Our Death-Denying Society (Revisited)
Americans are totally immersed in a death-defying, death-denying culture where the final outcome is often delayed by employing futile treatments and heroic measures. A cultural change needs to take place regarding issues surrounding death and dying because, even in the face of advanced medical technology and skilled interventions, every person in existence will die.Quote from PlatoDeath is not the worst thing that can happen to a man.Quote from National Hospice and Palliative Care OrganizationSeveral high-profile instances of brain death have entered the public's awareness in recent weeks, including the painstakingly tragic demise of 13-year-old student Jahi McMath. Hence, now is the time to provide some basic education on brain death, and at the same time, scrutinize some commonly-held attitudes regarding the issues surrounding death and dying.Funny how you'll plan every aspect of every trip except the most important one you'll ever take.
Simply put, the people of the United States are deeply engrossed in a death-defying, death-denying culture. Characteristics of this culture include an attitude of outright denial, the inability to openly discuss the topic of death, and misguided reliance on futile measures in spite of a terminal prognosis. However, the populace of this country was not always bathed in a collective state of denial.
In past times, death resulted in a sorrowful time for individuals whose loved ones succumbed. Dying was visible, expected, natural, out in the open, and an acceptable outcome. Death was a powerful affair that frequently involved the entire family: a person would die at home in the company of loving relatives who paid their final respects. The surviving family members would even give the post mortem care on the death bed.
In the present day, most deaths now take place in hospitals, nursing homes and other types of healthcare facilities. In the span of a few generations, the business of dying has been extricated from the home and conveniently transferred to institutionalized healthcare settings. American society has been doing a remarkable job of removing death from public view in the 21st century. Many people fear what they have not seen, so the invisibility of death makes it frightening in today's society.
The process of dying is a uniquely personal, unavoidable, intricate journey that every individual in existence will make when end of life approaches.
In a nutshell, brain death is the complete and permanent cessation of all brain function. It is important for the general public to understand that once the brain has died it will never, ever regain any function. Brain death is utterly irreversible; therefore, a patient who has been declared 'brain-dead' will not improve because he is dead. Contrary to misleading notions, brain death is not the same as a persistent vegetative state or a comatose state because the patient who is in a coma or PVS has some brain function, whereas the brain-dead patient has absolutely no brain function whatsoever (and never will).
No one has ever recovered from brain death. Ever. A brain-dead body might appear 'alive,' feel warm and appear to be resting, but these effects are the result of warming blankets, a ventilator, and medications to maintain the blood pressure. There is no medical treatment or intervention in existence that can reverse brain death. There is no miracle in existence that will restore cerebral function once a declaration of brain death is made. A brain-dead person is very much dead.
It is imperative that Americans have a national conversation about issues surrounding death and dying to clear up common misconceptions. However, in these bitterly politicized times, I doubt this conversation will take place anytime soon. Furthermore, a change needs to occur regarding our largely unrealistic views on death. Until Americans grasp that death is a natural and acceptable end to the circle of life, there will always be people who do everything humanly and technologically possible to evade the final outcome that every living individual will face.Last edit by Joe V on Jan 11, '14
TheCommuter is a moderator of allnurses.com and has varied workplace experiences upon which to draw for her articles. She was an LPN/LVN for four years prior to becoming a registered nurse.
TheCommuter has '9' year(s) of experience and specializes in 'acute rehabilitation (CRRN), LTC & psych'. From 'Fort Worth, Texas, USA'; 34 Years Old; Joined Feb '05; Posts: 29,858; Likes: 46,446.
Must Read Topics2Jan 11, '14 by vettechtoRNI am a veterinary technician and this will be the hardest part of my transition into human medicine!! When all has been done medically and my patient is suffering I can humanely end it. So many people are kept alive because we don't want to except death. We are fine with resusitating our 80 year old grandmother and for what so we can have a few more preciouse days with her body? Oh boy do I have a lot to learn!!3Jan 11, '14 by LadyFree28, BSN, RNDying is a natural part of life, we, as "healing managers" can manage this with an important aspect-quality of life and death. In a dying patient, the most important thing is to manage comfort, an important aspect of basic needs per Maslow, as well as providing safe effective care-a important aspect of the care we provide as licensed nurses.
Death can be a healing experience; fortunately this week I've have an excellent experience from families whose members are not getting better and were eligible for hospice. Comfort for their loved ones is their priority; as nurses we are able to provide that.
I've had the fortunate opportunity to be a hospice volunteer before I entered nursing school; I learned about end-of-life care at the age of 18. I am a proponent of palliative care; it behooves any nurse to understand end-of-life and comfort care entails and help their patients when they need it.0Jan 11, '14 by SemolinaI'm not a nurse, so obviously my knowledge is very limited. But the determination to preserve life no matter what is not something I've ever seen or heard about from my friends or family. I'm at the age where parents, aunts and uncles are inevitably dying, and I've had many, many conversations with friends and relatives about end-of-life issues. I've never had the feeling that death should not be acknowledged or openly discussed.
Is it really true that this attitude is in all of society? I assume this article was written in response to a recent, highly-publicized case, and I'm sure that case and others like it are very distressing to health care professionals. I also assume there is a big difference in issues involving younger people -- my experiences as described above involved people in their 70s and 80s.
Again, I have no doubt that there are individual cases where people insist on preserving life inappropriately -- my question is about how widespread this attitude is. I also question whether it's true that most people don't know what "brain dead" means -- when someone I know died recently, everyone I discussed it with knew that "brain dead" meant no hope, and as far as I know the family stopped life support in a timely fashion.6Jan 11, '14 by TheCommuter, BSN, RN Senior ModeratorQuote from SemolinaThis attitude is widespread. Just ask any experienced critical care nurse how many times they've been forced to 'do everything possible' because the family refuses to accept death as a possible outcome.Again, I have no doubt that there are individual cases where people insist on preserving life inappropriately -- my question is about how widespread this attitude is.2Jan 12, '14 by duskyjewelI'm a hospice CNA, and let me tell you that yes, the attitude of refusing to accept death is widespread and entrenched, and not only among the general public, but among medical professionals. I can't tell you how much damage we sometimes have to undo because of doctors who just can't handle having these conversations with their patients, and so do it extremely badly.
We deal with family members who don't want to accept hospice because they see it as "giving up." (Most times the person who is dying is more than ready to give up, because they're just so tired.) Sometimes I think they should be forced to see what happens when frail little 90 year old grandma or grandpa gets coded, because I have, and it's HORRIBLE.
Most people don't believe there is such a thing as a "good death." But I've witnessed many. Death done well can truly be loving, healing, and peace-bringing for all involved.
vettechtoRN - Euthanasia is okay for animals, not for humans. I know it's legal in some places, but legal doesn't equate with right.Last edit by duskyjewel on Jan 12, '143Jan 12, '14 by TheGoochQuote from duskyjewelWhy not? If someone is suffering because of a terminal illness wouldn't it be more kinder for the patient do decide that they would rather die a rather painless and quiet death by euthanasia than a long drawn out death full of pain?
vettechtoRN - Euthanasia is okay for animals, not for humans. I know it's legal in some places, but legal doesn't equate with right.1Jan 12, '14 by duskyjewel"More kinder?" Really.....
Hospice is about controlling pain and providing comfort. While we may not be able to eliminate all pain, we can get it manageable.
Human beings are not animals. Human life has an intrinsic value much higher than that of animals. Not protecting human life at every stage means it's not protected at any stage. And we don't have the right to end human lives, they don't belong to us.
And many times, the ones who want the quick, quiet, convenient, seemingly easy death are not the patients, but the people around the patient who want an end to their own suffering.2Jan 12, '14 by NurseDirtyBirdQuote from TheGoochA prime example of the politicizing of death. This comment could cause a poopie storm, the likes of which you've never seen.Why not? If someone is suffering because of a terminal illness wouldn't it be more kinder for the patient do decide that they would rather die a rather painless and quiet death by euthanasia than a long drawn out death full of pain?
In my own personal (not professional) experience, my own family wouldn't say the words "death," "dead," "dying," etc. It's always been "Passed on/away/over," or "left us," or "gone to a better place." They, and many many others couch death in euphemisms to avoid having to face the reality of it. My sibling and I are the only people on that side of the family who are comfortable talking about death. Nobody who has died in my family has made previous arrangements - inevitably, the officiant presiding over the funeral knows very little about the person they are eulogizing, to the point of mispronouncing their name. When I'm asked about my career and I express interest in providing end of life care, I get asked why in the world would I want to do "that sort of thing." I get the same response as if I would have told them I wanted to snort cocaine for a living. My family is not the only on like this. In my professional experience, I've had families run the gamut between realistic acceptance (and the expected concurrent grief), and complete and utter denial. One family did not want us to feed 98 year old (full code) grandma any food because they were afraid she would choke to death and they didn't want her to die. That was one of the more irrational responses I've seen.