Death and Dying

Death- is a state of being

- an end or beginning
- a private and personal event
- a part of the larger culture
- something to deny or avoid
- something to welcome

Dying- is a process

Thanatology- the study of death and dying, especially social and emotional aspect.

Religion

Christianity and Orthodox  A priest anoints the sick.

 Other sacraments before death
include reconciliation and Holy
Communion.
Protestant  No last rites (anointing of the sick
is accepted by some groups)
 Prayers are given to offer comfort
and support.
Church of Jesus Christ of Latter-day Saints  May administer a sacrament if the
(Mormons) client requests.
Jehovah Witness  Do not believe in sacraments.
 Will be excommunicated if they
receive a blood transfusion.
Islam  Client may choose to face Mecca
 The head should be elevated above
the body.
 Discussions about death usually are
not welcomed.
 Stopping medical treatment is
against Allah’s will.
 Grief may be expressed through
slapping or hitting the body.
 If possible, only asame sex Muslim
should handle the body after
death; if not possible, non-Muslims
should wear gloves so as not to
touch the body.
Judaism  Prolongation of life is important (a
client on life support must remain
so until death).
 A dying person should not be left
alone.
 Autopsy and cremation are
forbidden.
Hinduism  Rituals include tying a thread
around the neck or wrist of the
dying person, sprinkling the person
with special water, or placing a
leaf of basil on their tongue.

Developmental Concept on Death

Birth to 1 year  Infant has no concept of death

 Infant reacts to the loss of mother
or caregiver.
1 to 2 years  Child may see death as reversible.
 Grief response occurs only to the
 death of the significant person in
the child’s life.
 Child may scream, withdraw, or
become disinterested in
environment.
2 to 5 years  Child may see death as reversible.
 Child has a sense of loss and is
concerned about who will provide
care.
 Regression or aggressive behavior
may occur.
5 to 9 years  Child begins to see death as
permanent.
 Child may feel responsible for the
occurrence.
 Child has difficulty concentrating.
Preadolescent through adolescence  Adolescent sees death as
permanent.
 Adolescent experiences a strong
emotional reaction.
 Adolescent may regress.

Stages of Dying by Kubler Ross

Stage Response Suggestion for Helping the

Person Cope
Denial “No, not me!”  Answer questions
honestly.
 Allow person to talk
to physician.
 Do not argue.
Anger “Why me?”  Listen.
 Do not take the
client’s anger
personally.
 Do not get angry
yourself.
Bargaining “Yes me, but…”  Try to assist client’s
“If I could just live until…” wishes.
 Encourage family
support.
 Offer spiritual
assistance from
clergy or support
groups.
Depression “Yes, me.”  Be there.
 Listen.
 Offer counseling or
social service
assistance.
 Offer
encouragement.
 Allow person to rest
Acceptance “My time is close, and it’s  Provide physical
OK” care.
 Be there.
 Keep room lighted.
 Support family
members.
Legal Issues and Quality of Life

 The Patient Self-Determination Act

o Give person the right to accept or refuse medical treatment. They also have the right to make
advance directives.
o Advance directives- a written document stating a person’s wishes about health care when
that person can no longer make his or her own decisions.

 Living Wills
o A person’s written statement about the use of life-sustaining measures. Examples are tube
feedings, ventilators, and CPR.
o A living will instructs doctors not to start measures that prolong dying and to remove
measures that prolong dying.

 Durable Power of Attorney

The power to make decisions about health care is given to another person. Usually this is a family
member or friend.

 “Do not resuscitate” orders

o This means that no attempts will be made to resuscitate the person. The person is allowed to
die in peace and with dignity.

The Dying Person’s Bill of Rights

 I have the right to be treated as a living human being until I die.

 I have the right to maintain a sense of hopefulness, however, changing its focus may be.
 I have the right to be cared for by those who can maintain a sense of hopefulness, however changing
this might be.
 I have the right to express my feelings and emotions about my approaching death in my own way.
 I have the right to participate in decisions concerning my care.
 I have the right to expect continuing medical and nursing attention even though 'cure' goals must be
changed to ' comfort' goals.
 I have the right not to die alone.
 I have the right to be free from pain.
 I have the right to have my questions answered honestly.
 I have the right not to be deceived.
 I have the right to have help from and for my family in accepting my death.
 I have the right to die in peace and dignity.
 I have the right to retain my individuality and not to be judged for my decisions which may be
contrary' to beliefs of others.
 I have the right to discuss and enlarge my religious and/or spiritual experiences, whatever these
maymean to others.
 I have the right to expect that the sanctity of the human body will be respected after death.
 I have the right to be cared for by caring, sensitive, knowledgeable people who will attempt to
understand my needs and will be able to gain some satisfaction in helping me face my death.

Rigor Mortis:
The stiffening of the body that occurs about2 to 4 hours after death. It results from a lack of adenosine
triphosphatase which causes the muscles to contract and in turn immobilizes the joint.

Algor mortis:

The gradual decrease of the body’s temperature after death. When the blood circulation terminates and the
hypothalamus ceases to function, body temperature falls about 1 C per hour until it reaches room
temperature.
Livor Mortis:
After the blood circulation has ceased, the RBC breakdown, releasing hemoglobin which discolors the
surrounding tissues.