Death and Dying
Definitions
• Terminally ill
• Imminently dying
Objectives
• Describe problems associated with dying in
modern society.
• Discuss the fears of the person who is dying.
• Describe the role that denial, anger, bargaining,
depression and acceptance serve.
• Discuss: information sharing, how much and what
to communicate, treating losses and fears, and
maintaining hope.
• Discuss what you should do when your patient’s
death is imminent.
Objectives (cont’d)
• Discuss what you should do when you don’t know
what to say.
• Discuss responses of the family, including
anticipatory grief and phases of grief.
• Discuss what to say, and what not to say, to a
grieving family.
• Explain the structure and function of Hospice.
• Prepare a living will and a health care surrogate
form.
…in Modern Society
• The Death-Dying Relationship
• Dying: Denial and Beyond Denial
…Fears of the Patient
• Fear of Isolation
• Fear of Pain
• Fear of Dependence
• Fear of Death Itself
– Death and Immortality
– Death as the End
Stages of Dying
• Denial and isolation
• Anger
• Bargaining
• Depression
• Acceptance
Setting Treatment Priorities
• Information sharing
• Responsivity and responsibility
• How much and what kind?
• Treating losses and fears
• Maintaining hope
When Death Is Imminent
• Maximizing comfort
• Saying good-bye
• Accepting rejection
When You Don’t Know What To Say
• Avoid rote responses – each person is
unique.
• Avoid common greetings (e.g. “Hi! How
are you?).
• Be sincere, genuine and honest. Admit you
don’t know what to say.
• Don’t be afraid to discuss death.
When You Don’t Know What To Say
• Don’t lecture or preach.
• Let the person talk.
• Ask what you can do and do it. Keep your
promises.
• Watch your tone of voice. Avoid “cutesy”
baby talk and condescension.
• Don’t abandon the patient.
Responses of the Patient’s Family
• Anticipatory grief
• Phases of grief
– Shock and numbness
– Yearning and searching
– Disorganization and despair
– Reorganization
What to Say to the Family
• I’m sorry • I’m here and I want to
• I’m sad for you listen
• How are you doing with • Please tell me what you
all of this? are feeling
• I don’t know why it • This must be hard for you
happened • What’s the hardest part for
• What can I do for you? you?
• You must really be hurting • I’ll call you tomorrow
• It isn’t fair, is it? • Take all the time you need
• You must really feel angry • Thank you for sharing
your feelings
What NOT to Say
• I understand how you feel • You can have other
• Death was a blessing children
• It was God’s will • You can always remarry
• It all happened for the best • Call me when I can help
• You’re still young • Something good will
come out of this
• Be strong!
• At least you have another
• You have your whole life child
ahead of you
• He/she led a full life
• You’ll feel worse before
you feel better • It’s time to put it behind
you now
Hospice
• Cares for people approaching death
• Respects and values the dignity and worth
of each person
• Philosophy is to cherish and emphasize life
Hospice Services
• Interdisciplinary approach
• Palliative care
• Pain management
• Support for family (respite care)
• Death with dignity
• Grief and bereavement
• Funeral and memorial planning
Hospice Personnel
• Case manager
• Nurses
• Home health aides and homemaker services
• Social workers
• Spiritual counselors
• Volunteers
• Medical director and attending physician
• Dietitians
• PT, OT, ST
Preparing for Death – Advanced
Directives
• Health Care Surrogate
• Living Will
• Legal Proxy
Preparing a Living Will