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1) Discuss how attitudes toward death have changed over time.

  • Mourners wearing black.
  • Halting traffic for a funeral procession.
  • Wakes
  • Firing a rifle volley over the deceased.
  • Funeral wreaths

2) Discuss accepted criteria for determining death.

what is the Uniform Determination of Death Act?

  • A federal proposal that defines brain death as a means of determining when death actually occurs:
    • Circulation and respiration have irreversibly ceased.
    • The entire brain, including the brain stem, has irreversibly ceased to function.

What is the difference between a coma and a persistent vegetative state?

  • Coma: A condition of deep stupor from which the patient cannot be roused by external stimuli.
  • Persistent vegetative state (PVS): Severe mental impairment characterized by irreversible cessation of the higher functions of the brain, most often caused by damage to the cerebral cortex.

What tests may be performed to determine if death has occurred?

  • Cannot breathe without assistance.
  • No coughing or gagging reflex.
  • No pupil response to light.
  • No blinking reflex when cornea is touched.
  • No grimace reflex when head is rotated or ears are flushed with ice water.
  • No response to pain.

3) Determine the health care professional's role in caring for the dying.

What is the difference between palliative care and curative care?

  • Palliative care: Treatment of a patient's symptoms to make him or her more comfortable—also called comfort care.
  • Curative care: Treatment directed toward curing a patient's disease.

What is a hospice?

  • A facility or program in which health care practitioners and volunteers provide a continuous environment that focuses on the physical, emotional, and psychological needs of the dying patient.

What is meant by the phrase terminally ill?

  • A patient has six months or less to live.

What is thanatology?

  • The study of death and psychological coping methods.

4) Discuss benefits to end-of-life health care derived from the right to die movement.

What is the Uniform Rights of the Terminally Ill Act?

  • A 1989 federal proposal to guide state legislatures in constructing laws concerned with advance directives.

What is euthanasia?

  • Mercy killing of the hopelessly ill.
    • Active euthanasia: A conscious medical act that results in the death of a dying person.
    • Passive euthanasia: Allowing a dying patient to die without medical interference.
    • Voluntary euthanasia: Requires the patient's consent or the consent of the patient's legal representative to implement.
    • Involuntary euthanasia: The use of medical means to end a dying patient's life without his or her consent.
    • Physician-assisted suicide: Any of the previously listed methods in which a physician takes part in the patient's suicide.

What is the Patient Self-Determination Act?

  • A federal act that requires hospitals and other health care providers to give written information to patients regarding their rights under state law to make medical decisions and to execute advance directives.
    • Living will: An advance directive that specifies a patient's end-of-life wishes.
    • Durable power of attorney: An advance directive that gives a designee authority to make a variety of legal decisions for a patient, including health care decisions.
    • Health care proxy: A durable power of attorney for health care decisions only.
    • Do-not-resuscitate order (DNR): The patient specifies in writing that he or she does not wish to be resuscitated if his or her heart stops.

5) Identify the major features of organ donation in the United States.

What is the National Organ Transplant Act?

  • A 1984 federal law that provides grants to qualified organ procurement organizations and that established an Organ Procurement and Transplantation Network (OPTN).
    • Established the United Network of Organ Sharing (UNOS) to administer the OPTN. The UNOS
      • Increases the effectiveness and efficiency of organ sharing and equity in the national system of organ allocation.
      • Increases the supply of donated organs available for transplant.

What is the Uniform Anatomical Gift Act?

  • A federal proposal that states enact laws allowing anyone 18 or older, of sound mind, to make a gift of his or her body or certain organs for use in medical research, transplantation, or storage in a tissue bank. The act recommends that:
    • Donations made through a legal will are not to be held up by probate.
    • Except in autopsies, the donor's rights override those of others.
    • Survivors may speak for the deceased if no arrangements for donation were made prior to death, provided the deceased did not express an objection to donation before death.
    • Physicians who rely on donation documents for the acceptance of bodies or organs are immune from civil or criminal prosecution.
    • Hospitals, surgeons, physicians, accredited medical or dental schools, colleges and universities, and tissue banks or storage facilities may accept anatomical gifts for research, advancement of medical or dental science, therapy, or transplantation.
    • Time of death of the donor must be established by a physician who is not involved in transplanting the donor's designated organs, and the donor's attending physician cannot be a member of the transplant team.
    • Donors may revoke the gift, and gifts may be rejected.

What is grief?

  • The human reaction to loss.
6) Discuss the various stages of grief.

What are Elizabeth Kübler-Ross's stages of grief?

  • Denial
  • Anger
  • Bargaining
  • Depression
  • Acceptance

What are Roberta Temes's stages of grief?

  • Numbness
  • Disorganization
  • Reorganization

How Attitudes Towards Death Have Changed Over Time

Human beings are the only social animals endowed with the ability to reason. Due to this, they have established certain rules to maintain order and harmonious coexistence. These rules may be written or unwritten. Human beings are known to value human life. Since time immemorial, they have practised mourning for the loss of a life. Death has always been met with great sorrow and sadness. Traditionally, people have associated the black colour with sadness and mourning. For this reason, it was common for people to be in black when mourning or during funerals. In the modern days, this has changed. People wear almost anything when mourning or attending a funeral. Traditionally, drivers would stop if they came across a funeral procession. This was a way of showing respect. In the contemporary society, some may stop, while others may speed on without showing any interest. Traditionally wakes took place in the house of the deceased. In the modern time, wakes are held at funeral homes or some other convenient place. Traditionally firing a rifle volley over the deceased was done in military and police funerals to honour the deceased. This was common in England and later in the United States of America. This is not common in the contemporary society. Traditionally, people would pace flowers over the grave of the deceased. In the modern days, it is mostly synthetic flowers that are used. In a nutshell, there ahs been great changes in attitudes towards death over time.

There is a federal law that guides medical professional on the criteria to follow to determine death. This criterion has two main components. One, is when an individual has sustained an irreversible cessation of the function of either the respiratory of circulatory function. The second is when all the functions of the brain have ceased and the situation cannot be reversed. When these two criteria are met, a medical professional can declare a person to be dead.

The terms coma and vegetative state are often used interchangeably. However, they are different. Coma refers to a state of total unconsciousness (Alliance and World Health Organization, 2014). A person in a comma is totally unresponsive and remains in the state for relatively longer time, say a week or months or years. Vegetative state on the other hand refers to a state of unconscious that is characterized by episodes of being awake (Kelley and Morrison, 2015). In this state, the person is unconscious but they may occasionally open their eyes or show some other function.

Accepted Criteria of Determining Death

There are several tests that can be carried out to determine if a person has died. The diagnostic tests are going to be explained next. One is when a person cannot effectively breathe without being assisted in any way. Secondly, is when a person does not show any gagging or coughing reflex. Thirdly, the pupil of the eye is totally unresponsive to light. Fourth, a person demonstrates no reaction when the cornea of their eye is touched. Fifth, is when the person does not show any grimace reflex when the head is rotated or when the ears are flushed with ice water. Lastly, when a person shown no response to pain.

Palliative care refers to care administered to a terminally ill patient to help improve the quality of life and facilitate a dying process that is not painful. Palliative care not only focuses on the physical wellbeing of the patient but also others aspects such as emotional, mental and spiritual wellbeing. The health care team works together to ensure that the patient receives the highest possible form of care. Curative care refers to the kind of care that health care professional give with the aim of alleviating an illness and achieving cure. This means that curative care could help the patient regain their prior state of health. The main difference between palliative care and curative care is that in the former the patient is not expected to fully recover while in the later one is expected to.

A hospice refers to a place with health care professionals where the terminally ill are taken for end of life care (Pratt and Wood, 2015). a patient is usually transferred to hospice care when the doctor determines that they are not likely to live for more than six months or when the hospital care is no longer helping the patient. In a hospice, the health care professional ensure that the patients are receiving physical, emotional, mental and psychological care. Being terminally ill refers to a state where the patient has six or less months to live (Kelley and Morrison, 2015). Thanatology refers to the field of study that is concerned with death and ways of psychologically coping with the loss of a loved one.

The Uniform Rights of the terminally Ill Act refers to an act that was developed in the United States in 1985 (Corr, and Doka, 2018). The act was later revised in 1989. It contains the rights that a terminally ill patient is entitled to. Most states have adopted the act. Euthanasia refers to assisting a patient to die in a less painful way (Keown, 2018). This procedure is usually carried out to the terminally ill. The aim is to help the patient die and alleviate the pain that they are undergoing. It has become common in the modern days though raising debates and controversies. It is usually done where patient had requested that the same be done. There are several types of euthanasia. Active euthanasia refers to consciously carrying out a medical act that facilitates faster death. Passive euthanasia is where the patient is left to die without any medical interference. Voluntary euthanasia refers to a situation where the patient had requested to be assisted to die through medical intervention. Involuntary euthanasia refers to where a patient is facilitated to die via medical means where they have not given their consent. The term physician assisted dying refers any of the methods listed above. Patient self determination act refers to a law that requires that patients be given a written copy of their health rights to guide them in making decisions concerning their health. This helps the patient make informed decisions.

Organ donation practice in the United States is guided by the National Organ Transplant Act. The Act was established in 1984 and revised in years 1988 and 1990 (Fox, 2017). The act outlawed the sale of human organs. In addition, the act bestowed the responsibility of regulating organ transplants to the US department of Human and Health Services. Another important act in this area is the Uniform Anatomical Gift Act (UAGA). It was developed in the years 1968 and undergone some amendments in q987 and 2006. The act sets a framework for the regulation of organs in the United States. It mainly focuses on donations that are made for purposes of science, education and medicine.

Grief refers to the sorrow that is brought about by the loss of a loved one through death. Human beings are emotional by nature and they undergo great distress when they lose someone close to them through death (Robert and Kelly, 2015). There are various stages of grief. The first is denial. Here the person finds it hard to accept that they will never see the person again (Walter and McCoyd, 2015). The following emotional stages are anger, bargaining, depression and finally acceptance. Roberta Teme’s stages of grief are three. One is numbness where a person is shocked and unwilling to accept the truth. The second is disorganization where numbness slowly goes away usually due to support of friends. The third is reorganization which simply refers to recovery.

References

Alliance, W. P. C., & World Health Organization. (2014). Global atlas of palliative care at the end of life.  Worldwide Palliative Care Alliance.

Corr, C. A., Corr, D. M., & Doka, K. J. (2018). Death & dying, life & living. Cengage learning.

Fox, R. C. (2017). Spare parts: Organ replacement in American society. Routledge.

Kelley, A. S., & Morrison, R. S. (2015). Palliative care for the seriously ill. New England Journal of Medicine.

Keown, J. (2018). Euthanasia, ethics and public policy: an argument against legalisation. Cambridge University Press.

Pratt, M., & Wood, M. (2015). Art therapy in palliative care: The creative response. Routledge.

Robert, T. E., & Kelly, V. A. (2015). Grief and Loss: Critical Incidents in Integrating Spirituality into Counselling, (pp 87-97). Routledge.

Walter, C. A., & McCoyd, J. L. (2015). Grief and loss across the lifespan: A biopsychosocial perspective. Springer publishing company.

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