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We're a little crazy, about science!

What is a good death?

life and death quote

Food for the worms, a dirt nap, kicking the bucket, maybe there are so many euphemisms for death because it is still a taboo in certain cultures. Not so fun fact, my Uncle committed suicide some years back. I’m not going to go into details, but because suicide is looked down on, was his death still considered a “good death”? Trying to qualitatively and quantitatively define a good death, researchers have published a new paper offering help in defining the idea of a good death and have ultimately identified 11 core themes associated with dying well.

Attempting to make scientific sense of the topic, the research team focused on three groups of stakeholders: patients, family members (before or during bereavement) and health care providers.

“This is the first time that data from all of the involved parties have been put together,” said Dilip Jeste, MD,senior author.

“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 identified 11 core themes of good death based on 32 different qualifying research studies: preferences for a specific dying process, pain-free status, religiosity/spirituality, emotional well-being, life completion, treatment preferences, dignity, family, quality of life, relationship with the health care provider and “other.”

It may not be surprising to hear that different groups had different preferences for defining the good death. The groups all agreed that preferences for a specific dying process, pain-free status, and emotional well-being were important considerations for a good death. Which makes sense in as we move to a society that is increasingly leaning towards a “quality of life” approach to end of life care in general. Also, let’s face it, as that person is dying it would be outrageously selfish for significant outside influence towards that persons’ preferences for death.

As for the other themes regarding a good death, different stakeholders placed different levels of emphasis on what was more important. For example, the patients themselves more often cited religiosity/spirituality as important, while family members tended to believe dignity and life completion were more critical to a good death. Health care providers tended to represent a middle ground between patients and family members.

“Clinically, we often see a difference between what patients, family members and health care providers value as most important near the end of life”, said first author Emily Meier, PhD. 

“Ultimately, existential and other psychosocial concerns may be prevalent among patients, and this serves as a reminder that we must ask about all facets of care that are essential at the end of life.”

The end result is probably the most obvious, although to grieving families it may be of little consolation, but the researchers concluded end of life choices should be left to the dying person.

“Usually, patients know what they want or need and there is relief in talking about it. It gives them a sense of control. I hope these findings spur greater conversation across the spectrum.”

“It may be possible to develop formal rating scales and protocols that will prompt greater discussion and better outcomes. You can make it possible to have a good death by talking about it sometime before.”

Then again, why ask a scientist to define a good death when you can just as a mortician or another death professional, like the lovely folks at The order of the good death. We tend to put off the idea that we are going to die just because it is going to happen latter. Unfortunately, latter sometimes comes sooner for some than others and it is important to make sure you have a plan for end of life care.

Maybe people are just afraid of dying because it is so ordinary. As for my Uncle, well he did his best to live a good life despite life being good to him back. I like to think he had a good death and maybe that is the real secret — a dead person is dead no matter how arbitrarily we try to define a good death. It’s those of us left without them that need convincing that it was a good death, not the person who passed.

Sources:
Meier, E., Gallegos, J., Thomas, L., Depp, C., Irwin, S., & Jeste, D. (2016). Defining a Good Death (Successful Dying): Literature Review and a Call for Research and Public Dialogue The American Journal of Geriatric Psychiatry, 24 (4), 261-271 DOI: 10.1016/j.jagp.2016.01.135

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2 responses

  1. Kimberly

    “Do not pity the dead Harry. Pity the living and above all, those who live without love.” – Albus Dumbledore

    Like this quote, I think the families in the studies don’t want to think about death, but the quality of the life lived. I’ve had the misfortune to be in those shoes several times over thanks to that real life Death Eater: Cancer. It’s hard to think about death even when facing the possibility of the death of a loved one. A part of us knows that Death could be stalking us, especially when someone who shares your DNA is dying of a heritable disease. I’m taking a psychology course right now and this act would be called terror-management theory. Basically it’s a coping mechanism to help us avoid thoughts of death.

    Yet, if I try to take an objective look at the deaths I’ve seen in my family, it was not the person who necessarily lived the full life that had the best death. It would be my uncle who died on hospice. He had months of knowing he was going to die. He was able to prepare, to make right with his God, and die in the comfort of his bed in the presence of loved ones.

    Maybe removing the fear of unknowing is the key difference between the attitudes of the family and patients and why care givers are half way: they don’t know when they are going to die but have become habituated to the idea of death.

    April 1, 2016 at 6:46 pm

    • Hey a Harry Potter quote, right on. Cancer is awful, I really hope we find a better way to stop it. I have to agree, I think that having an advanced warning of death can be a great benefit, not just to the person who is dying, but to the entire family. It gives people a buffer to come to terms with everything, ironically it is usually the person dying that has an easier time with the idea than the people around them. Anyway, I think I’m getting off topic. Thank you for taking time to share your point of view and your own story.

      April 2, 2016 at 11:18 am

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