DEATH AND DYING

Outline for Examination I

INTRODUCTION

I.    Death Education.

       A.  History.

             –     Robert Fulton (1963).

       B.  Why do we need?

             1.    Increasing number of aging persons in society.

                     –     Epidemiological transition.

             2.    Extension of the dying interval.

                     –     Dying trajectories.

             3.    Psychology of entitlement.

             4.    Reaction to dehumanizing technology.

             5.    Need to find meaning in death.

II.   Demographics. 

       A.  Definition.

       B.  Lifespan.

             1.    Record holders.

                     –     Jeanne Louise Calment.

             2.    Prolongevity.

                     –     Compression of morbidity.

       C.  Life expectancy at birth.

       D.  Death (mortality) rates.

             1.    Crude death rate. (CDR).

             2.    Infant mortality rate.

             3.    Maternal mortality rate.

             4.    Future projections.

PERSPECTIVES

I.    Death Systems

       A.  Components.

             1.    People.

             2.    Places.

             3.    Times.

             4.    Objects.

             5.    Symbols.

       B.  Functions.

             1.    Warnings and predictions.

             2.    Prevention.

             3.    Caring for the dying.

             4.    Disposing of the dead.

             5.    Social consolidation after death.

             6.    Making sense of death.

             7.    Killing.

II.   Terror Management Theory

       A.  Theory.

             –     Definition.

             –     Culture.

       B.  Mortality salience hypothesis.

             1.    The hypothesis.

             2.    Studies.

             3.    Terrorism and politics.

III. A History of Death in Western Societies

             –     French historian Philipe Ariès, The Hour of Our Death (1981).

             A.   Model.

                     1.    Cultural defenses.

                     2.    Psychological defenses.

                            –     Defense mechanisms.

       B.  Historical perspectives on death.

             1.    The Tame Death.

                            a.    Religion.

                                    –     Sancti.

                            b.    Community.

             2.    Death of the Self.

                     –     Rise of the individual.

                     –     Homo totus.

                            a.    The soul.

                                    –     The soul remained under the protection of cultural supports.

                                    1'.   Religion.

                                           –     Last Judgement.

                                           –     Liber vitae.

                                           –     Hora mortis.

                                           –     Ars moriendi.

                                    2'.   The law. 

                                           –     The will.

                            b.    The body.

                                    1'.   Denial.

                                    2'.   Reaction formation.

                                           –     Macabre.

                                           –     Transi.

                                           –     Danse macabre.

             3.    Remote and Imminent Death.

                     –     The“Age of Reason.”

                     a.    Intellectualization.

                            –     Remote death.

                     b.    Asceticism.

                            –     Monasticism.

                            –     Memento mori.

                            –     Imminent death.

             4.    Death of the Other.

                     –     The “Age of Romanticism.”

                     –     Nuclear family.

                     –     Death is beautiful

                     –     Reunion.

                     –     Pain of separation.

                     –     Spiritualism.

             5.    The Invisible Death.

                     –     Technology.

                     –     Death is isolated.

                            –     Epidemiological transition.

                            –     Death-free generation.

                     –     Death is sanitized.

                     –     Death is medicalized.

                     –     Death is trivialized.

DYING & DEATH 1: MEDICAL/LEGAL ISSUES

I.     Definitions of dying.

       A.  At birth.

       B.  With age.

       C.  With body failure.

       D.  When the medical facts are recognized.

       E.  When the facts are communicated.

       F.  When the patient accepts the facts.

             –     Middle knowledge.

       –    Alternatively, a set of parameters.

II.   Theoretical definitions of death.

       A.  Biological.

             –     Levels of death:

                     1.    Clinical.

                     2.    Brain.

                            a.    Cortical death.

                            b.    Total brain death.

                     3.    Cellular.

       B.  Loss of Self.

             –     Persistent Vegetative State (PVS).

                     –     Difference between coma and PVS.

             –     Karen Ann Quinlan.

             1.    Life goods.

                     –     Nagel (1979).

             2.    Autobiographical.

                     –     Kleinig (1991).

       C.  The Good Death.

             1.    Dying with dignity.

             2.    Appropriate death.

       D.  Social Death.

III.  Practical definitions of death.

       A.  Legal.

       B.  Medical.

             –     The Harvard Definition.

       C.  Legislative.

             –     the Uniform Determination of Death Act (UDDA).

IV.  Advanced directives.

       –    Nancy Cruzan.

       –     The U.S. Supreme Court decision.

       A.  Living wills.

             –     Luis Kutner.

       B.  Durable power of attorney in health care matters.

             –     (Also called a “health care proxy” or in Florida “Designation of Health Care Surrogate”).

       C.  Do Not Resuscitate Orders.

             –     Orange card.

       D.  Patient’s Self-Determination Act (PSDA).

V.   Euthanasia.

       A.  Definition.

       B.  Types.

             1.    Passive euthanasia.

                     a.    Individually-driven passive euthanasia.

                     b.    Physician-driven passive euthanasia.

                            –     Futile care.

                            1'.   The Hippocratic oath.

                                    –     Non-maleficence.

                            2'.   Ex Ante Pareto.

                     c.    Socially-driven passive euthanasia.

                            –     Prioritizing.

                            –     Years of benefit.

                            –     Efficacy of Treatment (EOT).

             2.    Active euthanasia.

                     a.    The Person decides.

                            1'.   Under what conditions is such a decision be acceptable?

                                    –     End-state condition.

                                    –     

                            2'.   Who should provide the means.

                            3'.   Who should carry out the act?

                                    –     Physician-assisted death.

                                           –     Dr. Jack Kevorkian.

                                                   –     Mercitron.

                                    –      The Oregon Death With Dignity Act.

                     b.    Mercy killing.

       C.  The problem of intent.

             1.    Slippery slope.

             2.    Double effect.