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In an open awareness context persons are aware of dying bringing a new set of needs to the dying situation requiring different responses by staff.
In a closed awareness context, persons are unaware of their imminent death and hospital staff strives to hide this knowledge.
In situations with a low level of awareness of dying and little medical control of dying there may still be palliative care, but it is generally agreed that optimal palliative care services require an open awareness context [ 32].
The open awareness context of the dying situation, today a norm in many Western societies, is the starting point for a control of dying that can be met by palliative care, euthanasia or PAS [ 25- 27].
In a healthy brain, the hippocampus and select areas of the cerebral cortex receive and process signals from the amygdala to provide awareness, context, and judgment to the threat perception and subsequent fear response[ 30, 33].
In a closed awareness context, it is not possible to discuss either reversible or irreversible control of dying, and patient autonomy regarding end-of-life decisions is consequently low.
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First, suboptimal palliative care in closed awareness contexts seen in Asian, Islamic and Latin cultures, called closed dying.
Evidently, open awareness contexts also raise the patient's awareness of the option of ending one's life in a controlled manner.
Open dying awareness contexts can be seen as the start of a weakening of a taboo towards controlled dying called de-tabooing.
In the 1960s, when Glaser and Strauss discovered different awareness contexts of the dying situation in six American hospitals, medical paternalism was routine in the patient-physician relationship [ 5].
De-tabooing dying control is an assumed secular process starting with open awareness contexts of dying half a century ago, and continuing with the growth of the palliative care movement and later euthanasia and PAS legislation.
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