What is a good death?
It's different for everyone. Some people's focus is making sure they don't experience pain. Some people are more concerned with being in the presence of love. Or maybe the most important consideration is dying at home rather than in the hospital.
In American society, death is as taboo as sex — maybe even more so. Preferences about how to die are also as individual as people’s preferences when it comes sex.
We've moved death far away from the living. Death used to be a family, communal, and religious event. People used to die at home with friends and family present. The living would experience death over a period of time. They could care for their loved one and watch them approach the end, attending to their needs and comforting them in ways big and small.
Today, this is the exception. Most people have not attended someone’s death and haven't lived in a house with someone who is dying. Now most death is institutionalized, with mostly medical professionals being present for death.
What we see on TV is not realistic
People know death from media, TV shows, and movies. These portrayals are not accurate. TV shows and movies show lifesaving options like CPR with 50 percent or greater success in saving lives and returning a person to pre-cardiac arrest functioning. This is not realistic. The American Heart Association puts the out-of-hospital cardiac arrest success rate at 10-12 percent.
Questions to consider
When you think about a good death, there are many questions to answer: Where would you like to spend your final days? Who do you want to have around you at the end of your life? Who do you want to have make final decisions for you when you can no longer make those decisions yourself? What are your fears of death? The best time to answer these questions is before you're gravely ill.
What I want at the end of my life
I can answer these questions for myself. I do not want to be in pain. I want to be comfortable; I want to know that the end is coming so I can enjoy some things for the last time. I want to take pleasure in some of my favorite foods and meals while I can still eat and enjoy them. I want to be surrounded by my family and friends — not just in the last moments of my life, but in the last months, so I'm still able to participate in conversations and shared memories of great times and struggles we've gone through together. I want to have people around me who are helpful and attentive to my needs, whether that's easing my pain by a gentle touch or helping me to get to the bathroom.
I do not want to have CPR. I do not want to be intubated and be on a respirator. I only want to go to the hospital if I need to have my pain controlled. I would ideally like to be at home, but if my comfort cannot be maintained at home, then I would go elsewhere. Hopefully I would be able to go to a hospice to die in peace and comfort. I would like my husband to make decisions if I'm not capable of that. However, I want him to know what's important to me, so he's not guessing or making decisions for himself but following my wishes.
Let's normalize talking about the end of life
I have seen death up close and repeatedly, both at work and in my personal life. I've talked about death with those I love. I'm in a unique position to have formed many opinions about what a good death will look like for me. I want to offer conversation and dialogue about what a good death can be for others. I am comfortable speaking about this taboo subject, and I have much experience talking people through these questions and focusing on an end of life plan. I think this is something that everyone should address so they can have what they want at the end of their life.
Without planning, decisions are made with haste, and options are not always explored. I want to offer dialogue about options, timing, and people’s own preferences to help them have what they want at the end of life.
I would be curious to know where you think the stigma around death stems from and how as a larger culture we could tackle the taboo.
Thanks so much for speaking to the realities as a contrast to medical TV dramas. As a caregiver it brought so much comfort to know there was a plan and I could advocate for her wishes-not mine. It was great to have one less thing to worry about in a very emotional and anxious time.