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We identified 11 core themes of good death: preferences for a specific dying process, pain-free status, religiosity/spiritualty, emotional well-being, life completion, treatment preferences, dignity, family, quality of life, relationship with HCP, and other.
Mar 14, 2020 · What one chooses as a good death is subjective and should be based on the wants and needs of the one dying. For example, the loved one may want to die quickly while asleep. However,...
- Overview
- Discussing death
- The secret of a ‘good death’
- The future of death
Although many individuals shy away from contemplating the inevitability of death, most would agree that they would like to die well. A new review of existing literature, published in the American Journal of Geriatric Psychiatry, asks what makes a “good death” according to those involved in the process.
Although dying well is covered thoroughly by lay literature, scientific literature on the matter is much more sparse.
The concept of discovering the meaning of life when one is faced with his or her mortality is a common theme in films, novels and biographies.
But when the end comes, what is the general consensus? What do the dying and the soon-to-be bereaved consider to be a good death?
Some believe that American culture, indeed Western culture at large, is becoming increasingly death-phobic.
In sharp contrast to 100 years ago when seeing a dead body would be commonplace, nowadays, individuals outside of the relevant industries (health, funeral homes) very rarely see a corpse. Consequently, death is less likely to be discussed and considered.
In hospices and palliative care settings, these themes are more often debated. But coming up with a neat definition of a “good death” that fits all viewpoints is challenging, and there is very little research to back up the conversation.
Certain organizations have attempted to sum up the principles of dying well. According to an Institute of Medicine report, a good death is:
“Free from avoidable distress and suffering for patient, family and caregivers, in general accord with the patient’s and family’s wishes, and reasonably consistent with clinical, cultural and ethical standards.”
Few would disagree with most of the points listed above, but what is the split between each facet? What are the primary objectives for someone who is facing imminent death?
The team, headed up by Dr. Dilip Jeste, focused their research on three sets of individuals: patients, family members (prior to and during bereavement) and health care providers. This is, as far as the authors can tell, the first time that these three groups have been compared and contrasted in such a way. According to Dr. Jeste:
“Death is obviously a controversial topic. People don’t like to talk about it in detail, but we should. It’s important to speak honestly and transparently about what kind of death each of us would prefer.”
The team’s literature search returned 32 relevant papers. From these sources, the team uncovered 11 core elements to consider when contemplating a good death:
1.Preference for a specific dying process
2.Religious or spiritual element
3.Emotional well-being
First author Emily Meier confirms the gist of these findings from her personal experience as a psychologist at Moores Cancer Center, UC-San Diego Health:
“Clinically, we often see a difference between what patients, family members and health care providers value as most important near the end of life.”
Meier goes on to say that “ultimately, existential and other psychosocial concerns may be prevalent among patients, and this serves as a reminder that we must ask about all facets of care that are essential at the end of life.”
Dr. Jeste sums up the conclusions to be drawn from the investigation: “ask the patient.”
Although the topic can be uncomfortable for the patient, or, indeed, the family, it is essential to voice concerns and desires and listen to the patient’s wishes. Dr. Jeste hopes that in the future “it may be possible to develop formal rating scales and protocols that will prompt greater discussion and better outcomes. You can make it possible to have a good death by talking about it sometime before.”
Death is certainly not a topic that will be disappearing any time soon. The more open and frank everyone involved can be, the smoother the process will surely become.
- Experience as little pain as possible. When I talk of being pain-free, I mean physically, psycho-socially, and spiritually pain-free. Nowadays, there are medications that can manage most people’s physical pain and make them far more comfortable, and these should not be denied to any patient.
- Recognize and resolve interpersonal conflicts. We must also recognize psycho-social pain, the residue of life’s unresolved conflicts with other people.
- Satisfy any remaining wishes that are consistent with their present condition. Some people want to live long enough to go to a grandson’s graduation, to see a book published, to see a cousin they were close to who lives 3000 miles away.
- Review their life to find meaning. There are two main ways that people on their deathbeds find meaning: in the recognition of all of the people they have loved and who have loved them, and in the work that they’ve done that has contributed to the greater good.
May 21, 2015 · At Marie Curie, we define a good death (or good end of life experience) as having the right care, support and systems in place, so you feel protected and safe, and your carers and loved ones understand what support is available. A good death will be different for everyone, as it depends on what matters to you.
People often talk about a “good” death or a “bad'' death. For the patient and the family what constitutes those ideas may be different. If you were to ask 50 people what they consider would...
The “good death” is a dynamic concept and has evolved over time to become a “revivalist” good death: a planned, peaceful, and dignified death, at home, surrounded by family members. As the “good death” continues to evolve, the key questions are: How do cultural perceptions of death and dying change?
