What constitutes a good death in Hospice Care?

Dr. Saul Ebema.

Although dying is part of the human condition, dying poorly ought not to be. Researchers have begun to look at various domains of what constitutes a “good death.”

I believe that a meaningful dying process is one during which the patient is physically, psychologically, spiritually, and emotionally supported by his or her family, friends, and caregivers.

According to the Institute of Medicine, a good death is one that is “free from avoidable distress and suffering for patient, family and caregivers, in general accord with patient’s and family’s wishes, and reasonably consistent with clinical, cultural, and ethical standards.”1

Weisman described four criteria for what he referred to as “an appropriate death”:

  1. Internal conflicts, such as fears about loss of control, should be reduced as much as possible.
  2. The individual’s personal sense of identity should be sustained.
  3. Critical relationships should be enhanced or at least maintained, and if possible, conflicts resolved.
  4. The person should be encouraged to set and attempt to reach meaningful, albeit limited, goals such as attending a graduation, a wedding, or the birth of a child, as a way to provide a sense of continuity into the future.2

On the basis of qualitative studies, Singer, et al. determined the primary concerns of patients regarding their impending deaths.3 These included;

  • Receiving adequate pain and symptom management.
  • Avoiding inappropriate prolongation of dying.
  • Achieving a sense of control.
  • Relieving burden, and strengthening relationships with loved ones.

Creating every opportunity to bolster or enhance these relationships is in keeping both with patient wishes and fundamental principles of palliative care.

In a recent Institute of Medicine report entitled “Approaching Death: Improving Care at the End of Life,” several domains of quality end-of-life care were identified. These include;

  • Overall quality of life.
  • Physical well-being and functioning.
  • Achieving a sense of spiritual peace and well-being, patient perception of care, and family well-being and functioning.1

Sources

  1. Field M, Cassel CK. Approaching Death: Improving Care at the End of Life. Washington DC: National Academy Press; 1997.
  2. Weisman AD. On Dying and Denying: A Psychiatric Study of Terminality. New York: Behavioral Publications; 1972.
  3. Singer PA, Martin DK, Kelner M. Quality end-of-life care: patients’ perspectives. JAMA1999; 281: 163–168.
  4. Portenoy RK, Thaler HT, Kornblith AB, et al. The Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics, and distress. Eur J Cancer1994; 30A: 1326–1336.
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