After experiencing a loss, our minds often become preoccupied with dissecting the circumstances by which our loved one’s life came to an end. What were their final moments like? Were they scared or in pain? Were they surrounded by family and close friends? Was the death expected or unexpected? Did they have a chance to say goodbye? Did they have time to get their affairs in order? Did they die in the care of medical professionals or at home? We ask these questions in the hope that we might be able to discern whether or not they had a “good death”.
What dying well means is however different for each person, often shaped by their attitudes, cultural background, spiritual beliefs and medical treatments. For example, some people see staying at home as the key to dying well, but others feel more supported spending their last days in a hospital or palliative care unit. Some people might prioritise reconciling damaged or broken relationships before their time is up, or they might instead focus on resolving their regrets. Some people’s death may ideally involve an acceptance of mortality, a wish for medical relief from suffering and time to say words to the people they love. For others, a good death may mean fighting against it until the end with every medical intervention available.
In any case, friends, family or a health care team surrounding the person approaching the end of their life should understand what matters most to that person, so that they are able to pass in a way that aligns best with their values in life.
A good death, according to those most familiar with it
There are many professionals who have dedicated their careers to helping others transition into the next stage of life. We consider their insights and perspectives to help shape our own ideas of what it means to have a good death.
Among many other things, Dr. Shoshana Ungerleider is an internal medicine physician who founded the End Well Project. She emphasises that all human beings will eventually experience both the loss and grief that accompanies the passing of a loved one, as well as the realisation that our own time on Earth is finite. Rather than shy away from it, we should be spurred by this prospect to transform how the world thinks about, talks about and plans for the end of life by bringing people, ideas, technology, care and community together to create a new roadmap. This is because improving the end of life experience is not just a medical issue, but a cultural issue, and it needs to be evolved into a fully human and humane experience for everyone in order to be ‘good’.
Dr. Timothy Ihrig, a palliative care physician, also focuses on the ‘humanity’ in providing care for people in the final chapters of their lives. He highlights that the values of the humans being cared for are often overlooked, despite the important role they play in determining a patient’s overall quality of life. He observes that most patients wish to maintain their essential selves until their last breath, and so a good death is one that aligns with the values, beliefs and wishes of the individual - all that matters in the end, matters now. The understanding of the patient’s values can help in navigating serious illness from diagnosis to death with dignity and compassion, ultimately ensuring that they have been empowered to die well.
In her mission to help people talk about living life more fully, social worker and psychotherapist Linda Hochstetler encourages people to find their own priorities for their life. She believes that the most important determinant of a good death is the willingness - of both the dying person and their family - to see death coming for a few weeks before it comes. This makes it easier to say what needs to be said when the time is close, and for everyone involved to feel ready for the transition.
To end-of-life consultant Julie McIntyre, a good death involves some preparation around advanced care planning, so that there is someone who can confidently make healthcare decisions on behalf of a person who is no longer able to. This will make it more likely that a loved one can die where and how they would prefer, and ease the burden on those left behind. Much like funeral planning, talking about death or preparing your Will, this type of planning always seems too soon until it’s too late.
Licensed funeral director, Emily Bootle, poetically describes a good death for herself: “my hope is that by the time of my death I will have prepared my community so that I may drop like a small pebble with slow-moving ripples waving me goodbye”. In other words, she wants to leave the living with a sense of peace amongst the pain and sorrow, as opposed to making a traumatic or untimely “splash” like a “huge boulder falling into a lake”.
The first step to dying well
Most people who work closely with death agree that a good one starts with calm and open conversations about end-of-life while you are still living. This means empowering ourselves to make choices that directly affect the end of our life: having conversations with people that are important to us about our wishes, choosing our final disposition and making conscious decisions while we still can. Our hope at Willed is that these perspectives inspire you to contemplate your own desires and consider the elements of a (good) death that are within your control.