This paper will explore what would entail “A good Death”. I will discuss Pain Control, No Excessive Treatment, Retention Of Decision Making By The Patient, Support For The Dying Patient And His/Her Family And Friends, Communication Among All Parties And Acts Done Out Of Love That Make Dying More Difficult. I will make references from The Last Dance: Encountering Death and Dying, 9th Edition by DeSpelder, Lynn Ann; Strickland and Albert Lee and the “On Your Own” PBS series narrated by Bill Moyer.
Keywords: death, dying, palliative, hospice. pain management
A Good Death
“Everyone knows they’re going to die but nobody believes it. If we did, we would do things differently.”
A good death is dying surrounded by loving family and friends, free of pain, suffering and worries, a death where the dying has had great support from caretakers and family leading up to his final day. A good death is when there is no confusion of decision-making and will and when the dying, their family and caregivers are all on the same page. A goon death is when the last decisions come from love and not necessity and where all parties; the dying, the family and the care takers feel at ease and all decisions where well made.
A death free of pain is a large part of constructing “a good death”. As death is commonly physically painful, ways of controlling pain are a very important factor. When a person decides to stop their treatment of a terminal illness or may still be in the process of trying to treat a terminal decease, pain control is essential to make the patient have any kind of good quality of life. Pain control is an essential factor in hospice and palliative care. “For hospice and palliative care. The goal of medication is to restore or sustain a sense of equanimity and personal integrity despite the disturbances caused by the illness. The main aim is to control pain and other physical distress”. Dr. Meier at the Hertzberg Palliative Care Institute Mt Sinai explains in “On Your Own” the PBS series narrated by Bill Moyer that “ People that are in pain are exhausted, depressed and are not sleeping well and then taking pain medication does not mean they are giving up their fight against their disease”.
In the series an old woman named Mrs. Fort is featured. Mrs. Ford has Alzheimer’s decease and is dying. Her palliative care team that includes a Dr. Carter is helping her with Fentanyl patches to relieve her pain. Fentanyl patches are a new helpful way to distribute pain medication evenly for a long period of time. Mrs. Fords daughter is explaining that “when mother is in pain, I am in pain” and emphasizes how important her mother’s pain management helps not only her mother, but their entire family. “What would be a good death?” Bill Moyer asked a patient. “A pain free death” he answers.
No excessive treatment
When is the right time to make the decision to stop treating a terminal illness? At what point will the dying and their family come to terms with the illness being terminal and decide to face death and stop treatment? A decision to say no to excessive treatment is usually a hard decision for the dying and their family. It is hard to give up hope on life and difficult to come to peace with the fact that the patient is actually dying and that there is nothing anyone can do to stop it. Stopping treatment is a great decision that patient; family and treatment team should make together and has to be done with great care. Excessive treatment might extent the life of the patient, but to a cost that might be devastating.
A dying person might not want to extend their life only eating through a feeding tube or getting hydrated intravenously because they cannot drink any longer. A terminally ill person might not want to receive more treatment if he can no longer breath by his own will. Keeping a person alive by excessive treatment might devastate the family and make the dying suffer tremendously in the end. “Advance medical technology that seems to one person a godsend, extending life, may seem to another a curse that only prolong dying. Dignity can be devalued amid technology focused solely on the biological organism.”
Retention of decision-making by the patient
It is very important that each individual, if possible has a say in his or her own dying and death. Facing death is hard for everyone and there are specific issues to be talked about in advance. A living will or a Physician Order for Life-Sustaining Treatment (POLST) is extremely useful. The POLST is designed for people with serious or life-threatening illnesses. “This is a standardized form that describes a patient’s wishes and is signed by his or her physician, providing both summary of an individual’s advance directive decision and the physician’s order. It can be used to inform emergency personnel about a patient’s wishes for life sustaining procedures, such as CPR.
“ Every seriously ill patient and their family should have decided the following issues: proxy, resuscitation, hospitalization, and specific treatments. Every seriously ill person needs to have pointed out a person to speak on their behalf when they get too sick to do so. A “proxy” can be filled out at any hospital or nursing home granting “power of attorney” to a loved one to be able to make decisions. A person that does not desire to be resuscitated needs to have their physician write an order “not to attempt resuscitation” to not be resuscitated by emergency personnel in case of sudden death.
Hospitalization is also something that needs to be discussed in advance. Many terminally ill people do not want any more surgeries or tests done. They want to avoid hospitals except to relieve suffering. Specific treatments are also important to discuss in an early state of illness. Many patients fear breathing by machine or getting artificial hydration and nutrition. If the patient wants to forgo these treatments, he can write that down in advance. Support for the dying patient and his/her family
There are different kinds of support for the dying and their family. The most important part is that everyone involved receives support. For the dying patient there are many different points of support. There are family members and friends, physicians, therapists and hospice workers. Important things to do for a dying individual is being there, listening, helping with death planning, touching, talking and assisting with arrangements. Hospice assist patients with emotional and spiritual support as well as palliative care. “The mission of hospice care goes beyond the physical and seeks to relieve suffering by caring for all of a patient’s needs: physical, psychological, spiritual, and existential.”
“We take our elders and put them away not to see their pain instead of greeting death at the door” says Frank Ostoteski at Zen Hospice. Frank continues to explain that they “focus on the person and not the illness and that each person’s dying is unique.” He says, “pain can be relieved by morphine, suffering cannot.” Families that experience death need support as well and each person living through a death of a loved one learns something personal and unique. Mary Catherine Kinnick lost her mother at 21 years of age and realized at that point she was not afraid of dying. She did not want to dye, but she was not afraid. She now volunteers at a hospice facility. Some families grow closer while others grow apart when family members die as everyone experiences loss in their own way.
Pam Roffol-Dobies got emotional support from family and friends while dealing with the emotional trauma of loosing her husband to cancer; others lean on physicians and health care professionals for support. Family members are often involved as caregivers and usually report it being the hardest thing they have ever done, but also the most rewarding. Most dying individuals figure out their own tecnique to hold their heads up, to go through each day as strong as possible: “I don’t know about the rest of you, but I cannot live each day as if it is the last day that I am going to be alive. I can’t. That makes life really hard for me. But what I did discover is that I can live by the calendar method; I can live in yearlong segments. I could live each day on the calendar as if it were the last time I would be above ground that day. I could live each birthday that way, each wedding anniversary, each spring, each Christmas. And it not only worked, it actually made each of those days more special than it would otherwise have been”
Communication Among All Parties
Watching “A Death of One’s month” part of “On Your Own” PBS series narrated by Bill Moyer you are amazed over the great communication between the veterinarian Jim Wittier suffering from ALS and his wife Suzie. Jim slowly gets more and more paralyzed and doesn’t know when he will give up and give in to death. Jim changes his mind continuously as his disease progresses but continues to communicate these changes to his wife. His request to complete a physician-assisted suicide is denied from his health care team and resisted by some family members but his continued communication with his wife is remarkable. Jim’s papers are in order, denying feeding tubes and hydration though in IV and his family is aware of wishes and the signed papers. Communication between the patient, family members, health care team and hospice workers is essential for a good death. That all parties are on the same side, knowing about all documents signed, knowing the plan and what to do in each incident is crucial for complete teamwork in completing a good death.
Another important factor is communication about economics, like the will, insurance and death benefits. “Estate Planning not only optimizes survivor’s financial security but also helps to ensure peace of mind, both for the bereaved and for the person who has taken steps to put his or her affairs in order.” Insurance and death benefits are also issues that should all be in order and thoroughly communicated to family members involved as this can hold spouses left behind or children to cover medical and funeral expenses. “Depending on a person’s age and health, life insurance can be a convenient way of leaving a basic estate for our beneficiaries after we die. Life insurance offers some advantages not available with other investments. For example, life insurance benefits payable to a named beneficiary are not subject to attachment by creditors.”
Acts done out of love that makes dying more difficult.
As we care for our parents, spouses, brothers or sister in their dying hour it is very hard for us to know what the right thing is to do as we are emotionally attached to the dying individual. We want to save them, help them, cure them and rescue them. We want all their suffering to disappear and for them to return to the healthy happy selves we once knew. It is hard to make the right decision. When watching Jim’s daughter speak against his wishes to die with assistance from his physician, she does it out of love. She does not want him to die nor go against the church and sin. Is this really helping Jim? When loved ones choose feeding tubes and breathing machines to prologue the lives of their loved ones, dying become a lot more difficult. “Dying well, to many means control over choices to be made as we die. We fear dying in pain; we fear that too much will be done to keep us alive, or we fear that not enough will be done”
This paper has discussed issued of what would make “A good Death”. I have discussed different matters researched from The Last Dance: Encountering Death and Dying, 9th Edition by DeSpelder, Lynn Ann; Strickland and Albert Lee and the “On Your Own” PBS series narrated by Bill Moyer. I have talked about Control, No Excessive Treatment, Retention Of Decision Making By The Patient, Support For The Dying Patient And His/Her Family And Friends, Communication Among All Parties And Acts Done Out Of Love That Make Dying More Difficult.
Ending this paper on a personal note; I have learned that death is universal but also as personal and individual as something can possibly become. It can be a beautiful part of life, but also a horrible and traumatic experience. Everyone will die one day. Hopefully, as many of us can do it on our own terms, having “as good of a death” as it possibly gets.
1. The Last Dance: Encountering Death and Dying, 9th Edition by DeSpelder, Lynn Ann; Strickland p. 190 2. Dr. Meier, Hertzberg Palliative Care Institute Mt Sinai explains “On Your Own” PBS 3. Mrs. Ford, “On Your Own” PBS
4. Steve, “On Your Own” PBS
5. The Last Dance: Encountering Death and Dying, 9th Edition by DeSpelder, Lynn Ann; Strickland p. 253 6. The Last Dance: Encountering Death and Dying, 9th Edition by DeSpelder, Lynn Ann; Strickland and Albert Lee p. 190 7. Frank Ostoteski, Zen Hospice “On Your Own” PBS
8. Mary Catherine Kinnick, “On Your Own” PBS
9. Bill Bartholome, “On Your Own” PBS
10. The Last Dance: Encountering Death and Dying, 9th Edition by DeSpelder, Lynn Ann; Strickland p. 238. 11. The Last Dance: Encountering Death and Dying, 9th Edition by DeSpelder, Lynn Ann; Strickland p. 249 12. Jim Wittier, On Your Own” PBS series narrated by Bill Moyer.
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