Monday, September 28, 2009

What Is a "Good Death"?

Helping to ensure a "good death"
Poets, professors, priests, and plain folks all opine about what makes a "good death." In truth, deaths are nearly as unique as the lives that came before them—shaped by the attitudes, physical conditions, medical treatments, and mix of people that accompany them.
Still, many have pointed to a few common factors that can help a death seem good—and even inspiring—as opposed to frightening, sad, or tortuous. By most standards, a good death is one in which a person dies on his or her own terms, relatively free from pain, in a supported and dignified setting. Other things to consider:

Having affairs in order
Not everyone has the luxury of planning for death. But those who take the time and make the effort to think about their deaths during life and plan for some of the details of their final care and comfort are more apt to retain some control and say-so in their final months and days of life.

Legal specifics of such planning can include taking steps to get affairs in order by:

-Having an estate plan, with a will, trust, or other arrangement that sets out who gets property and how it should be divided.
-Specifying final medical care in an advance directive.
-Making final arrangements for body burial or cremation.
-Indicating preferences for a funeral or memorial service. Psychological preparation includes
talking about an impending death with caregivers, family members, and others.

Controlling pain and discomfort
Most Americans say they would prefer to die at home , according to recent polls. Yet the reality is that three-quarters of the population dies in some sort of medical institution, many of them after spending time in an intensive care unit.

As life expectancies increase, more people are becoming proactive . A growing number of aging patients are choosing not to have life-prolonging treatments that might ultimately increase pain and suffering—such as invasive surgery or dialysis—and deciding instead to have comfort or palliative care through hospice in their final days.

Having few regrets
Often quoted in the literature on death and dying are the tenets in The Four Things That Matter Most, by Ira Byock, a medical doctor who professes the need for a dying person to express four thoughts at the end of life:

I love you.
Thank you.
I forgive you.
Forgive me.

This supports the idea that, for many people, a good death requires ending life without unfinished business, and with reconciling damaged or broken relationships when possible.

Receiving mindful care and support
The right company can help aid a "good death." Although dying may be scary or sad or simply unfamiliar to those who are witnessing it, studies of terminally ill patients underscore one common desire: to be treated as live human beings until the moment they die.
@-Most also say they don't want to be alone during their final days and moments. This means that caregivers should find out what kind of medical care the dying person wants administered or withheld and be sure that the medical personnel on duty are fitting in skill and temperament.
@-Favorite activities or objects can be as important as final medical care. Caregivers should ascertain the tangible and intangible things that would be most pleasing and comforting to the patient in the final days: favorite music or readings, a vase of flowers, a back rub or foot massage, being surrounded by loved ones in quiet or conversation.
@-Spirituality can help many people find strength and meaning during their final moments. Think about the patient's preferred spiritual or religious teachings and underpinnings, since ensuring access to this can be especially soothing at the end of life.

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