Although we all may have similar wishes, we are vastly more likely to age slowly, acquire a few chronic conditions, have periodic illnesses with declining health, and then have some kind of "terminal event." So most of us have time to think about a "good death", but what does that really mean?
There was a recent piece in the New York Times written by a knowledgeable woman, whose father didn't die the way he wanted to - no heroic interventions at the end. He had a sudden cardiac arrest with subsequent cardiac resuscitation and invasive ICU care. Once the CPR was initiated it was unclear at to whether her father would survive. To me it demonstrates that all situations can't be anticipated and that often families need to sit down with the medical team participating in shared decision making.
So what is a good death? I was asked this question by our local NPR radio station. After talking to many patients over the years, the following seems most important to have our own wishes adhered to:
- Pain and symptom management - palliative care consultation and hospice are often needed
- Preparation for death – spiritual & natural - advance directives - POLST if indicated.
- Completion of goals - each individual has his/her own wishes
- Contributing to others – a legacy
- At peace surrounded by loved ones - most people wish for a home or home-like death. The ICU isn't a peaceful place necessarily, but at times I've felt a spiritual connection when tubes are removed, monitors turned off, and the family holding and talking quietly to their loved one at the end.