"Good death" concept
The "good death" concept refers to the idea that individuals can die in comfort and according to their personal wishes, supported by family and healthcare professionals. This approach emphasizes a death free from distress and suffering for the patient, loved ones, and caregivers, aligning closely with the desires of both the patient and their family. The concept has gained traction particularly in the context of end-of-life care for those with terminal illnesses and has influenced movements within the funeral industry, such as the Order of the Good Death, which advocates for a more positive perception of dying.
Historically, the understanding of a good death has evolved, shaped by cultural and social shifts. Modern hospice care, which originated in the mid-20th century, plays a key role in facilitating a good death, offering specialized support to dying patients. Research has identified several key elements that contribute to a good death, including pain management, family involvement, and respect for individual beliefs. However, cultural variations exist; for instance, in some cultures, community and family practices may take precedence over individual desires, affecting how a good death is defined. As societal values and medical practices continue to evolve, so too will the concept of a good death, reflecting the diverse perspectives surrounding end-of-life experiences.
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"Good death" concept
The "good death" concept is the idea that someone can die in comfort and in the manner he or she wants because family members and medical professionals follow the dying person's wishes. According to a report from the National Academy of Medicine (formerly known as the Institute of Medicine), a good death is one that is free from distress and suffering for the patient, family members, and caregivers, and is in concurrence with the patient's and family's wishes. This idea has become an important part of the health care field, particularly for end-of-life care when someone has a terminal illness. The concept has also inspired social movements within the funeral industry such as the Order of the Good Death, which promotes a positive attitude toward dying. Additionally, the concept has helped psychologists and therapists in their attempts to help patients understand what makes a death "good" when patients are dealing with their own impending death or with the death of a loved one.
Brief History
The good death concept has changed over time. Cultural and social changes have affected how death is viewed by any particular society. For example, a historical account from an impoverished French woman who died in the 1800s of cholera describes her desire to speak to a priest before she would feel ready to die. American Civil War soldiers who died in battle surrounded themselves with pictures of their families as they died so their deaths would be considered "good."
The modern concept of a "good death" can be traced back to the modern hospice movement. A hospice is a special type of facility for patients who are dying. While in hospice, patients receive special care to help them feel more comfortable as they die. The word hospice comes from a medieval term for places where tired or sick travelers could rest. In 1948, Dame Cicely Saunders, a British physician, began working with dying patients and became interested in helping them feel more comfortable in their final days of life. In 1963, Saunders gave a lecture at Yale University that introduced the concepts of hospice and a good death to health care professionals in the United States. Then, in 1967, Saunders founded the first modern hospice, St. Christopher's Hospice in London.
Saunders's efforts would soon be joined by Elisabeth Kübler-Ross, an American psychiatrist. In 1969, Dr. Kübler-Ross published her book On Death and Dying: What the Dying Have to Teach Doctors, Nurses, Clergy, and Their Own Families. This book outlined five stages of death that have since become well known among health care professionals. Those stages are denial, anger, bargaining, depression, and acceptance. Kübler-Ross's findings while writing this book, as well as her discoveries as a mental health professional who worked with dying patients, helped start the hospice movement in America.
Soon the good death concept began affecting modern politics. In 1972, Kübler-Ross testified in front of the US Senate Special Committee on Aging about patients' rights to die with dignity. In that testimony, she argued that society should stop denying death by locking dying patients away in institutional hospitals, but should instead provide comfort to these patients. In 1982, the US Congress introduced a hospice benefit to the country's Medicare plans. President Bill Clinton's health care reform bill of 1994 guaranteed a hospice benefit in US health care plans.
Overview
The primary difference between dying in historical times and modern death is the presence of modern medicine. Diseases that once killed people either no longer exist or can be cured with medicine or antibiotics. Terminal diseases can take months or even years to result in death. Therefore, a dying person often has time to plan his or her death.
Many organizations have worked to define what makes a death a "good death." In 2016, the Stein Institute for Research on Aging, a program at the University of California at San Diego's School of Medicine, published a study in the American Journal of Geriatric Psychology that reviewed previous articles on the good death concept. This study, according to program director Dilip Jeste, found less than forty previous studies about the subject. The previous studies included research from the United States, Japan, the Netherlands, Turkey, and other countries that offered a multicultural look at the good death concept. These studies helped the program find eleven main ideas about what makes a death good. These ideas included dignity, freedom from pain, quality of life, the participation and presence of family members, emotional care, and attention to the dying patient's religious or spiritual beliefs.
According to Dr. Elizabeth Collins, who specializes in end-of-life care at Lahey Hospital & Medical Center in Burlington, Massachusetts, five elements define a good death. These elements are the control of a patient's pain, the involvement of family members and friends, the patient's ability to understand and accept the illness, the consideration of the patient's religious or spiritual beliefs, and the ability for a patient to feel that his or her life had meaning or purpose. Several of these elements are similar to the main ideas discovered by Jeste's program.
In other cultures, however, a good death is not necessarily defined according to what an individual wants. For example, Hindu culture believes that a person should die while lying on the floor while family members pray. This poses a problem for some Hindus while in hospice because they may be embarrassed to ask for what their culture requires. Also, in cultures that focus on a person's individual choice, a good death may be impossible. For example, a patient who dies with Alzheimer's disease may not have the mental ability to make his or her own choices about the dying process.
Overall, the concept of a good death will continue to change as society and medical technology continues to develop. Individualistic societies, such as the United States and Great Britain, tend to look at the preferences of an individual person over what society says that person should do. Therefore, those societies are more likely to allow a patient to make his or her own choices about death. As these societies become more multicultural through immigration, however, ideas about what constitutes a good death will continue to evolve.
Bibliography
Gordon, Peggy Sturman. Psychosocial Interventions in End-of-Life Care: The Hope for a "Good Death." Routledge, 2015.
Granda-Camerson Clara, and Arlene Houldin. "Concept Analysis of Good Death in Terminally Ill Patients." American Journal of Hospice and Palliative Medicine, vol. 29, 23 Feb. 2012, pp. 632–39.
"History of Hospice Care." National Hospice and Palliative Care Organization, www.nhpco.org/history-hospice-care. Accessed 13 Nov. 2017.
Illiades, Chris. "Renewing the Concept of a 'Good Death'" Parentgiving.com, www.parentgiving.com/elder-care/renewing-the-concept-of-a-good-death/. Accessed 13 Nov. 2017.
Kehl, Karen A. "Moving Toward Peace: An Analysis of the Concept of a Good Death." American Journal of Hospice and Palliative Medicine, vol. 23, no. 4, Aug./Sept. 2006, pp. 277–86.
Netburn, Deborah. "What Does It Mean to Have a 'Good Death'?" Los Angeles Times, 1 Apr. 2016, www.latimes.com/science/sciencenow/la-sci-sn-a-good-death-20160401-story.html. Accessed 13 Nov. 2017.
"On Death and Dying." Elisabeth Kübler-Ross Foundation, www.ekrfoundation.org/five-stages-of-grief/. Accessed 13 Nov. 2017.
Walter, Tony. "Historical and Cultural Variants on the Good Death." BMJ: British Medical Journal, vol. 327, no. 7408, 2003, 218–20.