A Good Death

A good death means different things to different people. To many, it is where the transition from life to death is seamless, painless and free from stress. Some common ideas to consider for end of life planning are:

  • Having affairs in order, such as funeral/memorial/burial/cremation plans.
  • Specifying final medical care through Advance Care Planning.
  • Appointing a proxy or power of attorney for health and finance, tying up financial commitments, and updating your will so that your estate is distributed the way you want it to be.
  • Controlling pain and discomfort.
  • Being cared for by people you would choose. This could be doctors, nurses, home carers or family and friends.
  • Being in a place of your choosing – home, care home, hospital, or a special place with happy memories.
  • To receive mindful and respectful care.
  • Not being alone.
  • Favourite activities or objects such as music or readings, photographs, flowers, a back rub or foot massage, or simply being surrounded by loved ones in quiet conversation.

Talking to family and friends

Talking with your loved ones, before a medical crisis happens, gives everyone a shared understanding about what matters most to you at the end of life. Even if they don’t agree with you, the conversations can help both you and them to realise what you want your end of life to look like

Conversations about your wishes can:

  • Bring families together by helping them understand what is important to you.
  • Help your loved ones to communicate to health professionals what is most important to you.
  • Help you to figure out where you stand and what you want in terms of:
    • the information you want to receive about your condition and your treatment
    • how much of a say you want to have in decisions about your treatment and how much you will leave to doctors
    • whether you want to know the timeline or prognosis
    • what your worries about medical treatment are
    • preferences about where you would like to spend your last days
    • how involved you want your loved ones to be in your care/treatment decisions

Conversations about dying and end of life choices can be difficult. Here are some ways you could introduce the conversation:

  • “I was thinking about what happened to…., and it made me realise…”
  • “Even though I’m okay right now, I’m worried that …, and I want to be prepared.”
  • “I need to think about the future. Will you help me?”

When having these conversations, it’s good to remember that a good death can mean different things to different people, and people can change their minds as circumstances change.

Talking to your doctor

After you’ve had the conversation with your loved ones, the next step is talking to your doctor or other health professionals about your wishes. It’s better not to wait for a crisis. Talking while you’re well makes it easier to make medical decisions when the time comes.

Ask your doctor to explain where things stand with your health today, and what the future may hold. Your doctor can explain the available treatment options — and the chances of certain treatment options working.

Ask questions if anything is unclear. It’s important to remember that even for health professionals there is often a lot of uncertainty — both about the course of your illness, and about how different treatment options will work. Some questions you can ask include:

  • “Can you tell me what I can expect from this illness? What is my life likely to look like 6 months from now, 1 year from now, and 5 years from now?”
  • “What can I expect about my ability to function independently?”
  • “What are some possible changes in my health that my family and I should be prepared for?”
  • “What can I expect to improve (or not improve) if I choose this course of treatment, or another course of treatment?”
  • “Would you recommend this course of treatment if I want to live as long as possible or have as good a quality of life as is possible”
  • “What can I expect if I decide to do nothing?”

You are  the expert about what matters most to you, so tell your doctor what your preferences are and what you would like to happen. Together you can decide which treatment options are right for you.

Even if you’re in good health, it’s still important to make sure your doctor and family know your wishes, as your health status can change suddenly.

Some of the treatment options your doctor might mention:

  • Intubation/mechanical ventilation: When you can’t breathe on your own, a breathing tube is placed in your throat and into your lungs, connecting you to a machine that can breathe for you. This can be used short-term or long-term, depending on your needs and preferences.
  • Artificial nutrition and hydration: When you can’t eat or drink on your own, fluid and nutrients are delivered via an IV or through a tube in your nose or stomach. (This is sometimes called a “PEG tube” — an abbreviation for “percutaneous endoscopic gastrostomy.”) Can be used short-term or long-term, depending on your needs and preferences.
  • CPR (Cardiopulmonary resuscitation): If your heart stops, attempts are made to restart your heart with chest compressions or electricity.
  • Comfort care: When curative care is no longer likely to help, medication or other non-invasive options are used solely to keep you comfortable. Palliative care falls into this category.

Make sure to ask your doctor or other health professionals to document your discussion, and your wishes, in your medical record. Remember it’s ok to:

  • Ask a lot of questions.
  • Take time to decide.
  • Ask for numbers and statistics if it helps you, but also realize that in many cases, there is a lot of uncertainty.
  • Have a private conversation with you doctor without loved ones being present.

It’s important to have follow-up conversations to revisit these issues, as what you want may change as time passes and your health changes.

Preparing emotionally and spiritually

Along with the practical matters of having your 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/religious sustenance.

Spirituality can help many people find strength and meaning during their final moments. Think about your preferred spiritual or religious beliefs and how you want these to be honoured in your last days.

Saying goodbye to loved ones and pets can be difficult for everyone. The finality of it can be overwhelming, but many say that once this is done, a presence of peace prevails.

Often quoted in the literature on death and dying are “The Four Things That Matter Most” by Ira Byock, a medical doctor who says that a dying person needs to express four thoughts at the end of life:

  • I love you.
  • Thank you.
  • I forgive you.
  • Forgive me.

Your death is just that – yours – to plan and prepare for. You may relish in the sound of your grandchildren, the generation to come, running around your home filling it with laughter and light, or you may want peace and quiet, to say your final goodbyes and to be alone with one or two special people or animals. However it ends up, you have the best chance of achieving a good death when you plan and prepare for it.

If you need any help or assistance with planning for the end of life, or just want to talk through how best to approach decision making, get in touch with Friends at the End. We have staff on hand who are well versed in this work and we offer a free, confidential, professional counselling service, should you need it.