L18: Death & Dying

Question 1

Describe dying well

Answer 1

• Free from avoidable distress and suffering - General accord with wishes of pt and family - Reasonably consistent with clinical, cultural and ethical standards - (time) Dying person ready to go = time(survivors ready to let go)

Question 2

Psychological stages of dying

Answer 2

• Shock and denial - Anger - Bargaining (if, then) - Depression - Acceptance

Question 2

Spiritual needs for dying / Big 3

Answer 2

• Meaning (of life) - Relationship (before I die, I need to say…) - Legacy-leaving

Question 3

Describe dying badly

Answer 3

• Needless suffering / pain (poor symptom management) - Dishonoring pt or family wishes/values - Sense among participants or observers that decency offended

Question 4

Pts autonomy and its implications in care for dying pts.

Answer 4

• Lost in dying process, as pt progresses through illness, more and more is lost - Goal is to help dying maintain a sense of this

Question 5

Role of physicians during EOL care

Answer 5

• Support pt/surrogate in exercising authority over medical decisions - Effect communication - Provide considerate respectful care - Support family - Recognize and respect proportionality (benefits:burdens) - Minimize, reduce, potentially eliminate pain and suffering - Not dishonoring family/pt wishes and values - Anticipate physical changes, provide realistic teaching, assist pt and family with support need in home - Telling someone at earliest occasion that he/she is dying - Tell truth, but don’t bludgeon with truth - Reduce expectations of medicine - Maximize independence/postpone disability - Coping practically with dependence - Attend death bed - Mourn

Question 7

Do psychological stages of dying follow linear pattern? Can more than one stage occur at once? Does everyone experience all stages?

Answer 7

• No linear pattern - May be experiencing more than one at a time - Not everyone experiences all stages

Question 8

Needs of dying

Answer 8

• Treated as living human being - Maintain sense of hopefulness - Cared for by those who maintain sense of hopefulness - Express feelings and emotions - Participate in decisions - Cared for by sensitive, compassionate and knowledgeable people - Continuing medical care - Seek spirituality - Free of physical pain - Express feelings and emotions about pain - Children to participate in death - Understand process of death - Die in peace and dignity - Not to die alone - Know that sanctity of body will be respected