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What constitutes a “good death” is likely a question few of us have thought of, let alone discussed over tea and cake. Yet cafes are springing up around the nation where people do just that—gather together for informal discussions about death—and these “Death Cafes,” as they are referred to, provide people a place to talk about that which we very often wish to avoid like the plague (pun intended, if you prefer).
Discussions about death are commonly avoided. We often feel there is little positive to be gained from a discussion about the end of someone’s life, let alone our own. Yet research overwhelmingly shows that having these discussions can dramatically increase the quality and significance of death. A recent study from the American Journal of Geriatric Psychiatry analyzed 36 other studies that gathered data from terminal patients, family members, and health care providers. The 11 themes they discovered of a “good death” are:
1. Having control over the dying process
2. Pain-free
3. Religion or spirituality
4. Emotional well-being
5. Life completion/legacy
6. Treatment preferences
7. Experiencing dignity
8. Presence of family
9. Quality of life
10. Relationships with health care providers
11. Miscellaneous (cultural specifics, presence of pets, etc.)
One of the researchers, Dr. Emily Meier of the University of San Diego School of Medicine, said: “We often see a difference between what patients, family members and health care providers value as most important near the end of life… other concerns may be prevalent among patients” that remind providers to ask patients what they value most and remember the importance of asking patients how they would like to die. Patients often feel relief and comfort as they gain more control over their death through choosing the circumstances that will surround it.
We can be better prepared for these conversations if we begin having them now. While having them as we are closer to death can still offer benefit, they can be increased by beginning these conversations early in life. The earlier we begin, the more we can determine the circumstances of our eventual exit. Natasha Billawala, a Los Angeles based writer, said of her mother’s death from the disease ALS, “It was immensely helpful to know what she wanted.” When asked whether her mother had a “good death,” she replied “Yes and no,” indicating that while her mother lost the ability to swallow, and that “last decision was taken from her,” there was still good in her death because “there was so much love and a focus on her that was beautiful.”
Like Natasha’s mom, many older patients facing death often face pain and a loss of motor control. During these slower deaths, allowing patients to return home yet continue to receive treatment for pain was key. These factors add to the emotional and physical well-being vital in providing a good death. Deciding now what you want your quality of life to be when you are older, or terminally ill, and documenting these desires, will help your family and health care providers create the best possible circumstances surrounding your death.
Despite the resistance often faced when discussing death, it’s important to remain positive, optimistic, and perhaps even with a dose of humor. When a group of British terminally ill British patients were asked about what they would consider a “good death,” their answers ranged from thoughtful to comical. One declared “I want a meteor to kill me,” while another out-of-this-world responder said “floating in a space suit while looking down at the Earth. One last good view.” A more thoughtful responder spoke of the comfort she has always felt in the arms of her husband, “as if it was the safest place in the world. That is where I want to die.”
While there are many common themes we may each consider in what will make our own death a good one, we also shouldn’t be afraid to inject our unique wishes and personality into the discussions. Perhaps, if you’re lucky, you will go the way another British patient desires—“carried away by a robotic Pterodactyl after narrowly surviving other robotic creatures. It would be a cool way to die.”
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