Behavioural Science

Death and Dying

Heart disease stats:
● Diabetes – 50% more likely
● Shift workers – 23% more likely than those on day shift
● MI risk in winter months > 50% than summer months
● Early mornings/Mondays most common
● **Depression in cardiac pts doubles mortality rate

Death:
● Irreversible loss of function (lack of pulse, respirations, BP, brain activity)
● Determination of death
o Cardiorespiratory death: irreversible cessation of circulation and respiration
o Bain death: irreversible cessation of all functions of entire brain including brain stem
▪ Evidenced by lack of reflexes
▪ Do not need permission to withdraw treatment if patient meets all criteria of brain death

Organ donation:
Attempt to save life -> test for brain death -> alert procurement organization -> obtain authorization (registry/next of kin) ->
matching to recipient -> maintain donor -> recover + transport organs -> organ transplantation -> family aftercare

Approach to death:
Infant and childhood: Young adults: Middle-age: Late-adulthood:
<5 yrs = death as temporary state, guilt Anger towards care More aware, accepting of death; Less anxious about dying; incr
>5 yrs = death as universal and final providers have fear suicide rate; evaluate life

Stages of grief (Kubler-Ross)

Palliative care Hospice

-Symptom mngmnt, relief of -End-of-life care”
suffering, end-of-life issues -Incurable illnesses
-All stages of care -<6 months of life
Ambiguous loss:
● Loss w/out clarification or verification (“lack of
closure”)
● Ex. Alzheimer’s disease, divorce,
infertility/miscarriage, mentalillness

Traumatic loss, stress, physiology:

● Inflammatory state (impact on chronic disease)
● Decreased immune response
 Behavioural Science
● Risk of “broken heart syndrome” (↑risk of sudden death, especially dementia)

Physician-assisted death:
● At the request and w consent of pt, doc provides w knowledge or means for pt to end their own life (ie counselling on lethal
dose of drug VS supply drug)
● Pt send administers VS physician administered (euthanasia)
● Legal in Oregon, Montana, Washington and Vermont
● Req min age of 19 yrs, <6 mo life expectancy, 2 oral (min 15 days apart) and 1 written request to physician