What’s Considered a ‘Bad Death’ in End-of-Life Care?

Updated

Preparing for your death is not something at the top of everyone’s to-do list. But in some cases, the lack of death planning can bring about a “bad death experience” as you near the end of life. Some people actively choose not to do any end-of-life planning, and choose instead to leave most of the decision making to their families.

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This is true even in cases where people have strong opinions about the end-of-life care they wish to receive. They either find it's too painful to face one’s mortality, or a fear of death keeps them from making any necessary plans.

Where Does the Concept of a ‘Bad Death’ Come From?

A bad death is a concept derived from the opinions and experiences of various death workers who deal with sick and dying patients daily.

Through the years, these professionals have observed, noted, and interviewed patients in various stages of dying, and have come up with clearly defined concepts of what constitutes dying a bad death. 

These observations by the medical, legal, and death community have culminated in what’s known as advance care planning. In their studies, they’ve noticed how race and social structure play a part in the willingness of certain individuals to establish end-of-life care plans, while others ignore it altogether.

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What Makes Up a Bad Death vs. a Good Death? 

There are very distinct characteristics that differentiate dying a good death from experiencing a bad one. The concept of a good death is one that can be created by almost anyone who chooses to utilize end-of-life planning tools. These are available through various sources at either medical clinics, through an attorney, or online. 

Death workers in general—such include doctors, clinicians, morticians, lawyers, and other health and hospice workers—agree that dying with dignity is the starting point of having a good death.

Bad death vs. good death

What makes a good death possible is having the mental capacity and clarity to make your end-of-life decisions well ahead of time, documenting them, and choosing a trustworthy person to execute them when the time comes. There are many other factors that constitute dying a good death that are explored below:

  • A bad death can mean experiencing prolonged and untreated unnecessary pain and suffering.
  • A good death can be defined as a medically managed ending of pain and suffering under the legal and medical concept of “death with dignity.” Dying with dignity is a form of physician-assisted death or euthanasia available in some states for terminally ill patients.
  • For some, a bad death includes living out your last days in a persistent vegetative state.
  • By contrast, a good death would mean having the proper DNR or “pull-the-plug” documents in place so that your family or loved ones can intervene with these medical decisions. 
  • A bad death can equal keeping you alive against your will.
  • A good death means that ensuring that your end-of-life wishes are met and followed through regardless of your family’s attempts at keeping you alive at all costs.
  • A bad death may happen through experiencing prolonged hunger or dying a death by starvation.
  • A good death can happen by allowing your medical team to accelerate your death while increasing your overall comfort.
  • A bad death might happen as a result of enduring non-beneficial surgeries and treatments.
  • A good death means that your care team works to avoid all non-essential and non-beneficial treatments even if doing so hastens your death.

The examples above are some of the more common ways in which a person experiences a bad death versus a good death. Another way bad death manifests is when your family has no control over medical decisions at the end of your life. 

Bad deaths are more likely to occur when a patient is admitted into the hospital under emergency care. They can also happen when a planned procedure goes wrong and there are no medical directives in place.

Other ways a bad death differs from a good death

Read on to understand more of the differences between and good death and bad death.

Being in control vs. you and family having no control:

If you do not fill out the necessary documents while you are still able to do so, you may risk losing all decision-making control when it comes to your end-of-life medical care.

For example, instead of having you or your family control any medical decisions, your medical team will take decisions for you in the absence of legally binding documents.

Being comfortable vs. living in pain

Most medical teams will not give you the necessary medication to alleviate your pain without the full legal authorization to do so.

You may have to suffer through the end of your days living in relative pain and agony until someone is appointed as your medical power of attorney to make these decisions on your behalf. 

Mending broken relationships vs. no opportunity to make amends

Many people, as they near the end of their lives, start thinking about everyone whom they’ve wronged, or who have wronged them in the past. They typically want to use their last days as an opportunity to make things right.  

A part of dying a good death is being able to mend relationships and heal from past hurts and traumas. A bad death would mean dying without ever having had this opportunity. The person who is dying may not experience a peaceful death without forgiveness from their friends and loved ones. 

Finding closure vs. leaving things unsaid

Another closely related part of dying a good death is finding closure. This differs slightly from mending broken relationships in that dying without saying all the things you wanted to say can happen even in the best of relationships. 

Perhaps you’ve thought of expressing your feelings of love and gratitude to your children, but have been too shy or ashamed to say those words. You’ve put it on your list of things to do as you get closer to the end of your life. And then, tragedy strikes unexpectedly, and you’re left fighting for your life without an opportunity to say the things you wanted to. 

Ability to make decisions vs. loss of dignity

There are many things that you may wish for or want as you face the end of your life. One of those things is having the choice of dying at home or in a hospital setting. You might have envisioned spending your last days in your own bed surrounded by your loved ones, but instead, you’re connected to machines in an unfamiliar place.

Losing your dignity in this sense is equal to having to defer all of these decisions to someone else that may not even know who you are. It can lead to sadness and depression in your final days. 

Minimal burden on family vs maximized 

When you properly plan for your death, you ensure that all the details are taken care of as much as possible. All the end-of-life planning has been put in place, funerals have been pre-paid, and money has been allocated for all the ancillary expenses that may creep up at death.

Without proper planning, your family may be left with the burden of figuring out what to do and how to pay for it all. A good death leaves you with the peace of mind that your family won’t have to be faced with added expenses at the time of your death.

Honoring of cultural beliefs and traditions vs. random funeral rites

For some people, nothing is as important to them as having a properly executed funeral and burial according to their traditions, cultural and religious beliefs. But when no one is aware of what those are, they are left to make up their own version of what they think you would’ve wanted. 

Naturally, those who love and care about you will do their best to ensure that you have a proper funeral and burial, but they might miss out on key elements that you would’ve wanted as part of your final exit. 

Death positive movement

The death positive movement is a modern movement aimed at getting people to start talking openly about death and dying. The movement started by a mortician named Caitlin Doughty who created the group The Order of the Good Death to explain why there wasn’t much discussion about death positivity in our society.

The goals of the death positive movement are to promote open, honest, and healthy discussions about death, dying, and end of life planning. There are other facets of death that are discussed at death salon meetings and conferences held across the United States. 

How Can You Prevent a ‘Bad Death’?

Preventing a bad death is not as complicated as you might think. Certain documents are a must for anyone looking to plan ahead to their death. They include, but are not limited to the following:

  • Last Will and Testament
  • Power of Attorney
  • Healthcare Power of Attorney
  • Living Will
  • HIPAA Release

All of these documents are used in combination to guide your medical and legal teams in managing your end-of-life care. They each act independently of each other and each one has its own unique purpose when it comes to executing your decisions.

It might be best to seek the help of your lawyer and/or doctor in determining which documents are right for you. 

Avoiding a Bad Death

Although no one can guarantee a good death, the steps you take now to plan ahead will help you experience the best death possible. Getting your affairs in order well in advance of any cognitive decline will also ensure that you receive the best possible treatment.

The directives you put in place will help you avoid experiencing a bad death and increase your chances of having a peaceful death on your own terms. 

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