Despelder8_ppt_ch04

Despelder8_ppt_ch04 - o Chapter FourC Ð Chapter Ð Death...

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Unformatted text preview: o Chapter FourC Ð Chapter Ð Death Systems Mortality and Society Mortality Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Aspects of the Death System s s s s s Defining and determining death Organ transplantation and organ Organ donation donation Death certification The coroner and the medical examiner Autopsies Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Disasters s s s Life-threatening events that affect Life-threatening many people within a relatively brief period of time, bringing sudden and great misfortune great Result from natural phenomena as Result well as from human activities well Minor events can interact to produce Minor major problems major Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Disasters (continued) s s s Adequate preparation and warning can Adequate reduce the impact of disasters reduce In the wake of disaster, meeting the In immediate needs of survivors is essential essential Survivor’s emotional, as well as Survivor’s physical, needs must be addressed physical, Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Disasters (continued) s Caregivers providing support to Caregivers survivors are also “survivors” of trauma (e.g., first responders, hospital personnel) personnel) Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Hurricane Katrina’s Lessons s s s s s s Changes in the natural environment Eroding protective measures Urban and coastal development Investments and/or contingency plans Insufficient resources to respond “Back to business as usual” Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Homicide and Capital Punishment s s Assessing the homicidal act Capital Punishment Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Assessing the Homicidal Act s s Criminal homicide Noncriminal homicide Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Steps in Determining Death s s s Establish a definition of death Decide upon the criteria and Decide procedures used to determine when death has occurred death Apply the criteria and procedures in a Apply particular case particular Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Steps in Determining Death (continued) s s If criteria are met, make If pronouncement of death pronouncement Attest to the person’s death on a Attest death certificate death Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Determination of Clinical Death s s Cessation of heartbeat and breathing Cessation or Criteria for “brain death” Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Criteria for “Brain Death” s s s s Lack of receptivity and response to Lack external stimuli external Absence of spontaneous muscle Absence movement and breathing movement Absence of observable reflexes, Absence including brain and spinal reflexes including Absence of brain activity, signified by Absence flat EEG flat Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Ways of Defining Death s s s s Irreversible loss of flow of vital fluids Irreversible loss of soul from body Irreversible loss of capacity for bodily Irreversible integration integration Irreversible loss of capacity for Irreversible consciousness or social interaction consciousness Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Legislation Defining Death s s s 1968: “Brain death” (Harvard criteria) 1970s: Various statutes proposed and 1970s: adopted with brain-based criteria for defining death defining 1980s: Uniform Determination of 1980s: Death Act (President’s Commission Death for Study of Ethical Problems in Medicine) Medicine) Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Organ Transplantation/Donation: Definition s Transfer of living organs from donor Transfer to recipient with intention of maintaining the functional integrity of transplanted organs. transplanted Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Milestones in Organ Transplants s s s s 1954: First kidney transplant (from 1954: one twin to another) one 1967: First successful adult heart 1967: transplant (by Christiaan Barnard) transplant 1968: Definition and criteria for 1968: determining brain death determining 1976: Discovery of 1976: immunosuppressive drug cyclosporin immunosuppressive Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Organ Transplantation/Donation s s Ideal candidate is patient whose Ideal condition is deteriorating despite best conventional treatment and for whom transplant offers likelihood of recovery recovery Shortage of donated organs to meet Shortage demand demand Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Uniform Anatomical Gift Act s s s s Any person over 18 years old may Any donate organs donate Next of kin can donate after person’s Next death death If same degree of kin disagree, If donation not accepted donation Donation can be amended or revoked Donation anytime before donor’s death anytime Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Uniform Anatomical Gift Act (continued) s s If person made provisions for If donation, it is not revocable by relatives relatives Time of death must be determined by Time physician not involved in any transplantation transplantation Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Uniform Anatomical Gift Act: Donor Authorization s s Donor card or designation on driver’s Donor license license Written or recorded verbal Written communication from a relative communication Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Xenotransplantation s s s Experiments using animals -Experiments including baboons, chimpanzees, and pigs -- as sources of organs for transplant transplant Main difficulty is cross-species Main rejection of donor tissue rejection Genetically engineered “transgenic Genetically animals” may be possible donors animals” Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Japan: Brain Death & Organ Transplantation s s s Mistrust of doctors (“closed door” Mistrust medicine) medicine) Traditional beliefs about keeping body Traditional intact intact Cultural ideas about “center of the Cultural self” or “seat of the soul” self” Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Japan: Brain Death & Organ Transplantation (continued) s s Traditional practices involving Traditional exchange of gifts exchange Maintaining cultural identity Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Functions of Death Certification s s s s Affects disposition of property, life Affects insurance, and other death benefits insurance, Assists in crime detection Aids in tracing genealogy and family Aids histories histories Adds to knowledge about disease and Adds other aspects of health other Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Death Notification s s s s s Ask what is known Give brief description of events Emphasize resuscitative efforts made Describe victim’s response to Describe treatment treatment Make the statement that death has Make occurred with brief explanation of cause cause Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Coroners and Medical Examiners s s Coroners are elected officials; medical Coroners examiners are usually appointed examiners Medical examiners are qualified Medical medical doctors with advanced training in forensic pathology forensic (application of medical knowledge to questions of law) questions Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Coroners and Medical Examiners (continued) s Coroners and medical examiners are Coroners responsible for investigating and determining the cause of death in questionable circumstances. questionable Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Death Investigation s s s When death occurs in suspicious When circumstances (e.g., suicide or homicide) homicide) When death is sudden and there is no When physician to sign the death certificate attesting to the cause of death attesting When death occurs due to an accident Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Death Investigation (continued) s s When death occurs on the job, in jails, When and in other government institutions and When death occurs in hospitals or When other health care facilities and negligence is suspected or the death is unexpected unexpected Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Death Investigation (continued) s When death occurs at home and there When is no attending physician who can attest to the cause of death and thereby sign the death certificate thereby Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Reasons for Autopsies s s To satisfy legal or official To requirements of a coroner’s or medical examiner’s investigation into a questionable death questionable To increase medical knowledge as To part of a hospital’s teaching or research program research Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Reasons for Autopsies (continued) s s s To determine whether a genetic or To infectious condition caused death infectious To help resolve questions about To malpractice malpractice To identify human remains in To situations involving war, human rights violations, or catastrophic accidents violations, Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Impact of Death System s s s Network of people, places, and times, Network as well as objects and symbols as Shapes social order and individual Shapes lives lives Affect our collective and personal Affect relationships to mortality relationships Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright ...
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