We talk a lot about the importance of a “good death”, but we’re unclear as a society on what this phrase might actually mean. There’s a lot of information on what constitutes a bad death – it usually happens in a sterile hospital, without family and in a very frail condition – and lack of guidance on how to achieve a good one. Here we look at the art of dying well, what the definition of a ‘good death’ is for experts, and why it’s not always a helpful phrase.
Is there an art to dying well?
The so-called art of dying finds its origins in the Middle Ages, with a group of books which offered practical guidance for those dying and those close to them on how to have a good death.
The Ars moriendi, or ‘the art of dying’, encourages the dying person to take on a sense of hope, with heaps of reminders about how loving Christ is and what’s appropriate death bedside behaviour for family and friends. While they’re no longer relevant to our society, the books note that planning for a good death meant caring for the whole needs of the dying person.
Now, some 400 years later, we’re still grappling with the best way to go about dying.
The official definition of a “good death”
The London End of Life Clinical Network has set out it’s own definition of what a ‘good death’ might mean. Working with healthcare professionals and end of life care teams, here’s what the Network came up with:
“A good death is the best death that can be achieved in the context of the individual’s clinical diagnosis and symptoms, as well as the specific social, cultural and spiritual circumstances, taking into consideration patient and carer wishes and professional expertise.”
In order to achieve a good death, the Network states that there must be the following attributes to any service supporting someone at the end of life:
- Access to psychological and spiritual support
- Tailored pain management
- Assessment and provision of bereavement services
- Care which is competent, confident, compassionate and personalised
- Joined-up, co-ordinated services and pathways which are easy to access and navigate
The role of hospice care in achieving a “good death”
It’s encouraging that the basis for having a ‘good death’ is now incorporated into our healthcare system. The hospice movement that came about as an answer to the perceived dreariness and even depressing nature of dying in a sterile hospital aims to create a good environment for people to live out their last days.
But dying at home isn’t always viable. While outpatient and inpatient hospice care can be valuable to free up the burden on an already strained care system, emphasis should be on how decision-making surrounding your death must be informed by the best thing to do in your given situation. This might include improving how dying people are cared for in hospitals.
How does an ageing society complicate the notion of a “good death”?
It can start to feel like achieving a ‘good death’ means a matter of juggling small doses of luck in the local care services lottery with good timing. With older age now a prolonged process, frailty has become a bigger risk factor for death than cancer and organ failure. As modern healthcare has got better, we’ve become used to more people surviving illness and disease.
When people do die, or become frail, there’s usually a larger stigma surrounding it. The phenomenon of an increasingly ageing population only adds to the importance of dealing with death honestly and clearly. With cases where families would prefer medics to prolong the life of someone who no longer enjoys an adequate quality of life, the rhetoric around the “good death” isn’t helpful.
By extending the role of palliative care into the simple ageing process, new discussions surrounding the success of this care are brought forwards. Prolonged ageing creates new challenges throughout all levels of society, from the age of retirement to the efficacy of the benefits system as it stands. For older people who’s main concerns are immobility and frailty, and with no neat cut off point for the ‘end of life’, the promise of a “good death” for all starts to sound hollow.
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