends often pass through these stages as they observe loved ones dying

VI. Near Death Experiences

A. In a study of more than 100 people who had near-death experiences, some or all of the following experiences were reported:

1. A sense of well-being and peace

2. An out-of-body experience

3. Movement into extreme blackness or darkness

4. A shaft of light that generally leads upward

5. A decision to enter into the light

B. Near-death experiences are reported by 30 to 40 percent of those who come close to death

VII. Interacting with Dying People

A. This is a reality of living

B. People tend to deny that the people we love is dying with our words and non-verbal behavior

C. This is seldom beneficial or supportive

D. We should be genuine and honest

E. Avoid trying to pull someone out of denial, anger, or depression

VIII. Talking with Children

A. Children are exposed to death at very young ages through the media, adult conversations, and discoveries

B. Psychologists encourage parents to avoid shielding children from or misleading them about the reality of death

C. Children should realize that death is not temporary

D. Adults are usually present when relatives die, but not children

E. A tendency is to tell children that the deceased has gone to sleep-- This can cause the child to fear falling asleep

F. Children should know that the dead person will never return and the body has been buried or burned

G. Children should be given the truth and sympathy

H. Parents should respond with honesty and openness

IX. Death of a Child

A. Miscarriage

1. Researchers believe that about one-third of pregnancies end in miscarriage

2. Many individuals believe that this tragedy will only happen to others

3. The mother may think that the miscarriage happened because of something she die

B. Death During the Birthing Process

1. Parents may know beforehand that the baby has a poor chance of surviving through birth

2. Many parents are being allowed to spend time holding the baby and telling him/her good-bye

C. Losing a Baby After It is Born

1. Support of family and friends is important when trying to recover from the death of a child

2. NOT talking about the baby can cause pain for the parents

3. Remembering the child can give a sense of meaning to the parents

4. Parents may do something constructive to help remember the child and help them get over the death

5. Eventually, the grief should lose its intensity

D. The Grieving Process- Adults who are grieving for dead children should consider the following:

1. Avoid trying to cope by using alcohol or other drugs

2. Do not make important life changes

3. Share feelings with others

4. Avoid trying to erase the death

5. Give time and space to complete the grieving process

6. Don't attempt to replace the child

X. Hospice Care for the Terminally Ill

A. An approach to caring for terminally ill patients that maximizes quality of life and allows the patient to die with dignity

B. The goal of hospice care is to maximize the quality of life for the patient and family

C. Hospice care strategies:

1. Pain control

2. Family involvement

3. Multidisciplinary approach

4. Patient decisions

XI. Grief and the Resolution of Grief

A. Grief- Feelings that people experience after the death of a friend of relative

B. Mourning- Experiencing emotional feelings in a culturally defined manner

C. Most people have some of the following emotions:

1. Physical discomfort

2. Sense of numbness

3. Feelings of detachment from others

4. Preoccupation with the image of the deceased

5. Guilt

6. Hostility

7. Disruption in daily schedule

8. Delayed grief

D. The duration of the grief process varies but usually lasts from a few months to a year

XII. Rituals of Death

A. Rituals give us the chance to formalize our good-byes and receive support

B. Most funeral rituals take place in funeral homes, churches, and cemeteries

C. Full funeral Services- Three significant components:

1. Embalming

a. The process of using formaldehyde to replace blood components

b. Helps preserve the body and give it a natural look

2. Calling Hours

a. An established time when friends and family members can gather

b. The body will usually be in a casket in the same room

3. Funeral Service

a. Most services today take place in a funeral home

b. Some services are held at graveyards

D. Disposition of the Body

1. Ground Burial- The most common method

2. Entombment- Refers to non-ground burial usually in structures called mausoleums

3. Cremation- Both the body and casket are incinerated with the ashes placed in a container called an urn

4. Anatomical Donation- Organs can be donated to a medical school, research facility, or donor network

5. Costs

a. Full funeral services average $2,000 to $2,500

b. Casket prices average between $1,500 and $2,500

c. All expenses for an typical funeral average between $5,000 and $6,500

d. You can save your family a lot of misery by putting your desires in writing before you die

XIII. Personal Preparation for Death

A. The goal of death education is positive: To help us best use and enjoy our lives

B. You can prepare for you own death by Preparing a will, purchasing life insurance, and making funeral prearrangements

C. One should talk with family and friends about his/her own death

D. One suggestion is to prepare an eulogy for yourself

E. Eulogy- A composition or speech that praises someone delivered at a funeral or memorial service

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