Death and Dying

"Death is more universal than life: everyone dies but not everyone lives." - A. Sachs

• The ultimate truth in life is that all of us will die.
• What is your first recollection of death?
• How old were you when you first experienced the death of a friend or family member?
• How was death explained to you as a child?
• How would you explain death to a child?

• Denial
• Patient Behavior -
• In effect, the patient says, "It cannot be true!" Patients often search frantically for a favorable diagnosis.
• Response -
• Understand why the patient is grasping at straws. Patience and willingness to talk are important
• Anger
• Patient Behavior -
• The patient says, "Yes - but why me?" Deep anger follows, and the patient may bitterly envy those who are well and complain incessantly about almost everything
• Response -
• Consider that the patient is angry over the coming loss of everything: family, friends, home, work, play. Treat patients with understanding and respect, not by returning the anger.
• Bargaining
• Patient Behavior -
• The patient says, Maybe I can bargain with God and get a time extension." Promises of good behavior are made in return for time and some freedom from physical pain.
• Response
• If the patient’s bargaining is revealed, it should be listened to, not brushed off. This stage passes in a short time
• Depression
• Patient Behavior -
• The patient grieves and mourns approaching death
• Response
• Attempts to cheer up or reassure the patient mean very little. The patient needs to express
• sorrow fully and without hindrance
• Acceptance
• Patient Behavior -
• The patient is neither angry nor depressed, only quietly expectant
• Response
• News of the outside world means little, and few visitors are required. There will be little talk,
• and it is time merely for the presence of the close family.

• Easy Death
• Active-Positive 
• Passive-Negative 

• We come to understand the meaning of death developmentally.
•   1) Childhood (2-3)
•   2) Childhood (4-8)
•   3) Childhood (9-12)
•   4) Adolescence
•   5) Young Adulthood
•   6) Middle Adulthood
•   7) Older Adulthood

• History -
• Crusades
• Pilgrims
• World War II
• After the War
• The modern Hospice

• 1) Dying is a natural part of living.
• 2) Dying people have all the rights of other living people.
• 3) People have a right to die where and with whom they choose.
• 4) Medical efforts are directed to pain prevention and symptom control.
• 5) The patient and family are the unit of care.
• 6) Hospice care is comprehensive and integrated.
• 7) Bereavement care is an integral part of hospice.
• 8) The backbone of hospice is the volunteer.
• 9) The spirit of hospice is love.