What Is a Good Death?

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We rarely give much thought to our own death until it is upon us. Sigmund Freud said that we are incapable of imagining our own death. Even though we know and can imagine someone else's demise, we are convinced of our own immortality.^[1] As a result, we give little or no thought to how we would like our last days and moments to be. Or, for that matter, even what we need to do to ensure that our wishes will be carried out. 

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 constitute a good death, you might easily get 50 different responses. Most people would feel that a peaceful, painless death would be considered good. A bad death would be one in which violence, severe pain, torture, dying alone, being kept alive against your wishes, loss of dignity, and being unable to let your wishes be known. No one wants to see someone suffer as death is near. These are some of the “bad” deaths that can be traumatizing for the dying, their family and the medical staff. 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, this might be a more traumatizing death for the family.

A research project from the University of California, San Diego School of Medicine, reviewed the available research that examined what constituted a good death or dying well. They found that there were 11 areas that were associated with dying well. The three main areas found throughout all the groups were being able to give specific information as to how they wanted to die, being pain free and to experience emotional well being by addressing the quality of the life they want in their time before death. Other factors that were included in a good death were religion or spirituality and having a sense of completion of their lives. The dying want to be able to make choices in the treatments they receive, be treated in a dignified manner, and have a good relationship with the treating providers. Being with family members and saying goodbyes is also important in a good death.^[2] Additionally, in my work with hospice, I would add another factor based on nurses’ reports. They comment that when the dying experience a deathbed vision of a departed loved one, it helps to calm and soothe them so that they have a more peaceful death.^[3] 

There are some who believe that calling a death “good” is a value judgement that might not necessarily belong to the patient. As a result, a newer model for working with the dying has been developed. It is referred to as a Respectful Death^[4]. It basically is a model in which the dying, the family and professionals all work together and support each other with the goal of improving end-of-life care and achieving the best possible outcome for the dying. One would assume that everyone was already working together to ensure the best possible outcome. Sadly that is not always the case. Decisions are often made unilaterally without necessarily considering what the one dying wants or needs. A respectful death involves truly listening to the dying and being open and honest with them and the family about the diagnosis and future. As mentioned in a previous article, the patient, family, and physicians often engage in a conspiracy of silence where no one acknowledges that the patient is dying.

If there was one word to describe the secret of a good or respectful death, it would be communication. We do not have to be at the end of our life to begin to have open discussions with others about what our wishes are. For example, do we want to die at home? Or does the place matter as long as family is there? Do we want to be kept alive at all costs or do we not want to be resuscitated? Knowing these and other such matters is beneficial for the family and the medical providers. There are many accounts of families not knowing what the dying wanted and having to make agonizing decisions about their care. However, once there is open communication and an understanding of the values and goals of the dying and family, a respectful death can be achieved.