Peaceful Death

A good death is like the final chapter of a good book: it wraps up the story of "life" with panache; is physically, emotionally, and spiritually satisfying to the author (the deceased) and the readers (kith and kin); and leaves no loose ends to be explained in a sequel.

Many people want to die quickly, painlessly, peacefully and painlessly at home with their loved ones. No one wants to die a painful, prolonged death where they are depended or a burden to others or to die alone--all characteristics of a bad death. Most people want a death that is physically, emotionally and spiritually satisfying.

In 1997 The Institute of Medicine (IOM) came up with one of the more commonly recognized definitions of a Good Death as:

A decent or good death is one that is: free from avoidable distress and suffering for patients, families, and caregivers; in general accord with patients' families' wishes; and reasonably consistent with clinical, cultural, and ethical standards.


The Moment Of Death
Someone who has never witnessed a death may find it difficult to imagine what actually happens. When death is duden -- for example, followin ga heart attack or a road accident -- there is no time for the patient to suffer. Consciousness is lost immediately.

When death occurs at the end of an illness, it is not usually dramatic. A very ill patient may breathe intermittently(Cheyne-Stokes respiration). The rate of breathing slows down until it stops altogether, for perhaps half a minute or so, only to restart at an increasing rate; then the breathing slows down and the cycle starts again.

Cheyne-Stokes respiration may last for days and does not always mean that death is near. When death actually occurs, the patient becomes limp. Patients often die in their sleep -- a painless end.

A Place To Die
About two-thirds of deaths occur in hospitals or nursing homes, where experienced medical staff are able to provide the necessary care for people with terminal illnesses. There are number of hospices -- small hospitals devoted entirely to the care of the terminally ill. They provide expert nursing care, control of pain and other symptoms, and emotional support for the dying.

Much nursing of the terminally ill is carried out in the patient's home, among their family, where many terminally ill patients find it most comforting to die in familiar surroundings.

Good Death
There are six major components of a good death. These are:

1. Pain and Symptom Management
Many people fear dying in pain. Fear of pain and concerns about inadequate pain management can cause a significant amount of anxiety and distress for both the dying patient and their family. Many times this anxiety can be relieved or at least lessened with appropriate reassurance and clear decision making strategies.

2. Clear Decision Making
Patients feel more empowered when allowed to participate in decisions about treatment options. In other words patients want to have a say in their treatment plans. Fear of pain and concerns about poor symptom management can be reduced by good communication and determining a clear decision plan with the patient, their family and physicians.

Clear plans discussed before hand help reduce the chance of needing to make difficult decisions during the midst of a crisis, when people may be more emotional and less capable of thinking clearly.

3. Preparation for Death
Many patients want to know what to expect during the course of their illness. They want the opportunity to plan the events that follow their deaths--the will, the funeral and what is written in their obituary.

Preparing for death may give patients a sense of completion, because the burden of planning these events do not fall on someone else. Family members can prepare for the person dying by knowing the physical changes to expect when death arrives. Being prepared for the actual death can help prevent unnecessary emergency room visits around the time of death and allow the patient to die at home.

4. Completion
For many people Completion, or finding meaningfulness at the end of life, involves reviewing their life, resolving conflicts, spending time with family and friends, and the chance to say goodbye.

5. Contribution to Others
Many people at the end of life have a desire to contribute to others. These contributions can be gifts, time or knowledge. As the end of a person's life draws nearer, many people finally discover what is important to them in life; they discover that personal relationships are more important than professional or monetary gains and want to share these significant insights about life (learned from dying) with others.

6. Affirmation of the Whole Person
With end of life care, it is important for health care providers to affirm or recognize the patient as a unique, whole and complete person (mind, body and spirit). It is important for providers to consider the person in the context of their lives, their values and their personal preferences...and not just as a disease, a case or a patient.