End of Life

(Any age)

Death and Dying

• Thanatology - the study of death and dying
• Phases of death:
  • Agonal phase -"struggle" when regular heartbeat is lost
    • Death Rattle- "croak"
  • Clinical death - Brain/heart/breathing stops, but can still be resuscitated
    • Have <20 min, closer to 5-10min
    • low body temperature extends this, some records of 45 min
  • Mortality - Permanent death, person appears shrunken

When is death?

Brain death and vegetative states

Understanding death

Childhood

• Developing 5 ideas:
  • Permanence
  • Inevitability
  • Cessation
  • Applicability
  • Causation

• Understanding death early eases anxiety
• Culture (religion) affects understanding

Understanding Death

Adolescence

• Gap between logic and reality
  • don't take death personally
  • personal fable
  • risk-taking behavior
• Improved by talking about death

Adulthood

• Thought about death increases with age
• death anxiety
  •  

• Eased by well developed personal philosophy on death (esp when acted on)

Kübler-Ross’s Stages of Grief & Dying

Do stages of dying even exist?

• Kübler-Ross’s Stages
  • Denial
  • Anger
  • Bargaining
  • Depression
  • Acceptance
    • Often withdrawn

• Denial likely after learning of condition and Acceptance likely shortly before death
• but NOT a fixed sequence
• Best understood as 5 independant coping strategies

Adaptations to dying

• Acceptance isn't always best, appropriate death  is one that makes sense to an individual, is free of suffering, and is in ine with personal values.
• "Good death" according to most patients:
  • Maintained sense of identity
  • Clarifying meaning of one's life/death
  • Maintain/enhance relationships
  • Control over remaining time
  • Making preparations

Adaptations to dying

• "Good death" affected by
  • Nature of ones disease
  • Personality and coping style
    • Imprisonment or a manate to live more fully?
  • Family and Professionals' behavior
  • Cultural norms
  • Religious practices
• A place to die
  • Home
  • Hospital
  • Nursing home
  • Hospice  - prioritizes comfort over prolonging life

Euthanasia

Bereavement