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June 3, 2019 Beyond The Dash

What's a 'Good Death'?

All loss is hard, but being open about death can improve the end-of-life experience for those who are dying

What's a 'Good Death'?
The death positivity movement is a new way of viewing death, and reducing the harm caused by a culture of silence surrounding loss. (Getty Images)

Death is generally considered to be not great. Most people want to live long and healthy lives surrounded by loved ones. With modern medical practices and ever-increasing life expectancies, it's easy to slip into a sense of security that death is far off and avoidable. However, every one of us will die eventually. Preparing for this inevitability can mitigate some of the harm caused by ignoring death.

Why do we view death as an enemy?

Christian ideals are baked into the fabric of many parts of the world, including the United States, where over 70% identify as Christian. One common cultural view is that death is an enemy, and this perception is reinforced Bible:

"The last enemy to be destroyed is death."

- 1 Corinthians 15:26

Even outside of Christianity, all kinds of deaths are often seen as tragic. But when a person has reached old age, lived a good life, and feels ready to pass away under circumstances of their own choosing, is their death really a tragedy? Some death positives would argue that while it is always sad to lose a loved one, a death that is planned for, comfortable, supported and not prolonged is as close to good as anyone could hope.

When death is not accepted as a natural inevitability by a person who is dying and those supporting them, it's possible to actually create circumstances that lead to a bad death.

Just because there can be good deaths doesn't mean there aren't bad deaths. What makes a death good or bad is truly up to the individual who is dying. However, many people wouldn't consider a prolonged, agonizing death to be ideal. So what are the ways we can mitigate a traumatic end-of-life experience for ourselves and our loved ones?

Grief is universal, regardless of death positivity

Death positives believe that a good death is possible. If this is your first exposure to the death positivity movement, you might be at odds with the idea that you have to gladly accept all death as it comes. Nothing could be further from the truth. A good death does not mean that anyone has to be happy about it. Grief is an inherent part of loss. Moving through grief is a rocky road, and that's a natural part of loving someone who has passed. No one should feel forced to repress their reaction to a death.

A good death first involves acceptance that everyone must, at some point, die. Though the emotional loss is painful, this is the natural end for people who've lived a long and happy life. After a lifetime of living, a good death simply means getting to leave this world in the best possible way. Since death is inevitable, what can we do to ensure the best possible circumstances?

What could possibly make death good?

There are some common elements of what many consider to be a good death. This will vary from person to person, as the concept of a good death depends on an individual's values. For example, some Christians believe that suffering at the end of life is good, because Jesus' death was marked by suffering. For many others, a good death means slipping away from life in a comfortable environment, without worry.

While someone's medical condition may make it impossible to avoid all pain, a good death minimizes discomfort, pain and emotional anguish.

A good (or better) death might mean the dying person:

  • Has adequate medical care.

  • Has a comfortable place to live while they live out their days.

  • Has a pain management plan in place.

  • Has the support of loved ones, or a death doula.

  • Gets the chance to say goodbye to their loved ones.

  • Is empowered to make informed end-of-life decisions.

  • Is supported in their decisions regarding their own care.

  • Is afforded as much bodily autonomy as possible.

  • Has an advocate who will act on their behalf if they are unable to do so.

Steps to take

Tomorrow is never guaranteed. No one knows exactly when they will depart this earth, which is why it's important to make end-of-life decisions early. According to a recent study, over 60% of people think pre-planning end-of-life arrangements is a good idea. The same survey also showed that less than 18% actually have plans. What kinds of plans could help those hoping for a good death?

1. Make a legal will.

Having a last will and testament is a wise way to ensure your funeral, assets and dependents will be taken care of in accordance with your wishes after you pass away. A living will is a document that provides directions to medical practitioners in the event you are unable to communicate with them. Creating a living will is the best way to improve your odds of having a death that is as close to your wishes as possible.

2. Create open channels of communication.

Death is hard to talk about. In fact, a recent study showed that approximately 30% of people are uncomfortable with planning their own funeral. The death positivity movement aims to help people avoid bad deaths, by encouraging conversations about death. If you are able to openly discuss your end-of-life wishes, you can form your own opinion on what death should look like for you.

4. Let your wishes be known.

It's important to let your closest loved ones know what your wishes are, in addition to having a living will. Even informal discussions of your values will help loved ones make the right decision if you are ever unable to advocate on your own behalf.

5. Get professional help.

If you don't know how, or where, to start, consider getting help from a professional death doula. A death doula's job is to counsel the person who is dying as they come to terms with their own death. They can also help the family understand all of the options available for the funeral, and help the dying person formulate their memorialization plans. Death doulas are associated with the death positivity movement, as they can help normalize the process of death spiritually, practically and emotionally.

Limitations of the good death ideal

The concept of a good death is a wonderful ideal to hold for ourselves and those we love. But there are obvious issues with this way of viewing death.

  • Death is accessible to everyone; it's the 'good' part that evades some.

Having access to good end-of-life care usually involves access to medical care, pain management, and a facility that can support the dying person's physical and emotional needs. Not everyone has access to these.

  • Deaths aren't always predictable.

The ideal of a good death is only really practical in cases of predictable deaths: mainly terminal illness and old age deaths. For those who die unexpectedly, having a good death might be out of the question.

  • Laws don't always support a good death.

Even when a dying person has the means and preparation time, local laws may prevent a person from having a good death. There may be restrictions on the kinds of medication available or the amount that can be prescribed. Medical treatment can sometimes cause more pain in the cases of those suffering from terminal illness.

A final word

Death positivity can fall under the umbrella of harm reduction. While a death is unlikely to be perfect, it is possible to minimize the damage of a death that is painful, prolonged or unmanaged. Though the conversation about death can be ongoing, it doesn't have to be. It's okay to be uncomfortable with death, while still ensuring your wishes are known. Preparing your wishes in case tragedy strikes is a responsible step to take, that could ultimately save you from unnecessary anguish.

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