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. 

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.

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.

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. 

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. www.researchgate.net/publication/221872836_Understanding_the_concept_of_a_good_death_among_bereaved_family_caregivers_of_cancer_patients_in_Singapore
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