What Are the Elements of a 'Good Death' in End-of-Life Care?

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Talking about having a 'good death' means having a say in how you'd want to die when reaching the end of life. Preparing for a good death involves talking to your loved ones about how you view death and dying, how you’d like your end-of-life care to go, and having most, if not all, of your end-of-life planning in place.

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Some people don’t view death as a good thing, and many folks can be afraid of it. Despite the fear and taboo around death, there are many people who actively prepare to have a good death. There are many facets to having a good death, including spiritual care, end-of-life planning, and other more cut and dry pieces of paperwork. Spiritual care is central to many people's acceptance of death and the dying process.

Even when all of the paperwork and red tape has been sorted out, if you haven't yet reached a place where you're at peace with what comes next, then there may be work left to do. 

Is There Such a Thing as a Good Death?

Preparing for and having a good death means different things for different people. We usually don’t have control of when and how we die. But that doesn't mean we can't plan and prepare for what happens when that time approaches. 

All end-of-life decisions, like whether you’d rather die in a hospital or at home, if you want to be cremated or buried, and who gets to keep your personal belongings and assets, are part of what makes up the foundation of dying a good death.

Talking about your expectations before the need arises can contribute to experiencing a “good death.” But ultimately, the meaning you give to the term is highly personal with its unique significance to you.

Some common factors that people consider part of a good death include:

  • Lack of pain
  • Religious and emotional wellbeing
  • Living a fulfilling life
  • Dying with dignity
  • Having loved ones near
  • Quality of life


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

Having a good death comes from an individual’s need to remain autonomous for as long as possible, living a symptom-free life, having decision-making authority over healthcare, having loved ones around, and dying with dignity.

These concepts were established in the 1900s and pre-date the Civil War where death on the battlefield changed the course of what it meant to have a good death. Soon after, these fundamental concepts were reintroduced to fit a post-war era of reclaiming control over the dying process. 

Good death vs. bad death

Some core thought processes separate a good death from a bad death. Depending on your personal beliefs about death, dying, and end-of-life processes, your opinion of a good death differs from the next person’s.

Something to consider is how death in different cultures, as compared to your own, affects your outlook on death and dying. The following are some examples of how a good death contrasts with a bad death in modern American culture.

  • Having control over your end-of-life decisions vs. having no control due to a lack of pre-planning
  • Being comfortable and pain-free vs. suffering in agony
  • Finding healing and closure vs. not having the opportunity to mend relationships
  • Reaffirming the value of the individual vs. being another patient
  • Recognizing an impending death vs. unprepared for death
  • Having a death-positive outlook vs. living in fear of death

Here’s What’s Considered a Good Death

Here are 10 things that people may think about and discuss in order to have a good death.

1. Preferences on specific dying process

When your end-of-life paperwork is in order, you’re prepared for different scenarios that may come up. This doesn’t mean that if you’ve signed all of your directives that you’ll automatically experience a good death. What it does mean is that you’ve given yourself the best chance of having control over how your medical treatment will go at the end of your life.

Taking care of the details ahead of time with a sound mind helps to relieve stress, anxiety, and depression. Some things that you may consider are: 

  • Having a voluntary discussion with your family and doctors to discuss your end-of-life wishes, concerns, and care preferences.
  • Discussing options for different scenarios or changes in your medical condition such as changes to your care plan, how things will change if you’re diagnosed with a terminal illness, and what choices to consider as your condition worsens or in the event of the progression of any disease. 
  • Having an advanced care plan in place to support your decisions and identify any foreseen issues that may impede having an informed choice in your care and treatment. This can also apply to unforeseen accidents or injury, decisions regarding hospice care, or palliative care.  

2. Being pain-free

Many people who've been diagnosed with a terminal condition will spend their last days suffering from pain as their condition worsens due to lack of planning. Advancements in modern medicine make it easier for people nearing the end of life to live their last days in relative comfort and free from pain.

Instead of suffering through their final moments, they can now focus on things that are important to them like connecting with their loved ones and reflecting on their lives.

3. Spiritual health

There’s a distinction between spiritual care and pastoral care that’s not often recognized. One involves an outside party coming in to offer religious or spiritual guidance and counseling as a person nears the end of their life. This person may offer words of wisdom based on religious text or alleviate the fear of death by explaining how thanatophobia affects a dying person.

The other involves internal addressing of religious beliefs, spirituality, and finding inspiration, hope, and peace in dealing with the spiritual pain they may be suffering. In this scenario, spirituality can be looked at as all the things that give meaning and purpose to a person’s life. Spiritual pain is linked to the suffering that’s attached to the struggle of finding what gives your life meaning, hope, love, peace, comfort, and strength.


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4. Emotional well-being

A person nearing the end of life may be suffering emotionally as they come to terms with dying. Their emotional well-being is considered as part of the whole in their plan of care.

Having family and loved ones around offering love and support, coming to terms with how their life played out, and discovering all of the reasons they find life worth living in their present condition are all components of a person's well-being leading to a good death. 

5. Life completion

In general, as a person struggles to find meaning in the life they've lived, they tend to consider all the people they've loved and who've loved them. They reflect on their work contributions, educational achievements, and career ups and downs. They mostly look for meaning through these two tracks—their personal and professional lives.

Many people are conditioned to view life's successes by these two measures. However, they may find that their lives were not lived fully and that they didn't find personal meaning at the end of life. 

While others who find these two standards of measure to be normal may find that their life is now complete because they lived a good life, raised a good family, and were successful in their careers. Spirituality or religion don’t often come into play in determining whether they lived a complete life.

6. Treatment preferences 

Deciding among treatments is an end-of-life planning decision that can be made in anticipation of a decline in a current medical condition. Your medical directives can outline a detailed treatment plan that takes into consideration the scenarios you’re likely to experience.

Consider asking your medical professional about the following:

  • Prolonging life at all costs
  • Having a DNR (Do Not Resuscitate) order in place
  • Hospice vs. palliative care
  • Dying at home vs hospital or clinical setting
  • Assisted death
  • Medicines that provide comfort over prolongation of life
  • Feeding tubes vs. medication to alleviate hunger

7. Dignity

Dying with dignity is having control over your end-of-life decisions, having the autonomy to decide your end-of-life care as it relates to your pain and suffering, and the ability to decide whether to hasten your death if you're terminally ill.

Not all doctors proscribe to the assisted death that’s outlined in the Death with Dignity laws that are in effect in some states. These laws allow for medically assisted death supervised by your doctor. It's important to have these discussions with your doctor and family as early as possible so that your wishes can be known and so that you and your doctor can come to terms regarding your plan of care.

8. Family

Spending time with family during the last few days and weeks of your life is an important aspect of dying a good death. You’re able to strengthen bonds and address issues that may have caused separation, hurt, or anger. 

Lastly and what some may consider most important, you’re given a final opportunity to tell your loved ones what they’ve meant to you throughout your life. This also allows them to make amends, apologize for past behaviors, and to express their thoughts and sentiments concerning your relationship with them.

9. Quality of life

Having a good quality of life doesn’t mean the same thing for everyone. For some, it may mean extending their life for as long as possible without regard to their medical condition so long as they can live longer. For others, it may mean spending their last days in a meaningful way free of pain and suffering.

Things to consider are your medical decisions regarding treatment if you're in a coma or vegetative state, linked up to life-prolonging machines, if you can no longer recognize your loved ones, or can't care for yourself at home.

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10. Relationship with the care team

Having a good relationship with all members of your care team ensures that your directives are followed as closely as possible.

Having open and honest communication with everyone involved in your care makes it easier when having to make tough life or death medical decisions. 

How Can You Make Sure You or a Loved One Die a Good Death?

There is no guarantee that your loved ones will carry out all of your wishes, even with proper planning. It's essential to have ongoing, open, and honest conversations with your family and loved ones about your expectations. 

The more openly you talk about end-of-life planning with your family, the easier those conversations become. You'll want to be very specific about different aspects of your medical care and treatment, where you'd like to spend your remaining time, and under whose care and control. The following tips may help ensure a good death for you or your loved ones.

Start early

Getting used to talking about death may take several months or years, depending on who you're having this conversation with. Some people are afraid of dying and are reluctant to talk about what'll happen when death comes. This hesitation isn't unusual and is quite common.

The sooner you start talking about death, the more time you have to plan and ensure that you or others are meeting your expectations whenever possible. No planning will ever ensure complete compliance with final wishes, but it's a great place to start, especially when people are anxious about talking about death.

Get things in writing

Too many people rely on their loved ones to take care of end-of-life planning matters for them. There's sometimes a lack of planning because of the fear of talking about and preparing for death. When they finally open up and let others know what they'd like to see happen, it may be too late. 

Not leaving things to chance is why it's important to lay out all of your wishes in writing, have the documents properly sealed by a notary or attorney whenever necessary, and keep the documentation in an easily accessible location.

Preplan your funeral

Ensuring that your loved ones meet your end-of-life wishes can include planning for your funeral and cremation or burial. Why leave the planning to your loved ones when you can do it yourself ahead of time? 

Planning for the burial or final disposition of remains should be a part of everyone's end-of-life planning. Most funeral directors will sit with you to plan out every detail of your funeral, and they'll ensure that there's a point of contact they can follow up with when the time comes.

This is the time for you to talk about everything, like the body's preparation, the length of time for viewing, the type of interment you'd like, the size and location of your gravestone, and many other details that many people don't think about planning. 

Set aside money

Planning for your end-of-life wishes also includes setting money aside to pay for healthcare, medical expenses, experimental treatments, lawyers, and final expenses. Dying can be a costly event that many people aren't prepared to pay for. Fortunately, life insurance policies exist to help offset some of these expenses. 

They range from basic policies that are enough to cover funeral expenses to those that leave substantial inheritances for your loved ones. Purchasing a life insurance policy is often less expensive than trying to save up enough cash to cover all of the costs associated with dying.

Dying a Good Death

Having everything in place doesn’t guarantee that when the time comes all will fall into place, but it does mean that you can relax into the next phase with full knowledge that you’re prepared and ready for it.

This is how many may hope to die. However, no matter how much planning you do, the end comes when it's ready regardless if you are. 

If you want to read more about dying a good death, read our guides on race and who gets to die a good death and what's considered a "bad death" in end-of-life care.


Sources:
  1. Meier E.A., Gallegos J.V., Montross-Thomas L.P., Depp C.A., Irwin S.A., Jeste D.V. (2016) Defining a Good Death (Successful Dying): Literature Review and a Call for Research and Public Dialogue. American Journal of Geriatric Psychiatry,  24  (4), pp. 261-271.
  2. Lee, Geok & Woo, Ivan & Goh, Cynthia. (2012). Understanding the concept of a "good death" among bereaved family caregivers of cancer patients in Singapore. Palliative & supportive care. 11. 1-10. 10.1017/S1478951511000691. researchgate.net

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