A "good" death

The NYTimes actually has a decent article about end of life care...

Dr. Karen E. Steinhauser and colleagues at the Veterans Affairs Medical Center in Durham, N.C., examined the constituents of a good death for patients, their families and health care providers. The 85 study participants had no trouble describing a “bad death” — having inadequately treated pain while receiving aggressive but futile cure-directed therapy.

Patients felt disregarded, family members felt perplexed and concerned about suffering, and providers felt out of control and feared that they were not providing good care. Decisions not previously discussed usually had to be made during a crisis. Families unprepared for what happens when death is imminent often panicked and rushed the patient to the hospital, where last-ditch and usually futile attempts at resuscitation were made, when both patient and family would have preferred a home death.

The study identified six components of a good death, described in The Annals of Internal Medicine of May 16, 2000:

¶Pain and symptom management. Pain, more so than dying itself, is too often the cause of acute anxiety among patients and their families.

¶Clear decision making. Patients want to have a say in treatment decisions.

¶Preparation for death. Patients want to know what to expect as their illness progresses and to plan for what will follow their deaths.

¶Completion. This includes reviewing one’s life, resolving conflicts, spending time with family and friends, and saying good-bye.

¶Contribution to others. Many people nearing death achieve a clarity as to what is really important in life and want to share that understanding with others.

¶Affirmation. Study participants emphasized the importance of being seen as a unique and whole person and being understood in the context of their lives, values and preferences.

This study says that dying can, and should, be a much less painful experience for many more people and their loved ones than it now is.