What is considered a "Good Death"

I

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4828197/

Defining a Good Death (Successful Dying): Literature Review and a Call for Research and Public Dialogue

Am J Geriatr Psychiatry. Author manuscript; available in PMC 2017 Apr 1

 

“Finally, an important goal of this review is to issue a call for action to the professional and lay community to accelerate its open dialogue regarding death and dying, as the United States has a largely “death-phobic” culture.⁶³ Although individuals in many states in the country are formally asked and encouraged to consider advanced directives and organ donations, should we, as clinicians, also not ask our older patients to stipulate their preferences for the dying process? If, as a society, we begin to address the question of how people want to die and what they actually need and want at the end of their lives, perhaps we can enable more people to obtain a good death, reaching their full potential, with dignity and whole-person well-being. As stated eloquently by Gawande,⁷ “…our most cruel failure in how we treat the sick and the aged is the failure to recognize that they have priorities beyond merely being safe and living longer; that the chance to shape one’s story is essential to sustaining meaning in life; that we have the opportunity to refashion our institutions, our culture, and our conversations in ways that transform the possibilities for the last chapters of everyone’s lives.”

II.

https://www.cancercouncil.com.au/cancer-information/advanced-cancer/end-of-life/common-questions/what-is-a-good-death/

Cancer Council

What is a ‘good death’?

People often talk about wanting to have a ‘good death’. What dying well means is unique for each person, shaped by individual attitudes, cultural background, spirituality and medical treatments.

Think about what dying well means to you. Many people have found that it helps to:

• know that death is coming and have some understanding of what to expect
• have some control over pain relief and other symptoms
• be able to retain some control over where death occurs and how it happens
• maintain a sense of dignity
• have the opportunity to prepare for death
• reconcile damaged or broken relationships
• have the chance to say goodbye
• resolve regrets
• be able to have a say in end-of-life care and ensure wishes are respected.

There is more than one way to die well. Some people see staying at home as the key to dying well, but others feel more supported spending their last days in a hospital or palliative care unit. The important thing is that your family, friends and health care team understand what matters most to you.

Open conversations and planning ahead for dying and death can also help family members and friends cope better with bereavement. They may feel a sense of peace knowing that they helped you to die according to your wishes.

Click on the icon below to download a PDF booklet on “Facing End of Life” This is well written and comprehensive book-
Read more at https://www.cancercouncil.com.au/cancer-information/advanced-cancer/end-of-life/common-questions/what-is-a-good-death/#1YZVyRT7tkEeWOWo.99

III.

https://www.webmd.com/healthy-aging/news/20180619/what-is-a-good-death

What Is a 'Good Death'?

By R. Scott Rappold June 19, 2018

There are helpful facts and a report on Colorado Assisted Suicide law-In the first year of Colorado's assisted suicide law, 69 people were prescribed aid-in-dying drugs by 37 different doctors, and 78% of them were able to die at home.

"It really is a two-pronged approach to getting acceptance. We need the patients to know their rights and to be willing to have a hard conversation with their doctor, but we also need to educate the doctors … so the patients feel comfortable discussing it and the doctors feel comfortable prescribing or referring them to someone who will prescribe it," DeWitt says.

IV

https://www.medicalnewstoday.com/articles/308447.php

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.

…

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?

…

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?

A research team from the Sam and Rose Stein Institute for Research on Aging at the University of California-San Diego School of Medicine decided to carry out a review of the existing literature to uncover what a good death entails.

The secret of a 'good death'

The team, headed up by Dr. Dilip Jeste, focused their research on three sets of individuals:

1. patients,

2. family members (prior to and during bereavement) and 

3. 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:

• Preference for a specific dying process
• Religious or spiritual element
• Emotional well-being
• Life completion
• Treatment preferences
• Dignity
• Family
• Quality of life
• Relationship with health care provider
• Life completion
• Other.

Across all three of the groups being studied, the categories considered most important were preferences for a specific dying process (94% of all reports), being pain-free (81%) and emotional well-being (64%).

However, certain discrepancies between the groups came to light. For instance, spirituality and religiosity were deemed more important by patients than family members - 65% compared with 50%, respectively.

Family members were more likely to put emphasis on life completion (80%), quality of life (70%) and dignity (70%).

Meanwhile, health care professionals tended to occupy the middle ground between the patients and family members.