To die

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Dying is the extinction of the organ functions of a living being , which leads to its death . The beginning of dying cannot be clearly determined. The end of a dying process is limited to the onset of death, although this cannot be assigned a precise point in time due to the lack of a uniform definition.

etymology

Die from Old High German stërban goes back to the West Germanic root * sterb-a- st. The initial meaning is “rigid, rigid, freeze”, as the old Norse stjarfi “ rigid cramp ” shows; Latin for "to be stiff", "to be numb ", after the faded initial s torpére ; Russian sterbnútї “to become hard”, “to freeze”, “to die”. The word subsequently belongs to the large group of words around rigid (Storch, Störr, Sterz, etc.).

Signs of the last stages of life

The dying process of a person takes place at different speeds depending on the cause. The German Medical Association defines the dying as "the sick or injured with irreversible failure of one or more vital functions in which death can be expected in a short time". The most vital functions are those of the cardiovascular system , breathing and the central nervous system . Functional failures in these areas can lead to death without medical intervention. The period of agony can range from seconds to hours. The decisive factor for the duration is whether an acute event or a chronic course leads to the failure of vital organs.

The phases described in the following can be observed primarily in people who do not die immediately from an acute event, but rather over a longer period of time as a result of illness or lasting damage. In medicine, the terms pre-terminal, terminal and final phase are used, although no uniform definitions have been established so far. These phases are not necessarily linear. They are therefore only to be regarded as a rough classification, in particular the time information is subject to considerable fluctuations, which are due to the disease and the individual circumstances. The patient's condition can stabilize in each phase, or the final phase occurs suddenly, for example during remission . In medicine, in addition to this phase classification, the Karnofsky index or ECOG score are used to assess the progression of the disease and to be able to make a prognosis .

Pre-terminal phase

The seriously ill Valentine Godé-Darel, half a year before her death. Painting by Ferdinand Hodler , June 1914

Weeks to months before death, the dying person is in the pre-terminal phase: There are already clear symptoms that limit active life, for example considerable emaciation . The increasing weakness and fatigue is evident, among other things, from the increased need for rest. Everyday activities are more difficult and take longer, and some activities require support. The corresponding ECOG score 2–3 means that any chemotherapies will be terminated in this phase. The focus of medical treatment is placed on the control of possible disease symptoms.

Terminal phase

In the subsequent terminal phase, which can last from a few days to several weeks, the progressive physical decline often leads to restricted mobility and even bedridden . Control over urine and stool excretion is often lost, and in rarer cases urinary retention occurs . The gravely ill is increasingly on support and care instructed by others. During this phase, new symptoms such as anxiety, shortness of breath, nausea and constipation up to coprostasis or miserere , but also diarrhea can occur. The now more and more clearly dying can no longer concentrate well, is hardly interested in their surroundings, eating and drinking become secondary: loss of appetite is considered normal in this phase. Neurological changes can cause restlessness and confusion and be signs of delirium , which can indicate irreversible organ failure and the prevalence of which is up to 88 percent. With Alzheimer's dementia , this phase can take longer.

Final phase and death

Valentine Godé-Darel the day before her death (painting by Ferdinand Hodler, January 1915)

The final phase in the last days or hours before death is characterized by the ultimate failure of individual organs such as the liver, kidneys and lungs or the central nervous system. The slow cessation of organ functions manifests itself in increasing tiredness, indifference, sleepiness, loss of appetite and a lack of hunger. The dying gradually reduce their food intake and often stop it altogether. The feeling of thirst persists longer, but can often be quenched with small amounts of fluids until the desire to drink completely disappears.

The blood flow to the extremities decreases, which can be recognized by discoloration of the underside of the body , marbled legs and cold hands and feet. On the other hand, some dying people are more prone to sweating profusely. The pulse weakens and the blood pressure drops. The urine output decreases as kidney function deteriorates. Since the kidneys and the liver are only inadequately performing their detoxification function, pollutants collect in the blood, which then reach the brain. There these substances lead to disorders of perception and consciousness . The environment is no longer perceived or only to a limited extent. The temporal, spatial and situational orientation can be lost; in addition, acoustic and optical hallucinations or motor restlessness may occur. The increasing clouding of consciousness often leads to a comatose state, especially when the kidneys and liver fail completely.

Often dying people breathe through their mouths. There are frequent changes in breathing: the breathing rate is lower, the breaths appear more difficult because they deepen, then flatten out again and stop at times, as in Cheyne-Stokes breathing . If the breaths are accompanied by unusual noises, it may be rattle breathing . Shortly before the final respiratory arrest, a gasp is often observed.

Pale, waxy skin and the hippocratica facies with a pronounced mouth and nose triangle indicate the approaching death. When the heart finally stands still, the oxygen supply to all organs ceases. After about eight to ten minutes, the brain functions stop and brain death has occurred. After cardiac arrest and brain death, the body begins to decompose . Due to the missing parts of the metabolism , i.e. the lack of transport of oxygen and nutrients, the cells die. Make a start while the brain cells ( neurons ). Ten to twenty minutes after brain death, many cells in the heart tissue die. This is followed by the death of the liver and lung cells. The cells of the kidneys do not stop functioning until one or two hours later. Biologically, death is the loss of more and more organ functions.

Dying as a biological chain reaction

When all life functions of an organism finally come to a standstill, death has occurred. According to medical criteria, this is a process that takes place in several stages: In the phase of the Vita reducta , heart and respiratory activity is still present, while it can no longer be determined in the Vita minima . A person who is in this condition may be resuscitated (reanimated) with chest compressions and ventilation . This means that the Vita minima still belongs to the vital phase. The term clinical death used synonymously and also the term resuscitation appear problematic because death is irreversible by definition.

If resuscitation fails, the brain suffers irreparable damage from the lack of blood flow. Its particularly active metabolism and its low capacity to store energy make this organ very susceptible to any interruption in the supply of oxygen and nutrients. The onset of brain death is now considered the time of death. With it, the electrical activity of the brain also dries up - perception , consciousness and the central nervous control of elementary life functions fall out forever. The brain stem , which consists of the midbrain, the bridge and the elongated medulla, is of particular importance . Even if other areas of the brain have already been destroyed, the centers of the brain stem can keep the patient alive in a vegetative state: he can breathe and swallow or grimace when in pain, but can no longer process his perceptions.

The first death spots appear in the skin about half an hour after the cardiac arrest, as the blood sags into the deeper parts of the corpse and discolors them. The body temperature drops. Rigor mortis, also known as rigor mortis , sets in after about two hours , as proteins that otherwise slide past each other during muscle movement form a rigid network. This effect is strongly influenced by the outside temperature.

For each individual organ there is an individual period of time in which it would be possible to continue to live in the event of declining functionality (see organ donation ) if the supply of nutrients and oxygen were resumed. After this period of time, this is no longer possible and the organ finally dies. The exact determination of the respective expiry of this time may not be possible or costly from the outside.

Mental adjustment processes

At the latest when a person realizes that his life is threatened by a fatal illness, he will deal with it and with its impending end. This conflict was and is described in diaries, autobiographies, medical reports, novels and also in poetry. The “fight” against death has been researched in social science based on empirical data and field studies since the middle of the 20th century . The theories and models developed are primarily intended to serve the helpers who accompany terminally ill people.

In the theories of dying, both psychosocial aspects of dying and models for the process of dying are described. Particularly emphasized psychosocial aspects are: Total Pain (C. Saunders), Acceptance (J. Hinton, E. Kübler-Ross), Awareness / Insecurity (B. Glaser, A. Strauss), Response to Challenges (ES Shneidman), Appropriateness (AD Weisman), autonomy (HC Müller-Busch), fear (R. Kastenbaum, GD Borasio) and ambivalence (E. Engelke).

Phase and stage models

For the course of dying from a psychological and psychosocial point of view, phase and stage models are common. A distinction is made between three and twelve phases that a dying person goes through or has to go through. A more recent phase model, the Illness Constellation Model, was published in 1991 and a further developed version appeared ten years later. Shock, drowsiness and uncertainty about the first symptoms and the diagnosis are assigned to the phases; changing emotions and thoughts, trying to maintain control over one's own life; Withdrawal, grief over lost abilities and suffering from the impending loss of one's own existence; finally psycho-physical decline.

The best known is the phase model by Elisabeth Kübler-Ross , a Swiss-American psychiatrist . In her work, Kübler-Ross summarized various findings from the longstanding research on death that had already been published by John Hinton, Cicely Saunders , Barney G. Glaser and Anselm L. Strauss and others. So she is not the founder of mortality research, but she gave the topic a much greater public attention that has continued to this day than was the case until then. Above all, they dealt with the handling of dying with grief and mourning , as well as studies on the death and near-death experiences . According to Kübler-Ross, there is almost always hope in each of the five phases ("not wanting to admit it and isolation - anger - negotiating - depression - consent") that patients never give up completely. Hope must not be taken from them. The loss of hope is soon followed by death. The fear of dying can only be overcome by starting with themselves and accepting their own death.

Through her work, the psychiatrist gave new impulses for dealing with dying and grieving people. Her core message was that the helpers must first clarify their own fears and life problems ("unfinished business") as much as possible and accept their own death before they can turn to the dying in a helpful way. The five phases of dying extracted by Kübler-Ross from interviews with terminally ill describe psychological adjustment processes in the dying process and are widespread, although Kübler-Ross himself critically questions the validity of her phase model several times: The phases do not run in a fixed order one after the other, but alternate or they repeat themselves; some phases may not be passed through at all, and an ultimate acceptance of one's own death does not always take place. In end-of-life care, there is room for psychological confrontation, but managing the phases themselves can hardly be influenced from outside.

In international mortality research, serious, scientifically founded objections to the phase model and, in general, to models that describe dying with graded behavior are cited. Above all, the naive handling of the phase model is viewed critically. Even in specialist books, hope, a central aspect of the phase model for Kübler-Ross, is not mentioned.

Influencing factors

The scientifically founded criticism of phase models has led to the abandonment of stipulating the course of death in stages and instead working out factors that influence the course of death. On the basis of research results from several sciences, Robert J. Kastenbaum says : “Individuality and universality combine when dying.” Individual and social attitudes influence our dying and how we deal with the knowledge about dying and death. Influencing factors are age, gender, interpersonal relationships, the type of illness, the environment in which the treatment takes place, as well as religion and culture. The model is the personal reality of the dying person. Fear, refusal and acceptance form the core of the dying confrontation with death.

Ernst Engelke took up Kastenbaum's approach and continued with the thesis: “Just as every person's life is unique, so too is his death. Yet there are similarities in the dying of all people. According to this, what all terminally ill people have in common is that they are confronted with knowledge, tasks and restrictions that are typical for dying. ”Typical, for example, is the realization that life is threatened by the disease. Typical tasks result from the typical findings, also from the course of the disease, the therapies and their side effects. Typical restrictions result from the disease, the therapies and the side effects. The personal and unique is created by the interplay of many factors when coping with the knowledge, tasks and restrictions. Important factors are genetic makeup, personality, life history, physical, psychological, social, financial, religious and spiritual resources, the type, degree and duration of the illness, as well as the consequences and side effects of the treatment, and the quality of medical treatment and care, the material framework (equipment of the apartment, the clinic, the home) as well as the expectations, norms and behavior of relatives, carers, doctors and the public. According to Engelke, the rules for communication with the dying can also be derived from the complexity of dying and the uniqueness of each dying person.

Awareness

The question of whether it is ethically justifiable to inform terminally ill patients of the infamous diagnosis is not just a question of doctors and relatives. The sociologists Barney G. Glaser and Anselm Strauss published the results of empirical studies in 1965, from which they derived four different types of awareness of dying patients: With closed awareness , only relatives, caregivers and medical professionals recognize the patient's condition, he himself does not recognize his death. If the patient suspects what his environment knows, but is not informed, it is suspicious awareness . In the case of mutual deception , everyone involved knows about dying, but behaves as if they did not know. If all participants behave according to their knowledge, it is open awareness .

The hospice movement in particular has since advocated open, truthful interaction. The situation does not become any easier for everyone involved if difficult conversations are avoided; rather, it exacerbates and possibly leads to a disturbed relationship of trust, which makes further treatment difficult or impossible.

Life balance

The dying look back on their lives. The imminent death can induce to give an account of their life and to critically compare one's own life plan with the lived and unlived life, what achieved and what failed, what succeeded or what should have been done differently. Debit and credit, negatives and positives are often added up and compared.

A distinction is made between the life balance experienced and the life story told. The verbalized life balance can be glossed over, but not experienced. Some terminally ill people willingly and extensively talk about their lives. Others sum up their life in one sentence. People like to think of “beautiful things”. "Missed" is regretted.

The Australian dying companion Bronnie Ware published a report in 2011 on what people regret most in the face of death. First and foremost is the desire to “have had the courage to live my own life.” Many complained that they too often met the expectations of others instead of following their own wishes: “Why didn't I do what I did Wanted? ”In their last days and hours, men in particular regretted having spent too much of their life on the“ treadmill of working life ”and not caring enough about children, partners and friends. The third repentance motive: “I wish I had the courage to show my feelings.” The fourth regret: “I wish I had stayed in touch with my friends.” And the fifth motif: “I wish I had mine allows me to have more joy and to be happier. "

According to Ware, many people only notice at the end of their life that one can consciously choose happiness and joy. But many were stuck in firmly established behavior and would have forgotten or forgotten things like laughing or being silly. The majority of people are stuck in everyday life, family responsibilities, making money and other external circumstances.

The life review therapy is a short-term psychotherapy , are instructed in the patient to remember significant positive and negative events their lives and relive them. The goals are to balance, integrate and find meaning in the life that has been lived and, if necessary, to reassess individual events. The patient should be able to accept his biography ( Andreas Maercker 2013).

The dignity therapy is a psychotherapeutic brief intervention for patients in the terminal stage with the aim of spiritual to reduce existential or psychosocial stress and dignity to strengthen their sense (Harvey M. Chochinov u. A. 2005).

Life confession is one of the Christian end-of-life rituals. The dying person looks back on his life with a pastor. Stressful experiences are discussed and ways of reconciliation with oneself, with others and, in the end, with God are sought.

Places of death

It is repeatedly claimed that "in the past, most people died at home". It does not define which period is meant by “earlier” and which place is meant by “at home”; for this reason too, there is insufficient evidence to support this general statement. According to historical analyzes, dying in Central Europe has developed from a domestic to an institutionalized event that largely takes place outside of the social environment since the late Middle Ages.

Since the collection of such data has not yet been regulated or standardized in most countries, no specific figures can be used to determine the place of death. In Germany, the data situation is very precise with regard to age, gender and cause of death, among other things, but the place of death is only partially recorded statistically. In 2015, 925,200 people died in Germany. The Federal Statistical Office only records deaths in hospitals ; that was 428,152 deaths in 2015, which corresponds to 46.2%. Between 5 and 8% of them (estimated) died in a palliative care unit , a special department for the terminally seriously ill. All other information on places of death are estimates, because in Germany the place of death is not entered on the death certificate . The details vary. 384,565 patients have been transferred from a hospital to a nursing home. In home facilities such as assisted living , old people's and nursing homes , it is about a form of living at the end of life while maintaining the previous lifestyle as far as possible with the usual activities of daily life , which, however, can be characterized by the varying degrees of loss of skills in these areas. Around 25 to 30 percent of all deaths occur in these institutions, which some of their residents consider to be their home.
Inpatient hospices are special facilities for people who suffer from a terminal illness and whose medical care and care in the home environment or in the nursing home is not adequately guaranteed due to serious concomitant symptoms , but hospital treatment is no longer necessary. About 1 to 2 percent of total deaths take place here.
Between 10 and 20 percent of all deaths in a year have died in their own homes or those of caring relatives, and between 3 and 7 percent in other places.

A European comparison of the places of death shows that in Denmark, England, Wales, France, the Netherlands, Norway, Austria and Switzerland, too, most people (70 to 80%) die in institutions. Unmarried, chronically ill, and cancer patients are more likely to die in an institution than married or rural residents.

The representative population survey “Dying in Germany - Knowledge and Attitudes to Dying” by the German Hospice and Palliative Association from 2012 showed that 66 percent of those questioned would like to die at home. Eighteen percent of the participants say that they want to die in a facility that cares for the seriously ill and dying. 90% of those questioned and 76% of people living alone answered that someone from their family, friends or the neighborhood takes care of them when they are sick. 72% of all respondents and 66% of those aged 60 and over assume that someone from family, friends or the neighborhood will look after them when they are in need of care.

As a result of social changes and the progress of rescue services, dying in the familiar home environment has become less common since the 1950s. Dying is often shifted to the acute departments of hospitals due to strange ideas about the medical possibilities. Although the dying and their relatives in the hospital particularly hope for medical assistance in this situation, they are mostly accompanied by nurses, while doctors tend to withdraw.

At home, medical, nursing and psychosocial care can now be provided by relatives, general practitioners , outpatient nursing services and - if indicated - by specialized outpatient palliative care (SAPV), supplemented by the offer of voluntary terminal care by hospice services or associations that exist in many places .

Critical view of dealing with dying

ARD justified its theme week “Living with Death” in autumn 2012 by stating that death as the greatest threat to life was taboo and thus banned from social and public life. Almost all publications dealing with dying and death begin with these or similar claims. Death researchers have a different view: “Everyone is talking about dying. There can be no more talk of a taboo ”, which they explain in detail. There is an abundance of novels, non-fiction and specialist books, advice books and other media that illuminate dying and death from different perspectives and with different focuses.

Since time immemorial people have had an ambivalent relationship to dying and death: They fear dying and death and at the same time they are attracted to it. They avoid personal contact with dying and death, at the same time they cannot hear enough of it, but only from a safe distance. This way of dealing with dying and death has led to the "loneliness of the dying in our day". On the one hand, the fear of dying ensures growth in the healthcare industry, but on the other hand, it is also the reason for criticism of the actors and institutions involved. The health industry offers health services but cannot prevent death. Most of the criticism relates to the conditions under which people (have to) die today. It is lamented that more and more people are being deported to hospitals and old people's homes and have to die there inhumanely. Medical oversupply, high-performance medicine, medicalization and the prolongation of the dying process against the will of the dying person as well as the nursing, psychological and social undersupply of the dying, especially in nursing homes, are the main points of criticism. In recent years, for example, life-prolonging measures for terminally ill patients, such as the administration of artificial nutrition using a PEG tube, have been discussed as ethically problematic .

A hotly and controversially discussed topic is the answer to the question: "May the mature person who takes his life into his own hands, not also take his dying into his own hands when life has become unbearable?" When the first associations for assisted suicide were founded in Switzerland, the hospice movement , which was already established in England, began to develop into a countercurrent with the concept of palliative care . One goal of the modern hospice and palliative movement is to make society aware of dying and death as part of life.

To this end, leading organizations (the German Hospice and Palliative Association e.V. (DHPV), the German Society for Palliative Medicine e.V. (DGP) and the German Medical Association) developed the charter for the care of critically ill and dying people in Germany . It contains the key messages of the hospice and palliative movement in Germany: The dying should be accompanied appropriately and, if possible, also die where they lived - at home. That is why the nationwide expansion and further development of palliative and hospice care is required, the creation of legal framework conditions for better palliative and hospice care, the networking of the numerous outpatient and inpatient facilities and the promotion of research in palliative medicine and terminal care. More than 10,000 individuals and nearly 900 institutions have signed the Charter since its publication in September 2010. This response shows the importance and influence of the hospice and palliative movement. But the great success leads to an institutionalization process that shows "tendencies towards standardized care for the death", which in turn are being critically observed, especially by the pioneers of the hospice initiatives.

Trivia

On the Greek island of Delos (Cyclades) in antiquity, for religious reasons, nobody was allowed to be born, nobody to die and nobody to be buried; this was also prohibited by law.

In the recent past, mayors of various places ordered that no one in their community should die anymore because the local cemeteries were overcrowded:

Phrases and quotes to die for

  • " Mors certa, hora incerta " (death is certain, its hour uncertain)
  • Pray for a good hour of death
  • “... Now and in the hour of my death. Amen. "(Earlier version of the Ave Maria )
  • Those who die sooner are dead longer
  • "To live means to die."
  • Teach us to remember that we must die in order that we may become wise. Psalm 90.12  LUT
  • Often I think of death, the bitter, / And how do I manage it in the end ?! / I want to die very gently in my sleep / And be dead when I wake up! - Carl Spitzweg
  • Happy for whom, however close they may be, the hour of truth strikes before death. - Marcel Proust
  • When dying, the extent to which and how intensively one has explored and exhausted the possibilities of life in its ups and downs certainly plays a major role. - Hans-Peter Dürr in "We experience more than we understand."

See also

literature

Web links

Wiktionary: die  - explanations of meanings, word origins, synonyms, translations
Wiktionary: Die  - explanations of meanings, word origins, synonyms, translations
Wikiquote: Die  - Quotes

Individual evidence

  1. ^ Friedrich Kluge , Alfred Götze : Etymological dictionary of the German language . 20th edition. Edited by Walther Mitzka , De Gruyter, Berlin / New York 1967; Reprint (“21st unchanged edition”) ibid 1975, ISBN 3-11-005709-3 , p. 746.
  2. ↑ Principles of the German Medical Association for medical terminal care. In: Deutsches Ärzteblatt . 108/7, 2011, pp. 346-348.
  3. ↑ Reinhard B. Dettmeyer, Harald F. Schütz, Marcel Verhoff: Thanatologie. In: Dettmeyer, Schütz, Verhoff (Ed.): Forensic medicine. Springer-Verlag, Berlin / Heidelberg 2014, p. 8.
  4. ^ I. Jonen Thielemann: Terminal phase. In: Textbook of palliative medicine. Schattauer, Stuttgart 2012, p. 990.
  5. ↑ a b M. Thöns, Th. Sitte: Repetitorium Palliativmedizin. Springer-Verlag, Berlin / Heidelberg 2013, p. 150.
  6. ↑ a b Barbara Uebach, Martina Kern: Care and accompaniment of the dying and their relatives in the final phase. In: Zeitschrift für Palliativmedizin, May 2010, p. 108.
  7. ↑ after R. Twycross, I. Lichter, Oxford University Press 1993, pp. 651-661; German Society for Palliative Medicine. 2003; Department of Health. 2003.
  8. ↑ R. Langenbach u. a .: gastrointestinal symptoms. In: C. Bausewein u. a .: Guide to Palliative Care. Palliative medicine and hospice care. Urban & Fischer, Munich 2010, p. 404.
  9. ↑ C. Bausewein: Symptom control as part of holistic terminal care. In: F.-J. Bormann, GD Borasio (Ed.): Die: Dimensions of a basic anthropological phenomenon. De Gruyter, Berlin 2012, p. 191.
  10. ^ Sandy MacLeod, Christian Schulz: Psychiatry in palliative medicine. Treatment of psychological and psychosomatic problems at the end of life. Verlag Hans Huber, Hogrefe, Bern 2013, p. 157.
  11. ↑ Th. Sitte (Ed.): Die Pflegetipps Palliative Care. Verlag der Deutschen PalliativStiftung, Fulda 2013, p. 32.
  12. ↑ Th. Sitte (Ed.): Die Pflegetipps Palliative Care. Verlag der Deutschen PalliativStiftung, Fulda 2013, p. 33.
  13. ↑ E. Albrecht, Ch. Orth, H. Schmidt: Hospizpraxis: A guide for people who want to help the dying. Herder, Freiburg im Breisgau 2006, pp. 29-30, pp. 71-74.
  14. ↑ C. Bausewein (Ed.): Guideline Palliative Care. Elsevier, Urban & Fischer, Munich 2010, p. 61.
  15. ↑ Claudia Gottstein: Delirium. (No longer available online.) In: palliativ.net. 2008, formerly in the original ; accessed on May 5, 2019 (no mementos; 0, de-1106, version 1 at www.palliativ.net 2e5828; originally accessed on February 4, 2015).  ( Page no longer available , search in web archives )@1@ 2Template: Dead Link / www.palliativ.net
  16. ↑ M. Thöns, Th. Sitte: Repetitorium Palliativmedizin. Springer, Berlin / Heidelberg 2013, p. 165.
  17. ^ Johanna Bayer (WDR): Biology of death. (No longer available online.) In: daserste.de. November 21, 2012, archived from the original on February 25, 2015 ; accessed on May 5, 2019 .
  18. ↑ Gerhild Becker, Carola Xander: To the recognizability of the beginning of the dying process. In: Franz-Josef Bormann, Gian Domenico Borasio (Ed.): Die. Dimensions of a basic anthropological phenomenon. De Gruyter, Berlin 2012, p. 122.
  19. ↑ Erich Stern : Psychology of dying. In: The look around. Volume 37, 1933, pp. 21-24.
  20. ^ EM Pattison: The experience of dying. Englewood Cliffs 1977.
  21. ^ E. Kübler-Ross: Interviews with the dying. Kreuz, Stuttgart 1972.
  22. ^ AD Weisman: On Dying and Denying: a Psychiatric Study of Terminality. New York 1972.
  23. ↑ P. Sporken: Dealing with the dying. Medical and pastoral aspects of euthanasia. Patmos Verlag, 1975.
  24. ^ J. Morse, J. Johnson: Toward a theory of illness: The Illness Constellation Model. In: The illness experience: Dimensions of suffering. Newbury Park 1991.
  25. ↑ Ernst Engelke: The truth about dying: How we better deal with it. Rowohlt, Reinbek bei Hamburg 2015, ISBN 978-3-499-62938-9 , pp. 63–64.
  26. ↑ Video: Elisabeth Kübler-Ross on near-death experiences (1981). accessed on March 14, 2014.
  27. ^ J. Wittkowski: On the psychology of dying - or: What contemporary psychology knows about dying. In: F.-J. Bormann, GD Borasio (Ed.): Die. Dimensions of a basic anthropological phenomenon. De Gruyter, Berlin 2012, pp. 50-64.
  28. ^ E. Albrecht, S. Roller: Terminal phase and death. In: Guide to Palliative Care. Palliative medicine and hospice care. Urban & Fischer, Munich 2010, p. 523.
  29. ↑ J. Wittkowski: Psychologist of death. Wissenschaftliche Buchgesellschaft, Darmstadt 1990, pp. 117–140.
  30. ↑ N. Samarel: The dying process. In: J. Wittkowski (Ed.): Die, Tod und Mrauer . Kohlhammer Stuttgart 2003, pp. 122-151.
  31. ↑ C. Bausewein, S. Roller, R. Voltz: Guide to Palliative Medicine. Urban & Fischer, Jena 2004, p. 10.
  32. ^ R. Kastenbaum: Death, Society, and Human Experience . Routledge, New York 2007, pp. 126-149 .
  33. ^ R. Kastenbaum: Death, Society, and Human Experience. Routledge, New York 2007, ISBN 978-0-205-00108-8 .
  34. ↑ E. Engelke: The truth about dying. How we better deal with it. Rowohlt Taschenbuch Verlag, Reinbek bei Hamburg 2015, ISBN 978-3-499-62938-9 .
  35. ↑ E. Engelke: Against the loneliness of the terminally ill. How communication can succeed. Lambertus, Freiburg i. Br. 2012, pp. 209-341.
  36. ^ Barney G. Glaser, Anselm Strauss: Awareness of Dying. Aldine Pub. Co., Chicago 1965.
  37. ↑ A. Lübbe, I. Lübbe: Truth and truthfulness when dealing with terminally ill. In: Journal of Palliative Medicine. 3/2012, p. 121.
  38. ↑ E. Engelke: Against the loneliness of the terminally ill. How communication can succeed . Lambertus, Freiburg i. Br. 2012, p. 98-103 .
  39. ↑ Bronnie Ware: 5 Things The Dying Regret Most: Insights That Will Change Your Life. Translated from the English by Wibke Kuhn . Arkana, Munich 2013, ISBN 978-3-442-34129-0 (Original title: The Top Five Regrets of the Dying: A Life Transformed by the Dearly Departing. Balcony Press, 2011, ISBN 978-1-4525-0234-2 ) .
  40. ↑ Andreas Maercker: Forms of life review. In: Andreas Maercker, Simon Forstmeier (Hrsg.): The life review in therapy and counseling. Springer, Berlin 2013, pp. 25–45.
  41. ↑ Harvey M. Chochinov, Thomas Hack a. a .: Dignity therapy: A novel psychotherapeutic intervention for patients near the end of life. In: J Clinical Oncology. 23, 2005, pp. 5520-5525.
  42. ^ E. Weiher: Spiritual accompaniment in palliative care . In: C. Knipping (Ed.): Textbook Palliative Care . Huber, Bern 2006, p. 450-452 .
  43. ↑ Bringing dying into life. ( Memento from February 22, 2014 in the Internet Archive ) In: notfallseelsorge.de, accessed on May 5, 2019 (section dying then and now ).
  44. ↑ Hanne Isabell Schaffer: Special challenges. The historical sociology of death. In: Maria Wasner, Sabine Pankofer (eds.): Social work in palliative care. A manual for study and practice. Kohlhammer, Stuttgart 2014, p. 175.
  45. ↑ Basic data on hospitals. Retrieved October 17, 2016 .
  46. ^ GD Borasio: About dying . dtv, Munich 2013, p. 29-39 .
  47. ^ R. Gronemeyer: Die in Deutschland. How we can give death a place in our lives again . Fischer Taschenbuch Verlag, Frankfurt am Main 2008, p. 67-151 .
  48. ↑ G. Fasselt: death support / dying care. In: W. Korff, L. Beck, P. Mikat (eds.): Lexicon of Bioethics. Volume 3, Gütersloh 2000, pp. 440-444.
  49. ↑ Birgit Jaspers, Thomas Schindler: Expert opinion. Status of palliative medicine and hospice work in Germany and in comparison with selected countries. Duration May to November 2004; P. 24. Accessed January 24, 2019.
  50. ^ R. Gronemeyer: Die in Deutschland . Fischer Taschenbuch Verlag, Frankfurt am Main 2008, p. 155-165 .
  51. ↑ N. Elias: On the loneliness of the dying in our day . Suhrkamp Verlag, Frankfurt am Main 1982.
  52. ↑ E. Engelke: Against the loneliness of the dying. How communication can succeed . Lambertus, Freiburg i. Br. 2012, p. 14-37 .
  53. ↑ C. Fussek, G.Schober: In the network of the care mafia . How business is done with inhumane care . Bertelsmann, Gütersloh 2008 (afterword by Dieter Hildebrandt ).
  54. ↑ Gerd Göckenjan: Dying in our society - ideals and realities. In: Federal Agency for Civic Education: From Politics and Contemporary History . 4/2008.
  55. ↑ Michael de Ridder: Medicine at the end of life: tube feeding rarely increases the quality of life. In: Deutsches Ärzteblatt. 105, 9, 2008, pp. A-449 / B-402 / C-396.
  56. ↑ J. McCue: The Natural Ness Of Dying. In: JAMA. 273, 1995.
  57. ↑ M. Synofzik: PEG nutrition in advanced dementia. In: The neurologist . 78, 2007.
  58. ↑ U. Chr. Arnold: Last help. A plea for self-determined death. Rowohlt Verlag, Reinbek near Hamburg 2014.
  59. ^ Michaela Fink: From initiative to institution. The hospice movement between lively encounters and standardized services (= series of publications by the Scientific Advisory Board in DHPV eV Volume V). Ludwigsburg 2012.
  60. ^ Jon Henley: Citizens live under law's dead hand . In: The Guardian . London September 23, 2000 ( theguardian.com [accessed October 26, 2008]).
  61. ↑ Forbidden to die because of lack of room. (No longer available online.) In: weirdglobenews.com. November 25, 2007, archived from the original on May 28, 2008 ; accessed on May 5, 2019 .
  62. ^ French village bans death. (No longer available online.) In: AFP. March 6, 2008, archived from the original on March 10, 2008 ; accessed on May 5, 2019 .
  63. ↑ Cemetery full, mayor tells locals not to die. (No longer available online.) In: Reuters. March 5, 2008, archived from the original on June 4, 2011 ; accessed on May 5, 2019 .
  64. ^ A b Spanish Mayor Outlaws Death. (No longer available online.) In: stiffs.com. October 2, 1999, archived from the original on July 9, 2008 ; accessed on May 5, 2019 .