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What is a good death?

By Dr. Ong Tien Kwan

According to a study published in the American Journal of Geriatric Psychiatry, there are 11 core themes of a good death. They are:

1. preferences for a specific dying process
2. pain-free status
3. religiosity/spiritualty
4. emotional well-being
5. life completion
6. treatment preferences
7. dignity
8. family
9. quality of life
10. relationship with HCP
11. and other

It should be noted that these are not applicable to all people, and in fact, is dependent on each specific individual. After all, we are all different and we have lived a different life with different values and priorities.

The three stakeholders are patients, family members and health care providers(HCP). The top three themes across all stakeholder groups were:

1. preferences for dying process (94% of reports)
2. pain-free status (81%)
3. emotional well-being (64%)

However, some discrepancies among the respondent groups were noted in the core themes: Family perspectives included life completion (80%), quality of life (70%), dignity (70%), and presence of family (70%) more frequently than did patient perspectives regarding those items (35%–55% each). In contrast, religiosity/spirituality was reported somewhat more often in patient perspectives (65%) than in family perspectives (50%).

I consider it significant that of the 11 core themes, only 3 involves physical comfort (preference for a specific dying process, pain free status, and treatment preference) while the rest involves the non-physical, or more specifically the emotional, mental and spiritual.

Thus, for a good death, the bulk of the dying process - after initially taking care of the patient's physical comfot - is actually to take care of his or her emotional, mental and spiritual needs. This is further borne out by the various deathbed phenomena that patients experience.