1.2.25 Dealing with the dying

1 Purpose and objective

The procedure in the event of death in hospital must be regulated taking into account the legal requirements, the high emotional burden on relatives and hospital staff and knowledge of the patient's religious beliefs. The handling of miscarriages and stillbirths should be included in the regulations.

2 Scope of application

Dealing with the dying and their relatives. Dealing with parents in the event of miscarriage and stillbirth

3 Description

3.1 General information

The dying must be treated with dignity and respect. The focus is on preserving honorable remembrance, especially if the specific circumstances jeopardize this. The dying person's wishes regarding the end of life should be respected as far as is justifiable. The view of the world is of particular importance. If at all possible, the treatment team should inform themselves about this.

3.2 Medical duties

The doctor is obliged to help the dying in such a way that they can die with dignity. The principles of medical end-of-life care must be observed: palliative medical care in support and care for basic care Measures that only delay the onset of death should be avoided or terminated. In the case of the dying, the focus is on alleviating suffering. The dying person must be informed truthfully about their condition and possible measures. Living wills and other expressions of wishes regarding medical and nursing treatment and care must be observed.

3.3 Religious rites

The specific rites are to be identified in cooperation with representatives of the religious communities. Observance should be facilitated by suitable environmental conditions. The prerequisite here is that the people involved in the care are familiar with it. In the case of Christian patients, a clergyman or woman should be called at the request of the dying person. Relatives or team members can say prayers. The procedure should be supervised by the hospital chaplain.
In the Roman Catholic Church, the Old Catholic and Orthodox churches, the anointing of the sick (formerly known as "last rites") is considered a sacrament. The wish for a priest to administer it must be taken very seriously. Delay must be avoided under all circumstances. This is especially true in times of imminent danger of death, when the actual sacrament of the dying is celebrated as Holy Communion with the reception of the host, which is intended to strengthen the soul as it passes over into eternal life.
The removal of organs from members of the Jehovah's Witnesses religious community should not be considered, as the believers strictly reject this.

In the case of Jews, relatives and, if desired, a clergyman should be informed in good time. If the dying ask for it, a Torah should be fetched; Jews never give up hope of recovery. Every person should live as long as possible and thus serve God. Life-shortening measures are often strictly rejected. After death has occurred, a down feather is placed on the nose and mouth after eight minutes. The son or the next male relative closes the eyes and mouth. The corpse is left alone for about half an hour. Orthodox Jews entrust the Chewra Kadischah ("holy community") with the further care of the corpse. The hands of the deceased are stretched out along the torso. The body is washed, dressed in a white shirt, covered with a white cloth and positioned so that it faces the door. A candle is lit at head height.

Muslims often wish to lie with their faces turned towards Mecca as they die. The dying person raises a finger to heaven. If they lack the strength, a carer may help. The profession of faith is recited. The dying person should be offered something to drink, because a Muslim must not die thirsty.
Followers of Hinduism and Buddhism wish to ensure a quiet environment. Buddhists meditate while dying, which for them is a path to new life. A Buddhist priest or friend should be given the opportunity to attend the wake.

3.4 Dealing with miscarriage and stillbirth

After a miscarriage or stillbirth, the expressed or presumed will of the woman giving birth must be known. The further course of events should be discussed emphatically with the patient and the weight of the event should be accepted by welcoming and saying goodbye to the child. An emergency baptism should always be considered. The hospital chaplaincy should be informed. Discussions with a chaplain should be encouraged.
A strategy for communicating the news of the death must be drawn up. The partner or another person of trust should be able to be with the woman concerned if desired. Care should be taken to ensure physical separation from the obstetric ward. Older children should be given a name and a name ribbon should be attached to their wrist. The child should be bathed, cleaned, wrapped in a cloth and possibly dressed. Only in this state should it be shown and given to the mother/parents. You should also create mementos and give the parents a card with a photo and footprint of the child, for example. You should always talk about a child and a birth.

3.5 Dealing with the deceased

Further ritual requirements must be observed after death. Information on this can be found in VA 1.2.26 Dealing with the deceased.

4 Documentation

Decision to discontinue active treatment and transition to palliative care Information for relatives Notification of pastoral care Patient information, discussion on expressions of wishes Time of death

5 Resources

5.1 Room

The dying should lie alone in a room that offers enough space for relatives. The room should be suitable for ritual acts. Darkening is usually desired. A decision must be made about the use of lighted candles. Bathrooms or dressing rooms are not dignified places. A transfer to a hospice or palliative care unit should be considered.

5.2 Personnel

The hospital's pastoral care team should be informed if patients express a wish to do so. A member of the team is appointed to provide close support. The support should be empathetic but reserved. Adequate preparation and instruction in the task should precede this.

5.3 Time required

The support is not fully committed. However, it should be available at short notice if required. End-of-life care may be necessary for several hours or even days.

6 Responsibilities

Chaplains for ritual acts and empathic support Medical care Nursing care for securing the spatial conditions, accompanying relatives, maintaining care. Medical treatment ends in the face of death - care never ends.

7 Notes and comments

8 Applicable documents

8.1 Literature, regulations

Principles of the German Medical Association on medical end-of-life care:2011 (Deutsches Ärzteblatt | Jg. 108 | Heft 7 | February 18, 2011) http://www.bundesaerztekammer.de/fileadmin/user_upload/downloads/Sterbebegleitung_17022011.pdf

8.2 Terms

Dying patients or injured persons with irreversible failure of one or more vital functions who are expected to die within a short period of time. [BÄK Principles 2011]

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