Death and Dying
Butler County ATC
The student will:
• Explain the stages of death and dying including
the philosophy of hospice care
• Stages of Death and Dying
• Right to Life Issues
• Advance Directives
• Living Will
• Medical Power of Attorney
• Any disease that cannot be cured and will result
• Everyone reacts differently to news of a terminal
• Some react with fear and anxiety.
• Many fear pain, abandonment, loneliness, and
• They may become anxious about their loved
ones, unfinished work, or dreams.
Emotional and Physical Reasons
People May Fear Death.
• Dependence on others
• Physical faculties
• Mutilation by surgery or disease
• Uncontrollable pain
• Being unprepared for death
Social Reasons People May Fear Death
• Fear of separation from family or home
• Fear of leaving behind unfinished tasks or
Dr. Elizabeth Kubler-Russ
• Identified five stages of grieving that dying
patients and their families and friends may
• They may not be in order and may overlap
or repeat a stage at times.
• Others may not experience all stages.
• Stages include denial, anger, bargaining,
depression, and acceptance.
• Usually occurs when the person is first told
of the illness.
• Individual’s may say,
• “The tests are wrong.”
• “This can’t be happening to me.”
• “I don’t believe it.”
• Others don’t talk about it.
• Health care workers should listen without
confirming or denying it.
• This stage occurs when the patient can no
longer deny death.
• The patient may blame themselves, their
loved ones, or health care workers for their
• Health care workers must understand this
is not a personal attack.
• Usually occurs when patient accepts death but
wants more time to live.
• Patients turn to religion and spiritual beliefs
during this period.
• They want to see their child gradate, get
married, or hold a grandchild.
• Making promises to God to try and obtain more
time sometimes occurs.
• This stage occurs when the patient
realizes that death will come soon and
they won’t be with their families any
• They realize that some goals they set will
not be met.
• Health care workers need to let the patient
know that depression is “OK”.
• This is normally the final stage.
• The patient understands that they are
going to die.
• May complete unfinished business and try
to help those around them deal with death.
• Patients will slowly get farther away from
the world and other people.
• They need emotional support during this
Interventions for Health Care
• Talk as needed
• Avoid superficial answers, i.e. “It’s God’s
will.” or “It will be OK.”
• Provide religious support as appropriate
• Stay with the patient as needed
• Work with the family so they might be
strong enough to offer support to the dying
1.Unable to oxygenate the body enough for
adequate gas diffusion
2.Respirations become stridorous or noisy, leading
to “death rattle”
3. Cheyne-Stokes respiration sign of pulmonary
a. Consists of alternate hyperpneic and apneic
• Heart unable to pump strongly enough to keep blood
• Decreased blood causes decreased circulation to the
o Skin becomes cool to the touch, pale
o Person appears cyanotic, possibly mottled
o Failure of peripheral circulation frequently results in a drenching
sweat cooling the body surface.
• Pulse becomes weak and thready, ultimately irregular
o A stronger pulse typically means death is hours away
o A weak, irregular pulse typically means that death is imminent in the
next couple of hours.
o An apical pulse might be required.
• Metabolism rates decrease.
• The person might retain feces or become
• Urinary output decreases.
• Dying person may turn toward light as sight
• Dying person may hear only what is distinctly
• Dying person may remain consciousness or
• Some dying people rally in clarity and
consciousness just prior to their death
• A person’s eyes might be open even if
• Dying people might turn toward or speak to
someone who is not visible to anyone else in room
• Pain might be present
• Pain medication should not be withheld as person
Right to Die
• Most people with terminal illness believe that
someone with a terminal illness should be
allowed to refuse measures that would prolong
• This is the right to die.
• Respirators, pacemakers, and other medical
devices can be withheld and the person can die
• DNR – Do Not Resuscitate Order
• Do Not Resuscitate Order
• This philosophy is to allow the patient to
die with dignity and comfort.
• Pain is controlled so that the patient can
remain active as long as possible.
• Specially trained volunteers are an
important part of many hospice programs.
• A general term that describes two types of
• Living Will
• Healthcare (Medical) Power of Attorney
• Allows a person their wishes about
medical treatments for the end of life in
writing in the event that they cannot
communicate those wishes directly.
• Different states may use different names.
Healthcare Power of Attorney
• Also know as a “healthcare proxy,” “
appointment of a healthcare agent,” or
“durable power of attorney for healthcare.”
• The person you appoint will be authorized
to deal with all medical situations when
you cannot speak for yourself.