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10: Death and Dying

  • Page ID
    10242
  • Learning Objectives: Death and Dying

    • Define death
    • Describe what characterizes physical and social death
    • Compare the leading causes of death in the United States with those of developing countries
    • Explain where people die
    • Describe how attitudes about death and death anxiety change as people age
    • Explain the philosophy and practice of palliative care
    • Describe the roles of hospice and family caregivers
    • Explain the different types of advanced directives
    • Describe cultural differences in end of life decisions
    • Explain the different types of euthanasia and their controversies
    • Describe funeral rituals in different religions
    • Differentiate among grief, bereavement, and mourning
    • List and describe the stages of loss based on Kübler-Ross’s model and describe the criticisms of the model
    • Explain the dual-process model of grief
    • Identify the impact of losing a child and parent
    • Identify the four tasks of mourning
    • Explain the importance of support groups for those in grief

    We have now reached the end of the lifespan. While it is true that death occurs more commonly at the later stages of age, death can occur at any point in the life cycle. Death is a deeply personal experience evoking many different reactions, emotions, and perceptions. Children and young adults in their prime of life may perceive death differently from adults dealing with chronic illness or the increasing frequency of the death of family and friends. If asked, most people envision their death as quick and peaceful. However, except for a handful of illnesses in which death does often quickly follow diagnosis, or in the case of accidents or trauma, most deaths come after a lengthy period of chronic illness or frailty (Institute of Medicine (IOM), 2015). While modern medicine and better living conditions have led to a rise in life expectancy around the world, death will still be the inevitable final chapter of our lives.

    • 10.1: Death and Dying
      According to the Uniform Determination of Death Act (UDDA) (Uniform Law Commissioners, 1980), death is defined clinically as the following: An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead. A determination of death must be made in accordance with accepted medical standards.
    • 10.2: Most Common Causes of Death
      The United States: In 1900, the most common causes of death were infectious diseases, which brought death quickly. Today, the most common causes of death are chronic diseases in which a slow and steady decline in health ultimately results in death. In 2015, heart disease, cancer, and chronic lower respiratory diseases were the leading causes of death (see Figure 10.2, CDC, 2016).
    • 10.3: Where Do People Die?
      Gathering statistics on the location of death is not a simple matter. Those with terminal illnesses may be going through the process of dying at home or in a nursing home, only to be transported to a hospital in the final hours of their life. Thus, it should not be a surprise that in the United States, more Americans die in hospitals than in any other settings. However, as can be seen in figure 10.4, there has been a decline in the number of people dying in hospital in the last decade (Hall, Lev
    • 10.4: Developmental Perceptions of Death and Death Anxiety
      The concept of death changes as we develop from early childhood to late adulthood. Cognitive development, societal beliefs, familial responsibilities, and personal experiences all shape an individual’s view of death.
    • 10.5: Curative, Palliative, and Hospice Care
      Ill individuals need to make choices about the treatment they wish to receive. One’s age, type of illness, and personal beliefs about dying affect the type of treatment chosen: (1) Curative care is designed to overcome and cure disease and illness, (2) Palliative care focuses on providing comfort and relief from physical and emotional pain to patients throughout their illness and (3) Hospice care that involves providing terminally ill patients with medical, psychological, and spiritual support.
    • 10.6: Advanced Directives
      Advance directives include documents that mention a health care agent and living wills. These are initiated by the patient. Living wills are written or video statements that outline the health care initiates the person wishes under certain circumstances. Durable power of attorney for health care names the person who should make health care decisions in the event that the patient is incapacitated. In contrast, medical orders are crafted by a medical professional on behalf of a seriously ill patie
    • 10.7: Cultural Differences in End-of-Life Decisions
      Cultural factors strongly influence how doctors, other health care providers, and family members communicate bad news to patients, the expectations regarding who makes the health care decisions, and attitudes about end-of-life care. In the United States, doctors take the approach that patients should be told the truth about their health. Outside the US and among certain racial & ethnic groups within the United States, doctors and family members may conceal the full nature of a terminal illness.
    • 10.8: Euthanasia
      Euthanasia is defined as intentionally ending one’s life when suffering from a terminal illness or severe disability (Youdin, 2016). Euthanasia is further separated into active euthanasia, which is intentionally causing death, usually through a lethal dose of medication, and passive euthanasia occurs when life-sustaining support is withdrawn. This can occur through the removal of a respirator, feeding tube, or heart-lung machine.
    • 10.9: Religious Practices After Death
      Funeral rites are expressions of loss that reflect personal and cultural beliefs about the meaning of death and the afterlife. Ceremonies provide survivors a sense of closure after a loss. These rites and ceremonies send the message that the death is real and allow friends and loved ones to express their love and duty to those who die.
    • 10.10: Grief, Bereavement, and Mourning
      Grief is the normal process of reacting to a physical loss, such as a death, or a social loss including a relationship or job. Bereavement is the period after a loss during which grief and mourning occurs. The time spent in bereavement for the loss of a loved one depends on the circumstances of the loss and the level of attachment to the person who died. Mourning is the process by which people adapt to a loss. Mourning is greatly influenced by cultural beliefs, practices, and rituals
    • 10.R: Death and Dying (References)