‘Good death’ checklist sought by researchers
Aim is to ensure final moments are comfortable
Los Angeles Times
What do you see when you picture an ideal death?
Are you surrounded by friends and family members, or is the setting more intimate? Are you at a hospital or at home? Are you pain-free? Were you able to feed yourself up until your death? Is there a spiritual element to your experience?
“We talk about personal medicine, but there should be personalized death, too,” said Dilip Jeste, director of the Sam and Rose Stein Institute for Research on Aging at the University of California, San Diego School of Medicine. “Finding out what kind of death a person would like to have should not be a taboo topic.”
To help open up the conversation in our death-phobic culture, Jeste and his colleagues are working on a broad definition of a “good death” that will help health care workers and family members ensure that a dying person’s final moments are as comfortable and meaningful as possible.
“You can make it a positive experience for everybody,” Jeste said. “Yes, it is a sad experience, but knowing it is inevitable, let us see what we can do that will help.”
The group’s first step was to look at previously published studies that examined what constitutes a good death according to people who are dying, their family members and health care workers.
The results were published last week in the American Journal of Geriatric Psychiatry.
The researchers searched through two large research databases — PubMed and PsycINFO — but they were able to find only 36 articles in the last 20 years that were relevant to their work.
Jeste said the lack of studies on a good death was not surprising.
“We don’t want to deal with unpleasant things, and there is nothing good that we associate with death, so why do research on it?” he said.
The articles the team did find included studies done in the United States, Japan, the Netherlands, Iran, Israel and Turkey.
From these, they identified 11 themes that contribute to successful dying including dignity, pain-free status, quality of life, family, emotional well-being and religiosity and spirituality. Also on the list were life completion, treatment preferences, preference for dying process, relationship with health care provider and “other.”
The authors report that the most important elements of a good death differ depending on whom you ask, but there was agreement on some of them.
One hundred percent of patients and family members as well as 94% of health care workers said preference for the dying process — defined as getting to choose who is with you when you die, as well as where and when — is an important element of a successful death.
There was also widespread agreement that being painfree at the time of death is an important component of successful dying. Ninety percent of family members, 85% of patients and 83% of health care workers mentioned it across the various studies.
Religiosity and spirituality — meeting with clergy, having faith and receiving religious or spiritual comfort — appeared to be significantly more important to the definition of a good death by those who were dying than to family members or health care workers. The authors report that this theme was brought up by 65% of patients, but just 59% of health care workers and 50% of family members.
Family members were more concerned with the idea of dignity — defined here as being respected as an individual and having independence — at the end of life than either health care workers or patients were. The idea that dignity was an important element of a good death was brought up by 80% of family members, but just 61% of health care workers and 55% of patients.
Similarly, having a good quality of life — meaning living as usual and believing life is worth living even at the end — was listed as an important part of a good death by 70% of family members, but just 35% of patients and 22% of health care workers.
“For a dying person, the concerns seem to be more existential and psychological and less physical,” Jeste said.