Thanatology
The study of death and dying
Clinical Death
Heart and lungs stop functioning; in some cases can be brought back
Brain Death
Irreversible loss of all functions of the brain; no electrical activity (EEG); no blood flow to the brain (Blood Flow Study); total absence of reflexes (Clinical Assessment); cannot come back from
Biological / Cellular Death
Last stage; all organs cease to function
Rigor Mortis
Muscles change and become stiff
Psychological Death
Unresponsiveness to the environment (catatonic state)
Theological Death
Refers to when the soul leaves the body
Persistent Vegetative State
Brain damage that causes people to be unaware of their surroundings or themselves but still demonstrate certain reflexes and are able to breathe and pump blood on their own (cortex no longer functions but brain stem still functions)
Terri Schiavo
In irreversible persistent vegetative state for 15 years (1990-2005)
Elizabeth Kubler-Ross
Wrote book in 1969 called On Death and Dying; introduced the stages of dying
Stages of Dying
Denial, anger, bargaining, depression, and acceptance; some people don't go through all stages; people can move back and forth between stages
Denial
Defense mechanism; necessary in grieving
Anger
Hurts relationships the most by lashing out
Bargaining
Making a deal to live longer; short stage
Depression
Separate themselves; cheering up can lead to guilt and delays acceptance; necessary in order to accept situation
Acceptance
Letting go; receiving "permission" to die from loved ones
Purpose of a Death Certificate
1. Lists cause of death
2. Provides evidence of death for a will or insurance
3. Provides public health data
4. Can be required in some cases for burial/cremation
Who signs a death certificate?
Coroner or physician
Can a person be declared dead without a body?
Yes
Autopsy
Usually performed when someone dies under mysterious circumstances (injury, poisoning, infectious complications, foul play); done by a coroner or a medical examiner
Grief
An intense sorrow caused by the loss of a loved one; the normal process of reacting to a loss
Possible Physical Reactions to Grief
Numbness/tightness in the muscles, pressure/heaviness on chest or back, headaches/stomachaches/digestive problems, trouble sleeping or wanting to sleep all the time, deep tiredness/lack of energy, inability to concentrate, lowered immune response (getting sick), changes in appetite (eating more or less than before)
Stages of Grief
Shock and denial, pain and guilt, anger and bargaining, depression/reflection/loneliness, upward turn, reconstruction and working through, acceptance and hope
Hospice
A program that provides palliative care and attends to the emotional and spiritual needs of terminally ill patients
Palliative Care
Provides comfort rather than a cure
Functions of Hospice
Coordinates with doctors and provides nursing care, medical appliances/supplies, drugs for symptom management and pain relief, homemaker and home health aide, counseling/spiritual care (if wanted), bereavement services (15 months)
Factors that Influence Children's Perception of Death
Developmental stages and personal experiences
Developmental Stages
Pre-school, ages 5-9, ages 9-adolescence
Pre-School Stage
Usually see death as reversible, temporary, and impersonal
Ages 5-9 Stage
Start to see death as final but not personal; tend to personify death (skeletons, ghosts, nightmares)
Ages 9-Adolescence Stage
Death becomes permanent and personal
Needs of a Grieving Child
1. Information that is clear and understandable at his/her development level
2. Be reassured that basic needs will be met
3. Be involved in planning for the funeral and anniversary
4. Express own thoughts and behaviors, especially when different from adults
5. Maintain age appropriate activities and interests
6. Say goodbye to the deceased
7. Memorialize the deceased
Living Will
Document that allows a person to make medical care decisions when he/she is too ill to communicate; also known as advanced directive
Instructions in a Living Will
Designate a health care surrogate, refuse or request life-prolonging treatment, refuse or request artificial feeding or transportation, express wishes regarding organ donation
Common Flaws of Living Will
Cannot cover every scenario (end-of-life decisions not black and white), they don't get used, can be challenged in court
How to Improve on a Living Will
A durable power of attorney for healthcare designating who will make decisions if the person cannot; explore personal feelings about end-of-life care, consider the type of care desired in various situations; person should talk and keep talking about what he/she might want (views may change over time)
Why a Healthcare Provider May Reject a Living Will
When the decision is against the individual health care provider's conscience; when the decision is against the health care institution's policy; if the decision violates accepted health care standards
Will
A declaration of a person's wishes as to the disposition of his/her property after death
Testate
Dying with a will
Intestate
Dying without a will
Things That Should Be in a Will
1. Payment of debts (1st-funeral, 2nd-medical bills)
2. Bequests (general or specific)
3. Care for minor children (guardian and trustee)
4. Name of executor/executrix
Job of the Executor
Prove the will in Probate Court, contact insurance/banks/credit cards, pay bills/distribute assets, final settlement in court
Holographic Will
A will in one's own handwriting
Codicil
A change in a will
Criteria for Challenging a Will
Unfit mental state, fraud, coercion (all difficult because have to be proved in court)
Administrator
Appointed by court to be the executor for a person who dies intestate
Funeral
Comes from the word "funeralis" which is Latin for "torchlight procession"; body is present
Memorial Service
Similar to funeral but body is not present
Purpose of a Funeral
Say goodbye to a loved one, mourn a loss, show respect and support for person and his/her family
Embalming
Became customary during the Civil War to return dead soldiers; replacing blood with a fluid to preserve the body
Types of Caskets
Metal vs. wood; sealer vs. non-sealer
Gauge
Thickness of a metal casket (smaller number=thicker metal)
Vault
Container in which a casket is placed in the ground
Methods of Disposition
1. Underground burial
2. Above-ground burial (Mausoleum)
3. Donation to science
4. Cremation
5. Cryonics (freezing of the remains at the moment of death)
Cremation Process
1. Deceased is placed in a cremation casket/container
2. All items need to be removed that are not to be cremated
3. Container is placed in the cremation chamber (retort)
4. Cremation process begins (1800 F-2000 F) - use natural gas or propane
5. Process lasts 1.5-2 hours (body reduced to just bone fragments)
6. Crematory operator removes all metal debris
7. Bone fragments are pulverized into a fine powder
8. Ashes (cremains) returned to family
thanatology
the study of death and dying
grief
an intense emotional suffering caused by a loss
rigor mortis
stiffening of the body's muscles after death
Elizabeth kubler ross
author of pioneer work on death and dying
batesville
major producer of caskets in the United States
retort
cremation chamber
vault
receptacle placed in a grave to hold a casket or coffin in place
hospice
organization designed to provide care and comfort to terminally ill people
dnr
initials on a hospital chart ordering doctors not to revive a person
embalming
became customary during the civil war as a way to preserve bodies for transporation
torchlight procession
funeralis" is the latin term for this phrase
coffin
outer body container often used in early America; shaped to the contour of the body
sealer
term used for a metal casket that is water tight
codicil
an addition or deletion to a will
executor
person responsible for carrying out the provisions of a will
probate
court that oversees the process od distributing the assets of a deceased person
will
a person's declaration of how he/she wishes to dispose of property after death
holographic
will written in one's own hand
gauge
refers to the thickness of a casket
intestate
status of one who dies without a will
theological death
technically, when the soul leaves the body
clinical death
when the heart and lungs stop functioning
biological death
last stage of dying; all organs cease to function
brain death
no oxygen to the blood; brain cells die
5 stages of dying
denial, anger, bargaining, depression, acceptance
physical signs of grief
body numbing and trouble with eating
things you can do to take care of yourself during grieving
1. keep a normal routine 2. take time to yourself to reflect
why write the manner of death on a death certificate
1. public data information 2. insurance
things that can be done for a grieving child
1. explain clearly and fully what is going on 2. keep them to a normal schedule
things that should be included in a will
1. where personal items go 2. property 3. payments of debt
things that should be in a living will
1. life care 2. food and hydration 3. organ donation 4. name surrogate
services of hospice
1. comfort rather than a cure 2. religious or spiritual guidance 3. medical needs
method of disposition
the way in which your body is layed to rest ex. underground burial, cremation, mausoleum, and cryonics
how children in preschool perceive death
don't comprehend what's happening and don't realize that it is long term
how children age 9 through adolescent perceive death
they begin to understand the death on a higher level and can understand that it is a permanent situation
false
a person can be brought back from a brain death
true
death of a loved one can illicit feelings of anger against the deceased
false
one should feel free to talk opening around a dying patient since hearing is one of the first senses that we lose when death is imminent
false
psychologist developed the science of death and dying over 200 years ago
true
CPR is sometimes used to bring a person back from clinical or cardiac death
true
no matter how well a will is crafted, a family member may contest it in court
false
parents may legally cut their minor children out of their will
true
a mausoleum is an above ground burial area
true
a kentucky living will must have 2 witnesses or be notarized by a notary public
DNR
do not resuscitate
living will
A document that indicates what medical intervention an individual wants if he or she becomes incapable of expressing those wishes.
durable power of attorney
a legal agreement that allows an agent or representative of the patient to act on behalf of the patient
assisted suicide
Providing a seriously ill person with the means to commit suicide
passive euthanasia
A situation in which a seriously ill person is allowed to die naturally, through the cessation of medical intervention.
active euthanasia
death induced deliberately, as by injecting a lethal dose of a drug
bereavement grief
Typically lasts less than 6 months, but can last longer. Characterized by shock, denial, guilt, and somatic symptoms. May experience illusions. Treatment is generally limited to supportive pyschotherapy.