We use the words ‘dying’ or ‘terminal’ to describe when a person is in the last few days or hours of life. Sometimes a death is sudden and unexpected. For some family members of a loved one living with a dementia, saying goodbye occurred years ago. What is a good death? Is it filled with love?, Is it a right of passage?, Is it filled with rituals?, Is it freedom? Or is it a privilege?
As an ageing population, there is no escaping the fact that there will come a time when we will leave this world behind. Quality of care will be at the top of our personal agenda, whether it’s for a loved one or because we, ourselves, need support. The end won’t be a surprise for with living comes dying for us all.
Let’s talk about dying a good death.
Conversations About Death
Society still harbours a taboo when talking about death. As a nurse I do get to have conversations about death, and they are always powerful. Yes we discuss end of life we are talking but if you listen closely, what we really talk about is the gift of life, the value we place on it and the appreciation we have acquired for its fragility.
It’s time to get this conversation started.
By encouraging people to start talking about the end of life our goal, is to encourage us all to feel comfortable talking about death, more importantly planning for a good death. By this I mean what you envision, how you want to be treated, things you do want and things that you don’t when it is your time to die. These are important conversations, I know, I have seen what a bad death can look like with well meaning people inflict their needs and wants onto the dying person, without any consideration of what they might actually want or need.
Death brings out the best and worst of moments of our humanity. It’s raw, emotional, and exhausting. BUT… what if we took the time to sit down with the people we loved and asked them what their wishes are at the end of their life? Let’s break the taboo and discuss death. This is the first step in creating a good death.
How To Die Well
Physical pain vs Spiritual pain.
Being pain-free is more than physical, it’s spiritual. Medications can manage most people’s physical pain well however, spiritual pain is more complex. Easing spiritual pain can be accomplished by acknowledging the spirituality the person. Not one size fits all, understanding spirituality is not about religion or culture, but, it could be. Spiritual issues are common at the end of life, it’s better to have someone who can engage in meaningful spiritual questioning. A good death is one which can reconcile the feelings and emotions of one’s core spirit in a way which is not impacted by others spiritual bias.
Psychological pain.
We must also recognise psycho-social pain, the residue of life’s unresolved conflicts with other people, places or things. Interpersonal conflict is a reality for us all. It is important to acknowledge those conflicts and feelings that are unresolved and process them to the best of our ability. There are four basic ways to address psychological conflicts at the end of life:
- Love conquers all.
- Forgiveness is a way to heal the mind, soul and spirit.
- Acceptance is comforting.
- Reconcile regrets.
A good death creates a space for addressing the hidden mysteries of life.
Satisfy any remaining wishes.
Some people want to live long enough to see something come to pass. Look at the things you need to resolve and the things you need said or done before they become a burden that can’t be overcome. Find your inner peace and let go of any burdens you feel. This is what freedom feels like.
Every life has meaning, celebrate it.
There are two main ways that people on their deathbeds find meaning: in the recognition of all of the people they have loved and who have loved them, and in the work that they’ve done that has contributed to the greater good. Articulating what brought meaning to life will support all to die well.
Be protected from dehumanising procedures.
Know what you want and what you don’t. Dignity in death is having control over the experience. Be mindful many clinical supports work to preserve life. Be clear about what clinical practices you want and when. Be persistent and clear to avoid procedures that are unwanted. Be a positive vocal advocate and create an experience that is meaningful and right for the person.
Final Thoughts
Dying gives us the chance for the most glorious embrace of all. When that happens, it is a good death.
If I should go tomorrow
It would never be goodbye,
For I have left my heart with you,
So don’t you ever cry.
The love that’s deep within me,
Shall reach you from the stars,
You’ll feel it from the heavens,
And it will heal the scars.
RN (Australia)
Managing Director MCM
and Grandson of wonderful human beings who lived with dementia
REFERENCES
Meier EA, Gallegos JV, Thomas LP, Depp CA, Irwin SA, Jeste DV. Defining a Good Death (Successful Dying): Literature Review and a Call for Research and Public Dialogue. Am J Geriatr Psychiatry. 2016 Apr;24(4):261-71. doi: 10.1016/j.jagp.2016.01.135. Epub 2016 Jan 22. PMID: 26976293; PMCID: PMC4828197.
Lawrence, V., Samsi, K., Murray, J., Harari, D., & Banerjee, S. (2011). Dying well with dementia: qualitative examination of end-of-life care. The British Journal of Psychiatry, 199(5), 417-422.
Chu C. (2019). Normalising conversations about death and dying. BMJ. 366:1504. Doi:10.1136/bmj.15041.