What is a good death? In spite of our tendency to avoid serious consideration of death, open discussions about it are becoming common. We have started to reclaim our death as our own. Many people are seeking alternatives to a sterilized experience of death in an institution. Increased life expectancy means that more people are living deeper into the realm of old age. Approaching death with a creative spirit is a transformative experience that rehabilitates our relationship with mortality. It is a journey that begins with the humbling question, “How do I want to die?”
If we know the conditions for a good death, we are more apt to prepare ourselves and the ones we love to die with dignity and the sense of a life well-lived, rather than treating death as a calamity requiring a trip to the hospital.
– Charles Garfield, Seven Keys to a Good Death
This article originates in the struggles surrounding my parent’s end of life experiences, which took place in a nursing home. For a variety of reasons, I cannot say that they experienced good deaths. However, one reason remains clear; as a family, we did not properly discuss or plan for a good death. Death will always be frightening, heartbreaking, and traumatic, but is is also a necessary and vital conversation to have, before it is too late.
In a simple sense, a good death refers to a brief and relatively painless period of dying followed by a peaceful death. For loved ones of the dying, a good death means being fully present and attentive to the dying. In an ideal sense, death and dying are occur inside a beloved community of people who feel a deep connection to one another.
Aging means that death is the inexorable culmination of life. Death is a phenomenon steeped in liminality; it is the very essence of ambiguity, uncertainty, and mystery. It is a force of submission that is unavoidable. To contemplate death is to feel genuine humility amid the feral nature of life.
Death is worthy of our fear. However, we often hide often hide behind a thin veil of denial and avoidance. We mask death in euphemisms to suppress our anxiety. The media and entertainment industries trivialize death by turning it into a morbid fascination that drives their marketing strategy. We engage in offensive games in which imaginary forms of killing and destruction run rampant. Finally, in hospitals, death is often sterilized, rendered invisible, and morphed into a medical event.
Today, many people are reclaiming death. The Death Cafe, for example, is an organization that promotes gatherings to discuss death openly and honestly. In other words, death is being wrestled away from institutional expertise and making it a personal inquiry. A good death has become an accepted form of conversation.
The Feral Nature of Death
We cannot fully control the circumstances of death.
Death can arrive suddenly and unexpectedly, or the process of dying can become painfully extended. In a figurative sense, it is just as possible to live past our time as it is to die before our time. In other words, death is a feral creature that cannot be brought under our control.
Death belongs to nature; it is not an experience unique to humankind. Death is a wild and capricious force that inhabits all forms of life. It is an innate connection to the shocking mystery of finding ourselves here for a brief and uncertain period.
A good death is an act of courageous participation with life. Even though we will always fear death, we can find better ways to establish a relationship with it. To imbue death with a sense of goodness is to create a connection with the ineffable.
To prepare for death is an act of humility and reverence for the natural flow of life. To reclaim death as our own is a sacred acknowledgment of our true inheritance as well as our inherited limitations.
A good death is a symbol of our belonging to the mysterious energy that animates the planet.
Preparing for a Good Death
Death is the culmination of life, not just the end of it. Part of our task is to ensure the necessities are in place, which includes a will, power of attorney, and advanced care directive. In a deeper sense, our task is to engage in a life review and establish the meaning of our presence here.
We cannot control the circumstances of our death, but we can make necessary decisions that alleviate our stress to some degree. It is essential for each one of us to provide procedural documents that remove the decision-making burden from our loved ones. These legal documents are the first step in reclaiming our death.
A Power of Attorney and advance care plan (living will), or advanced care directive, can be established to release our loved ones from the pain of making healthcare decisions in the event of our incapacitation.
However, a good death is more than just having legal documents in place; it is also about extending compassion toward others. It is a conscious attempt to reduce the burden of our death on our loved ones. A good death is an experience that is good for self and others at the same time.
As we will see below, a good death is highly collaborative.
Seven Keys to a Good Death
In his article “Seven Keys to a Good Death“, Charles Garfield lists seven requirements for a good death:
- Experience as little pain as possible;
- Recognize and resolve interpersonal conflicts;
- Satisfy any remaining wishes that are consistent with their present condition;
- Reviewing their life to find meaning;
- Hand over control to a trusted person, someone committed to helping them have the kind of death they desire;
- Be protected from needless procedures that serve to only dehumanize and demean without much or any benefit;
- Decide how social and how alert they want to be.
An underlying principle of the seven keys is that a good death requires planning as well as the involvement of others. A good death necessitates open discussion as well as the participation of a loved one as well as various forms of expertise.
For example, pain management requires medical expertise. A trusted person who guides our death will be needed to develop the necessary expertise to help provide the desired death. Protection from medical procedures the cruelly extend the experience of dying requires legal expertise. Even the creation of a life review, an essential element of a good death, may require outside expertise.
It is interesting to note that the location, or place of our death, is not included in the seven keys.
Dying at Home
Though still bereft, I take comfort from the fact that in so many ways my beloved mum had a good death… she died knowing she was loved… And our experience has made me realize that preparing for death is not just about letting go of life. It’s also about planning, preparing and making your voice heard so that you get the death you want.
The article “The last gift of a loving daughter – fighting for mum to die at home” is a remarkable and inspiring quest in which a daughter sets out on a journey to give her mom the best possible death. A powerful insight emerges: a good death requires that you make “your voice heard so that you get the death you want.”
The primary directive of a hospital is to save lives, not to provide a good death. In The Ultimate Challenge, Death, Dying, and Bereavement, Marilyn Hadad notes that 80 percent of Canadian families felt that their relatives were not always treated with respect in a hospital. Also, terminally ill people spend, on average, more than 18 hours per day alone. She also noted that hospitals were not properly equipped or funded to support hospice palliative care.
In other words, a hospital is probably the last place we would choose to die.
Nursing homes, in my experience, are not a significant improvement. The environment is still sterile and clinical. Professional detachment remains the default mode of interaction. Nursing homes can give the impression of human warehousing in which people wait for death. I do not mean to say that nursing homes fail to provide a vital service, but I am saying that the provision of a good death, from my perspective, does not seem to be a priority.
Many of us, I suspect, would prefer to die in the comfort of our home surrounded by loved ones. Sometimes referred to as the right to die at home, it is an acknowledgment that we should have the ability to choose the place of our death.
In other words, a good death also means that we have the right to choose our last place on earth.
A Good Death is an Environment of Love
We can never know when death will come for us. It may not proceed according to our best-laid plans. But at least we have plans.
Ultimately, a good death is an environment, a total surround of love, compassion, dignity, respect, and gratitude. This means that we have to expand our consciousness of death as a medical emergency, failure of science, or patholo-adolescent form of entertainment.
A good death is a sacred space in which an individual must cross the final threshold in this life. It is a form of reverence for the mysterious animating force of life to which death belongs.
A good death means that death is not the opposite of life; it is the culmination of a life well lived.