1. Chapter 23
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2. Why Is There Death?
 There is no completely satisfying answer
to the question of why death exists
 Death promotes variety through the
evolution of species
 From the perspective of species survival,
the cycle of life and death makes sense
 Death challenges our emotional and
intellectual security
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3. What is Death?
 Defining death
 Defined as cessation of the flow of vital bodily fluids
○ Cessations of the heart beating and breathing
○ Life-support systems
 Brain death
○ Harvard medical school committee – death involves:
1. Lack of receptivity and response to external stimuli
2. Absence of spontaneous muscular movement and spontaneous
breathing
3. Absence of observable reflexes
4. Absence of brain activity
• Clinical death
• Cellular death
3
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4. Learning About Death
 A child’s understanding of death evolves
greatly from about age 5 to age 9
 Most children cone to understand that death is
final, universal, and inevitable
 Mature understanding of death
 Mark Speece and Sandor Brent’s facts
about death, including four components:
1. Universality
2. Irreversibility
3. Nonfunctionality
4. Causality
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5. Denying Versus Welcoming Death
 Understanding death in a mature
fashion does not imply that we never
experience anxiety about the deaths of
those we love or about the prospect of
our own death
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6. Planning For Death
 Making a will
 A legal instrument expressing a person’s
intentions and wishes for the disposition of
his or her property after death
 Estate
 Testator
 Intestate
 Testamentary letter
○ Document includes information about your
personal affairs (bank statements, credit
cards, documents etc.)
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7. Considering Options for End-of-
Life Care
 Home care
 Hospital-based palliative care
 Focuses on controlling pain and relieving
suffering by caring for the physical,
psychological, spiritual, and existential
needs of the patient
 Hospice programs
 Palliative care
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8. Deciding to Prolong Life or
Hasten Death
 Withholding or withdrawing treatment
 Assisted suicide and active euthanasia
 Physician-assisted suicide (PAS)
○ Physician provides lethal drugs or other
interventions
 Active euthanasia
○ Intentional act of killing someone who would
otherwise suffer from an incurable and painful
disease
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9. Completing an Advance Directive
 Any statement made by a competent
person about choices for medical
treatment should he or she become
unable to make such a decision
 Two forms:
1. Living will
2. Health care proxy
○ Surrogate (the decision maker)
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10. Figure 23.1 Sample living will
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11. Becoming an Organ Donor
 Each day about 77 people receive an
organ transplant while another 19
people on the waiting list die because
not enough organs are available
 98,000 Americans wait for an organ
transplant
 Uniform donor card
11
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12. Figure 23.2 The need for organ donors
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13. Planning a Funeral or Memorial
Service
 Disposition of the body
 Social, cultural, religious, psychological, and
interpersonal considerations
 Burial
 Cremation
 Embalming for a viewing or wake
 Arranging a service
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14. Coping With Dying
 Awareness of dying
 The tasks of coping
 On Death and Dying by Elisabeth Kubler-Ross
○ 5 psychological stages in response to an awareness of imminent
death:
1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance
 Charles Corr’s four primary dimensions in coping with dying:
1. Physical
2. Psychological
3. Social
4. Spiritual
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15. Coping With Dying
 The trajectory of dying
 Useful for understanding patients’
experiences as they near death
 Supporting a dying person
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16. Coping With Loss
 Experiencing grief
 Bereavement
 Mourning
 Tasks of mourning
1. Accepting reality
2. Working through the pain
3. Adjusting to a changed environment
4. Emotionally relocating the deceased and moving
on with life
 The course of grief
 Supporting a grieving person
 Helping children cope with loss
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17. Chapter 23
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