What Is a "Good Death"?

a good death

These days, everyone from poets to professors, priests, and everyday 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 combination of attitudes, physical conditions, medical treatments and people involved.

“A good death can, and should, mean different things to different people,” says Haider Warraich, MD, author of "Modern Death - How Medicine Changed the End of Life." "To me, it means achieving an end that one would have wanted, and that can really mean anything – from being in the intensive care unit, getting all sorts of life-sustaining therapies, to being at home, surrounded by family, getting hospice care.”

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 own terms, relatively free from pain, in a supported and dignified setting.

“I think what makes a good death is really different for every individual, but there are some common threads that occur with each person I’ve seen,” says Michelle Wulfestieg, executive director of the Southern California Hospice Foundation (SCHF) and author of "All We Have is Today: A Story of Discovering Purpose."

Some of patients' most common end-of-life priorities include being at peace spiritually, knowing that they have the support of loved ones, having their affairs in order and being reassured that they won’t have a painful death, says Wulfestieg, who has worked in hospice care for 14 years.

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 death in advance 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, weeks and days.

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

For those considering hospice care at the end of life, another crucial end-of-life planning step is to elect the hospice benefit under Medicare, notes Joseph Shega, MD, national medical director for national hospice care provider VITAS Healthcare. He points out that hospice care is covered by Medicare, along with most health insurance providers.

Richard Averbuch, Executive Director of the Massachusetts Coalition for Serious Illness Care, cautions not to wait until a serious illness or crisis before planning for end-of-life care.

“The best time to name a proxy and talk about your preferences is now – whatever your stage of life. Think of it as part of your overall wellness program – just as important as preventive care, an exercise regime, and a good diet,” he says. “And you need to revisit the conversations periodically, since your feelings may change as you age or as your health status changes.”

Controlling pain and discomfort

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

Part of that may be due to misunderstandings about the different options for treating a patient’s pain in their final days.

“There are still people who are uncomfortable with the use of pain medications at the end of life, even as their use is essential for the patients who are in pain,” says Warraich.

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.

Ways to help ensure a "good death" on an emotional level

Along with the practical matters of having one's affairs in order, it's equally important to prepare for death emotionally, to spend time with loving people toward the end of life, and to have spiritual sustenance.

Having few regrets

“Patients really want to know that their life had purpose, that they made a difference and that their lives mattered,” says Wulfestieg. “It has to do with family a lot of times, saying those I love yous and goodbyes.” The SCHF often works to reunite dying patients with family members, including those who have long been estranged.

Often quoted among hospice care providers and 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.

At the time Caring.com spoke with Wulfestieg, her organization was preparing to reunite Marilyn, a woman with ovarian cancer and only a few weeks to live, with her three estranged adult children and grandchildren.

Due to Marilyn’s problems with drugs, alcohol and crime, all three of her children grew up in foster care, and she'd lost contact with them. Her dying wish was to have a family meal with her children and grandchildren, so SCHF have arranged to fly out Marilyn’s family members to make it happen, Wulfestieg says.

“That’s really her dying wish, to be able to say 'I’m sorry, I love you and goodbye,'” she says. “It’s really a story of grace and forgiveness and hope.”

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.

“Before health care decisions around end-of-life care can be delineated, clinicians and patients must first recognize when life-limiting conditions such as heart failure, lung disease or cancer are no longer responding to disease-modifying treatment,” Shega says. Next, he says, there should be “a conversation between the patient and clinician about end-of-life care and the role of hospice.” He adds that care teams need to provide ongoing support to the patient and their loved ones throughout their final days, “never abandoning the patient and respecting their choices.”

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.

Caring.com Editorial Manager Laura Dixon contributed to this article.

Barbara Kate Repa

Barbara Kate Repa, a lawyer and journalist, has devoted her career to editing and writing about legal issues for consumers. See full bio

11 months, said...

Sorry - I meant my husband is in hospice right now. Article is spot on. Shows you how my mind is working.

11 months, said...

My husband is in husband right now. Your article is spot on.

11 months, said...

In 2003, on BMJ I have illustrated what is a good death in my opinion: Stagnaro S. What is a good death?: Good death will happen if life was good. BMJ; 327: 1047 [MEDLINE]

about 2 years, said...

My friend is at the last days of life. She refused hospice. Ran off care providers. Did it her way for 5/6 weeks. Now she is in hospital and might be going home with hospice {ANGELS ON EARTH}. I know I have no idea what she is going through. But she is not trying to have a "good death". She is fighting with her Mother and daughter, What I would like to know is this common? Do people really die letting love ones feel no peace. Without asking for forgiveness. Everyone has something needs forgiven. She and her mom & daughter have had their 'issues' but no family bond is stronger. Do people who have the opportunity to love, forgive, share peace with those dear to them, Let the last moments be ugly words for those left here. Isn't it comforting to know you leaving them sad but comforted by your love and being forgiven?

over 2 years, said...

My loved one is dieing of liver cancer and isn't expected to live till the first of 2016. He doesn't wasn't want anyone to visit. But he has a lot of friends ! He does let two come over. Most of this is because he has lost so much weight and looks bad. He is a very clean man and is proud of his appearance . But when Bruce and Brant come over he lights up and talks, I think he doesn't want to feel like a freak show! I understand his wishes but then again I wonder if he is making a mistake . He has a lot of people that love him. Sometimes he does things that hurts my feeling but I know he doesn't feel good ,so I am trying to stay strong for him. Is there anything that I need to do to help him? He also is having cravings for certain foods and then when I fix it he takes about 3 bites and is done ! WE do talk about the end as I think we need to and he has prepared for the funeral and the will. He mostly is preparing for me and that really touches my heart !!

over 2 years, said...

Iam dying with pulmonary fibrosis and am in need of what to expect at the end of my life and the process of dying.

over 2 years, said...

I am preparing for the fact my mom may have one more year. She doesn't want to move in with us(she lives 1400 miles away) but she is still lucid and pretty active for 88.She doesn't want to leave her comfort zone . We've talked about this numerous times.She has excellent medical care(is in NY) It still doesn't stop me from feeling sad though she told me how good we(her children) have been and this is her decision) What makes me feel sad is I've had 2 friends who were able to care for their parents during their last year. I have cared for her when she needed it(3-4 week post op care) but she just won't think about moving. I can't force her to leave because her mind is sharp and talking about this upsets her more.

almost 3 years, said...

My compliment about this blog is very positive I visit this blog first time and impress by this stuff nice work. Great Post Keep Posting such a good information.

about 3 years, said...

this text is extrordinary

over 3 years, said...

I think there is also a comfort in knowing the people/pets/things you love will be taken care of by those who are living on after you die. Getting that commitment from them relieves anxiety.

over 3 years, said...

I think many people feel guilt upon the death of a close family member. They wonder if they did everything they could do for that person. This gives reassurance and specific suggestions to make the process easier, since none of us are going to avoid it.

about 4 years, said...

I suppose you can tell that i really didnt read the hole thing up intell now. i dont comment a hole lot. I am taking care of my father in his home he is in his 80 and had a stroke his hole left side is parolized we have to feed him and q him to swallow sometimes he forgets. The big thing to me is to make sure he is turned every 2 hrs and he is comfortable. we try and get him up at least 2 times a day cuz he needs the range of motion. He has a very strong will to live and he is very terrified to die. I would like to help him with that however i dont know what to say i have a siter who is always asking him things like who do you think or want to help you crossover and why are you afraid to die and what can i do to help you and i cantell he gets uncomfortable when she asks him stuff like that.So i dont want to make him feel that way. I guess all i really can do is keep showing up for him everyday and i hope the rest will come to me.I do want so much for him to have a good death one thing i know forsure i have alote of brothers and sisters and he needs to see that we are happy and to get along and stop hurting one another i guess i can start there.

about 4 years, said...

I would like to leave a comment for Shoooobee. About her wondering question. My father had a stoke about 6 months ago. He is 81yrs diebetic and was in the hospital for 2 weeks than went to a skilled unit facility for 2 months. He had reached his point of improvement and they wanted to place him in a nursing home. His wish is to die at home in his worm bed so i went and purchaced an electric hoyer lift, recliner wheel chair and electric hospital bed and brought him home. His hole left side is parolized, most all the time he needs to be fed, He has mild dementia,one of the goals we are aiming for is to try and sit up on the edge of the bed (which takes 3 of us to help attempt,He is 6.1 and 290pds) Now with that being said you mentioned while shring that your mother would stair off to the side at the cieling for hrs and if anyone else expearience the same thing . I will tell you what my father does... I have seen him 3 or 4 times in the last mounth stair off to one side and his eyes looked as if he was gone almost spaced out with out blinking and what really baffled me was he was snoring at the same time now my father does snore but not once in 51 years have i seen him snore with his eyes open i havnt seen ANYBODY sleep with there eyes open its like he is looking at something with his periveral vision stairing eyes wide open and snoring .I dont know if he is actualy sleeping or not i told my sister about it and she said if it happens again to call her and she would drop everything and drive over which if she drives fast she can be at my place in 7 min. Well it happend again and she saw it to and we figured that he was having these minie strokes. or maybe a sieger. so we halled him off to Dr. for test to see if thats what it was and all tests came back negative. So we are thinking that he just goes away to his own little safe place a place that bring him joy he just tunes out and comes back when he feels its safe enough. Intell it happend again this time not only did he come back happy but he started talking about wondering why my mother9 who passed when i was 2 ) isnt here with him and where is she and talking about people who have passed, my father never talked about people that have passed he believes once there gone there gone get over it type of thing.all of a sudden he has a stroke and he's snoring with eyes open talking about loved ones who have passed as if there still here. I do not know who this man is anymore but i sure love who he has become.My father has always been highly intuitive. He has had his dog for 14 years she is a german shepard and he is very close to her they are very connected to her and he used to talk to her and say " i wonder who is going to die first you or me molly. or he would say " i dont know what iwould do if you were to leave me molly" well last week he told me to look at molly that she was surrounded by angels i about went into shock i said tell me more about that dad and he says look again you have to look past your eyes.Anyways i am way off base here but you wanted to know if anyone else expearience what you had and yes i believe i have i just wish i knew where he goes when he stairs eyes wide open snoring w/out a blink. Sence the stroke my dad rarely talks at all but when he does i listen but if my responses are not real or i act happy when i am hurting he will shut down he does that alot i come from a family of 10 siblings and i have gotten to respect his energy and pertect his energy and if he shows a pattern of shutting down when certain family members are around i try and shortin the visit when they do come because sometimes days will pass tell he comes back . Next time my father snores and stairs like that i want to ask him where he goes or who he see's but i am afraid he will shut down. i dont know how to go about it> if you are anyone has any ideas how i could find out what he see's i am open I know my father has a very strong will to live i also know he is very much afraid to die. We talk alittle about it he does'nt like to talk about it but sence the stroke he actualy is more open to talk.

about 4 years, said...

it was good imformation

about 4 years, said...

its not what people think its a knowing and peace that you want to share to aid others unprepared for there inevitable trip.More importantly an end of pain of abuse.Heart break broken promises.A life tired.. devoted to others.Seeing it as a positive trip to peace that could not be found on this cold plain.Death could never be as cruel as life...Thanks for this trip on breathing earth.Please protect our oceans and planet others will come and need this space.

over 4 years, said...

Shoodoobee: When my husband passed away he was staring at the ceiling and smiling at what he saw. He tried to reach up to whoever he saw but was so weak his arm kept falling back down on the bed. He had been comatose. I am so positive your mother was experiencing the same thing. Sounds like she saw several people who were there to take her over to the other side. I've seen it...I know it. Hugs

over 4 years, said...

My 84 year-old mother passed away 3 weeks ago in the hospital after about 3 days of pneumonia and breathing problems. She was diagnosed with Dementia over 3 years ago and spent her life since then in assisted living, happily continuing to sing and dance up until the night before she was rushed to the ER after the night staff found her struggling to breathe and unresponsive. In the ER I noticed that mom was looking upwards and to the left, like she was staring at something or someone - for hours and hours until they admitted her to the hospital. She could blink but could not speak or grasp my hand. She even seemed to be sleeping and snoring with her eyes open - staring off to that one place. Only once did she turn her head to look at me, but she looked very vacant. No expression. It was the oddest thing I ever saw. In the hospital, as her breathing got worse and she was officially dying, they started giving her morphine and oxygen to keep her comfortable. All her IV's were otherwise removed. Hospice was there even though I hadn't signed on with them yet, and they were wonderful. I also had a priest there for last rites. As my mom's only child, I was alone otherwise. While I was not with her at the moment of her death, I can honestly say that after I told her "go be with dad, I will be ok!" and that I loved her, I feel she somehow heard me and gave herself permission to let go. But I'm wondering if anyone else ever experienced their loved one staring off to the side like that? I think this is most interesting, I am wondering if she was able to "see" my dad and those who went before her. The last 3 weeks have been very calming for me. Knowing she is at peace and reunited with dad but I remain curious about those last days of hers and how she was not able to communicate or move even though her eyes were open. She was able to moan - indicating she was uncomfortable or fearful, but I am not sure of this. Her CT scan showed no stroke or seizure. Anyway, my thoughts are with all of you who still struggle with your loved one's illnesses. In my mom's case, death was not horrible for me - we had a loving relationship and it truly was her time. God bless!

over 4 years, said...

Hospice is a collective term for many organizations. I have worked in an inpatient Hospice facility for about five years now and I will never work in another field during my nursing career. Every day I see patients suffer needlessly because a family member is afraid of what a medication will do to them. A restless patient remains restless because a daughter doesn't want him "sedated." A patient remains in pain, with too few pain medications given, because a mother doesn't want her "overdosed." Hospice was not designed to help a patient die. It was designed to help a patient die with peace and dignity with as little pain and distress as possible. It was designed to help grieving families understand the dying process with as little guilt and regret as possible. A "good death" is one where the patient is able to pass without pain, distress, or worrying that those left behind will be alright. A "good death" is one where the family understands what is going on and what may happen next, where as much quality time is spent with their loved one as possible. A "good death" is one where the patient doesn't spend their last days or hours being poked and prodded by a medical professional in an attempt to "fix" what is not fixable. Nothing will make this time easy for the family members. But wouldn't it be better to know what may and probably will happen, to be prepared for it before experiencing it without understanding? Contrary to some belief, there are many people who wish to die, and they express those wishes. They don't want to die because they're selfish or tired of this world. They are tired of being in pain, tired of struggling for their next breath. They are usually ready to let go far sooner than those who love them. Hospices are businesses and not all business are created equal. The hospice I work for is a nonprofit organization. We never turn a patient away who doesn't have insurance, Medicare, or ability to pay. Our patients never see a bill, regardless of what is or is not covered by private insurances or government assistance. And like any medical facility, some outshine the others. If you or your loved one desires hospice, do your homework, read reviews. Those with true hospice hearts will only help in this trying time, not add to your burdens. God bless each of you going through your personal struggle. If you've not attended one, many of my families have told me that grief classes helped them tremendously. May God's peace and comfort cover you and yours.