Trying to determine a precise definition of a Good Death can be challenging for people and professionals alike. A dying person's perception of what constitutes a Good Death is determined by the person, family, friends and health care providers. Providers may have very different definitions of a Good Death than patients and families.
In search of a definition of a "Good Death," Steinhauser and her colleagues gathered descriptions from seventy-five physicians, nurses, social workers, clergy members, patients, volunteers and bereaved families.
They identified six major components of a good death.
Many people fear dying in pain. Fear of pain and concerns about inadequate pain management can cause a significant amount of anxiety and distress for both the dying patient and their family.
Many times this anxiety can be relieved or at least lessened with appropriate reassurance and clear decision making strategies.
Patients feel more empowered when allowed to participate in decisions about treatment options. In other words patients want to have a say in their treatment plans.
Fear of pain and concerns about poor symptom management can be reduced by good communication and determining a clear decision plan with the patient, their family and physicians.
Clear plans discussed before hand help reduce the chance of needing to make difficult decisions during the midst of a crisis, when people may be more emotional and less capable of thinking clearly.
Many patients want to know what to expect during the course of their illness. They want the opportunity to plan the events that follow their deaths--the will, the funeral and what is written in their obituary.
Preparing for death may give patients a sense of completion, because the burden of planning these events do not fall on someone else.
Family members can prepare for the person dying by knowing the physical changes to expect when death arrives. Being prepared for the actual death can help prevent unnecessary emergency room visits around the time of death and allow the patient to die at home.
For many people Completion, or finding meaningfulness at the end of life, involves reviewing their life, resolving conflicts, spending time with family and friends, and the chance to say goodbye.
In western culture Completion is often an individual life review that then gets shared with family and friends. With other cultures Completion may involve other members of the dying person's community and certain cultural rituals that are important parts of the dying process and coping after the death.
Issues of faith also important are individualized. Cues need to be taken from the patient how these might be expressed.
Many people at the end of life have a desire to contribute to others. These contributions can be gifts, time or knowledge.
As the end of a person's life draws nearer, many people finally discover what is important to them in life; they discover that personal relationships are more important than professional or monetary gains and want to share these significant insights about life (learned from dying) with others.
Dr. Leo Buscaglia had this to say about death:
- Death teaches us...that the time is now.
Death teaches us the joy of the moment.
It teaches us we don't have forever. Death says, "Live now."
With end of life care, it is important for health care providers to affirm or recognize the patient as a unique, whole and complete person (mind, body and spirit). It is important for providers to consider the person in the context of their lives, their values and their personal preferences...and not just as a disease, a case or a patient.
These personal, touching relationships with patients and families are often what allow healthcare professionals to continue working in this challenging area of medicine.
The results of this study helped confirm four important themes that were already known in palliative care:
- Pain and Symptom Management
- Clear Decision Making
- Preparation for Death
- Completion
Two new unexpected themes about a good death were also discovered from the study:
- Contributing to Others
- Affirmation of the Whole Person
Steinhauser KE, Clipp EC, McNeilly M, et. al. In Search of a Good Death: Observations of Patients, Families, and Providers. Annals of Internal Medicine. 132:825-832. 16 May 2000. 3 November 2006. <http://www.annals.org/cgi/reprint/132/10/825.pdf>
Brody JE. World Enough and Time for 'a Good Death.' New York Times. 31 October 2006. 1 November 2006.
Dyer KA. Rewards for the Physician Dealing with End-of-Life Care for "Dealing with Death & Dying in Medical Education and Practice," American Medical Student Association (AMSA) Convention March 30, 2001. 1998. <http://www.journeyofhearts.org/jofh/kirstimd/AMSA/rewards.htm>
