What Is a "Good Death"? What Research Says

People often say they want a “good death.” But what does that mean? For a long time doctors had little research to go on. Then, in 2000, a team of researchers asked the people who know the most: those who are dying, their families, and the people who care for them. This article summarizes what they found.

What did the study ask?

What a good death looks like to different people. The researchers, reporting in the Annals of Internal Medicine, held focus groups and in-depth interviews with 75 people: physicians, nurses, social workers, chaplains, hospice volunteers, patients, and recently bereaved family members. They came from a university medical center, a Veterans Affairs medical center, and a community hospice.

What were the six themes?

The group identified six main parts of a good death:

• Pain and symptom management. Being comfortable.
• Clear decision making. Knowing the options and having choices respected.
• Preparation for death. Making practical and emotional arrangements.
• Completion. Duke Health describes this as reviewing faith and meaning at the end of life.
• Contributing to others. Duke says this was a new theme, the importance of dying patients’ contributions to the well-being of others.
• Affirmation of the whole person. Also new: the need to be seen as a unique and whole person, and not just a patient.

The researchers say each theme has medical, psychological, social, and spiritual sides.

Is there one right way to die?

No. The authors say that although there is no “right” way to die, the six themes can serve as a framework for what people tend to value at the end of life. They also found that physicians discussed a good death in very different terms from everyone else. Doctors stressed the medical side, and patients, families, and other care professionals named a broader range of things. Duke Health notes that physicians did not talk about the need for life review and completion. The study’s conclusion: biomedical care is critical but is only a starting point toward a good death.

What about people who cannot make decisions?

A 2018 review in the journal Mortality points out that the research on a good death generally assumes the dying person is aware and able to reason about their own death. Some themes, such as clear decision making and affirmation of the person, raise difficult questions when someone has lost mental capacity, for example because of dementia. The authors say more thought is needed on how to achieve a good death for people with reduced capacity. A separate study asked family caregivers of people who died of Alzheimer’s disease in nursing homes. Although they believed their loved one had died with dignity, 16 of 57, or 28 percent, felt their loved one had not experienced a good death.

What can I do now?

Talk about it. Planning and conversation can help, and the first steps are practical: telling your family what you want, naming someone to speak for you, and learning about comfort care. See Advance Directives, Living Wills, and Healthcare Proxies, What Is Hospice?, and Does Dying Hurt?. For the philosophical side of the question, see What Do Philosophers Say About Death?.