A good enough death?

In the words of Dame Cicely Saunders, founder of the modern day hospice movement, ‘How people die remains in the memory of those who live on’.

Considerable effort has been made in recent years to improve the experience of death and dying and to ensure that people can make decisions about where and how they are cared for as they approach the end of life. Amid the early shock, denial and initial attempts to limit the spread of the virus and often in the absence of essential protective equipment, deaths have happened in ways that no one would have chosen. This has implications for all concerned.

Those providing end of life care in care homes can often feel very strongly that no one should die alone. The significance of this aspect emerges in research about what people want at the end of life. The following list is taken from Age UK’s 2013 End of Life Review:

• Pain and symptoms controlled
• Spiritual/existential peace/acceptance
• Preservation of identity
• Dignity – (wishes, cultural and religious traditions) respected
• Compassionate medical staff
• Die in place of choice (may be influenced by culture
• Not alone (family present)
• Not to be a burden on family
• Some want to make their own decisions, others to delegate
• Some want to die – acceptance of life’s natural course,
• Some want to die – loss of identity and independence

The concept of a good death is more complex and less defined than the idea suggests and the following passage acknowledges the range of factors that will determine how someone dies. Dr Scanlan writes:

Somewhere in between the ‘good death’ and the death that is too painful to be thought about, is the possibility of a ‘good enough’ death that allows for a good death to be held in mind and strived for whilst accepting that, for varied and often complex reasons, including the life that the dying person has lived, this may not always be possible. It is an idea that draws from Winnicott’s concept of the ‘good enough mother’ and takes into account the context of the dying person’s whole life and in particular how they may want/choose to die.