Chapter 21 – Accepting Dying and Death
1. The proportion of Americans who die in health care institutions is about ____ percent.
2. How have advances in medical technology affected our definition of death? They have
A) revealed that there is no such thing as the “moment” of death.
B) made the moment of death harder to define than in years past.
C) shown us that death cannot be identified without sophisticated equipment.
D) enabled us to more precisely mark the moment of death than in years past.
3. Brain death is defined as a(n)
A) electroencephalograph showing brain wave activity.
B) complete lack of central nervous system function.
C) complete lack of heartbeat, breathing, and pain response.
D) complete lack of heartbeat, breathing, and voluntary movement.
4. Cellular death is identified by
A) an electroencephalograph.
B) lack of breathing.
C) loss of heartbeat.
D) the presence of rigor mortis.
5. Thirty-eight-year-old Benito has been told that he has inoperable cancer, and he feels now that
God has cheated him out of a full life. Which of Kübler-Ross’s stages of dying is he
6. The first stage that dying people typically experience is
7. Which of the following BEST illustrates Kübler-Ross’s emotional stage of acceptance by a
terminally ill person? The person
A) becomes withdrawn and moody.
B) refuses to believe that it is happening to him
C) seems to be neither happy nor sad about the situation.
D) freely expresses frustration and disappointment about his situation.
8. Which of the following statements about Kübler-Ross’s emotional stages of dying is MOST
A) The stages are common, but are moved through unpredictably by individuals.
B) Everyone goes through these stages, but not in the same fashion.
C) Everyone goes through these stages, but not always in the same order.
D) The more exceptional a person’s life, the more his or her emotions will vary from
9. Among those people who are closest to a dying person, it has been observed that
A) more than half maintain a powerful denial almost to the end.
B) many go through the same emotional stages as the dying person.
C) their other relationships tend to weaken as they draw near to the dying person.
D) communication with the dying person usually decreases steadily until he or she dies.
10. The main purpose of a living will is to
A) keep control of your own health care as long as possible.
B) improve your care should you suffer a fatal illness.
C) allow a dying person to die peacefully and with dignity.
D) specify who should inherit your estate.
11. The main idea of durable power of attorney for health care is to
A) protect your estate from family members while you are sick.
B) choose a trusted person who can make health care decisions for you.
C) keep control of your health care decisions even when you are incapacitated.
D) declare under what circumstances heroic health care measures should be taken for you.
12. An accident victim has been kept on a respirator, heart beating, in a deep coma. Doctors now say
the victim is brain dead, and the family tells the doctors to remove the respirator. Without
respiration the patient’s heart stops. Is the act of removing the respirator euthanasia and, if so,
what type? It is
A) not euthanasia, because the victim was considered dead.
B) not euthanasia, because the victim’s heart might have continued beating after the
respirator was removed.
C) active euthanasia, because the person was only considered dead when the heart stopped
beating, and this action caused the heart to stop.
D) passive euthanasia, because the person was only considered dead when the heart stopped
beating, but this action was not the real cause of death.
13. Physician-assisted suicide is most similar to which of the following?
B) active euthanasia
C) passive euthanasia
D) comfort measures only
14. A common theme that runs through many different people’s near-death experiences is
A) facing judgment.
B) being lifted up by angels.
C) assuming a different identity.
D) having to decide whether to leave or stay.
15. The scientific explanation for near-death experiences is that they
A) are unexplained and unexplainable with the tools of science.
B) correlate positively with alpha wave activity in deep coma patients.
C) are truly spiritual experiences, because subjects met the clinical definitions of death.
D) are unexplained at present, but will become better understood as brain mapping
16. The best advice for interacting with a dying person is to be
17. Three-year-old Jeffrey’s father has just died. The best way to communicate with Jeffrey is to tell
A) that Daddy died and isn’t coming back.
B) that Daddy went to sleep.
C) that Daddy went away.
18. All of the following are ways to include a child when a loved one has died EXCEPT
A) taking the child to the funeral and helping her understand and accept death.
B) being honest and straightforward with the child
C) using age appropriate language.
D) not crying or showing your feelings in front of the child.
19. The BEST strategy for communicating your concern to a family that has lost a child is to
A) assure them that the death is part of a master plan.
B) come and express your sorrow over their loss.
C) avoid discussing the child.
D) send a card first.
20. Pam was well into her pregnancy when the unborn child suddenly miscarried, and she is grieving.
As her friend, the best thing you can do is
A) avoid mentioning the situation when you are with her.
B) assure her that miscarriages are common.
C) give her some time to be alone.
D) be sympathetic and supportive.
21. Of the following, the BEST advice for coping with the death of one’s child is to
A) give the child’s possessions to other loved ones or a worthwhile charity.
B) try to have another child as soon as possible.
C) avoid major changes in your lives.
D) not dwell on the child’s death.
22. More than other types of loss, the death of a parent often affects one’s
A) psychological stability.
B) sense of security.
C) daily routines.
D) sense of guilt.
23. The main reason why the death of a spouse is usually more severe than other types of loss is
A) has such a heavy financial impact.
B) usually catches people unprepared.
C) causes far more legal complications than other losses.
D) affects so many aspects of the surviving spouse’s life.
24. The main purpose of hospice care is to
A) provide a quasi-hospital setting for terminally ill patients.
B) permit people to die in peace and comfort.
C) keep down hospital costs.
D) control pain.
25. Hospices are unique in their emphasis on
A) acute pain.
B) chronic pain.
C) care given to the survivors.
D) psychosomatic pain.
26. The difference between grief and mourning is that
A) mourning precedes grief.
B) grief is a type of mourning
C) mourning is a process of experiencing grief in a culturally defined manner.
D) grief is an unhealthy reaction, while mourning is a healthy reaction.
27. Which of the following BEST describes an epitaph?
A) a memorial speech delivered at a person’s funeral
B) a brief announcement about a person’s death
C) an inscription that appears on a gravestone
D) a newspaper summary of a person’s life
28. Margaret’s husband died suddenly, and Margaret is torn by guilt over the times that she criticized
or neglected him in the days before his death. Margaret’s daughter wants to know if it is OK for
her to feel this way. What is your BEST reply?
A) Guilt is an abnormal reaction unless the death was sudden, so Margaret is OK.
B) If feelings of guilt persist, suggest Margaret seek counseling to deal with these feelings.
C) Guilt is an unusual reaction, but not an unreasonable one.
D) Guilt is always a normal part of the grieving experience.
29. Margaret’s husband died suddenly, and Margaret often explodes in anger at her children as they
try to help her organize her husband’s records. What should you tell them when they ask your
advice about her behavior?
A) Margaret needs to be removed from the situation for a while.
B) Margaret is expressing a normal response to her situation, and it will pass.
C) Margaret’s response is normal, but she may need counseling if it continues.
D) Margaret’s behavior probably signals that a nervous breakdown is imminent.
30. Which of the following is MOST likely to be a sign that a widow is not handling the grieving
process very well? She
A) has failed to renew contact with her friends eighteen months after her husband’s death.
B) still spends hours looking at photo albums years after her husband’s death.
C) is socially isolated two months after her husband’s death.
D) goes through a period of profound guilt.
31. Which of the following BEST characterizes a funeral?
A) the disposal of a dead body
B) an emotional anesthetic
C) a goodbye ritual
D) a celebration
32. Embalming must be done when
A) the body is to be placed in a tomb.
B) the funeral takes place in a home.
C) burial is to be in a cemetery.
D) the burial is delayed.
33. Ground burials constitute ______ percent of body dispositions in the United States.
34. A mausoleum is a
A) space in a funeral home reserved for the conduction of funerals.
B) structure containing spaces for caskets that are not buried in earth.
C) metal or concrete container that encases a casket for ground burial.
D) church building, typically very old, containing crypts for the burial of church leaders.
35. A memorial speech about a dead person is called a(n)
36. Philip wishes to donate his body to medical science after his death. What is the BEST way to
make sure this happens? He should
A) notify hospital authorities, if he is dying in a hospital.
B) contact his state’s department of health.
C) make his family aware of his wishes.
D) contact suitable medical institutions.
37. Which of the following BEST describes the current state of organ donation in the United States?
A) The need for organ donation is declining due to advances in medical techniques.
B) There is an efficient nationwide network for organ donation.
C) The need for donor organs continues to outpace the supply.
D) Organ donation is losing popularity.
38. In the United States, a typical funeral with all associated expenses will cost from
A) $2,000 to $2,500.
B) $3,500 to $4,500.
C) $5,500 to $7,000.
D) $8,000 to $10,000.
39. Almost half of all dead bodies in the United States are cremated.
40. The organ donation system in the United States has succeeded beyond most people’s
41. Almost three-quarters of Americans die in institutions such as hospitals and nursing homes.
42. One of the clinical criteria for death is lack of central nervous system function.
43. An electroencephalograph is used to measure heart function in a comatose patient.
44. The first emotional stage of dying, according to Kübler-Ross, is bargaining.
45. Although everyone’s experience of death is unique, everyone goes through Kübler-Ross’s five
stages in some fashion.
46. Medical power of attorney for health care gives someone else the power to make life and death
health care decisions for you if you cannot make them for yourself.
47. Few states currently recognize living wills.
48. The unexpected nature of accidental or violent death makes coping more difficult for victims’
49. Both direct and indirect euthanasia are illegal in the United States.
50. Indirect euthanasia occurs when an action makes death inevitable, even though the action itself
does no harm.
51. Near-death experiences commonly feature a sense of peace and well-being.
52. Honesty is the best quality to display to a dying person.
53. It is unusual for women to feel grief after a miscarriage.
54. Miscarriages, abortions, and stillbirths all commonly result in a period of grieving.
55. Parents who have lost a child should avoid major life changes until they have properly grieved.
56. For parents of a child who dies in infancy, it is usually helpful to have another baby as soon as
57. In hospice care, quality of life is more important than treatment of disease.
58. Patients are encouraged to make their own treatment decisions in hospice care.
59. It is not unusual for grief to cause physical discomfort in many people.
60. Delayed grief is a sign that grief is causing a psychological dysfunction.
61. When you are with grieving people, try to help them keep their minds off their grief.
62. In the United States, most full funeral services include embalming and a wake or visitation.
63. List the common criteria for declaration of death.
Answer: Lack of heartbeat and respiration; lack of central nervous system function as
recorded by two flat EEGs twenty-four hours apart; presence of rigor mortis.
64. Give an example of direct (active) euthanasia and an example of indirect (passive) euthanasia.
Direct euthanasia: A patient is dying painfully of cancer with no hope of recovery. To relieve
the patient’s suffering, another person gives the patient a massive overdose of painkillers that
causes the respiratory system to shut down.
Indirect euthanasia: A patient is dying of a brain tumor. She is in a deep coma with no hope of
recovery. Her breathing begins to fail. Doctors could place her on a respirator to keep her
breathing, but choose not to do so.
65. List and briefly describe Kübler-Ross’s five emotional stages of dying.
1) Denial: refusal to acknowledge that this is happening to you.
2) Anger: the feeling that your fate is unfair and that you have been cheated out of life.
3) Bargaining: a feeling of hope that if you can strike a deal with God or someone else in
control that you can escape death for now.
4) Depression: a feeling of hopelessness and grief in the face of inevitable death.
5) Acceptance: being at peace with the realization that you are going to die.
66. In what major ways does hospice care differ from hospital care?
Answer: Hospice care is based on maximizing the patient’s comfort and quality of life,
while the goal of hospital care is to fight the disease. Hospice’s emphasis on spiritual healing
tends not to be a priority of hospital care. Family involvement in the care enhances the hospice
experience, while in a hospital such involvement must be very limited. Another major area of
difference is in the autonomy of the patient; in a hospice the patient is encouraged to make his or
her own decisions, while the hospital patient must rely on a physician’s best judgment.
67. Describe the options commonly available for the disposition of a dead body.
1) Ground burial, the most commonly used option, involves purchasing a cemetery plot, a
casket, and usually a vault. Often the dead body is embalmed and presented at a wake or
visitation prior to burial.
2) Entombment is a similar procedure to ground burial, except that the casket is placed in a
mausoleum or crypt instead of in a buried vault.
3) Cremation involves the destruction of the body by burning. The remaining ashes may be
buried in the conventional manner in a cemetery or scattered.
4) Anatomical donation involves donating the entire body or parts of it. Most commonly,
organs are retrieved as potential donor organs and the rest of the body is returned to the
family, or the entire body is embalmed and given to a medical school for use in
instruction. These bodies are eventually cremated and returned to their families, if