\u2018How would you describe a good and a bad death?\u2019<\/strong><\/p>\nAlmost all interviewees stressed that different people will have different ideas about what is \u2018good\u2019 or \u2018bad\u2019 in the experience of death. As a consequence, their own job involves finding out and fulfilling the wishes of patients and their families. On the other hand, several interviewees questioned the general belief that a \u2018good\u2019 death is necessarily one that happens at home. There was also general agreement that dying in a hospital \u2013 \u2018on a busy ward\u2019 \u2013 does not make for a good death. This was associated in the interviews with hospice care.<\/p>\n
The difference between good and bad deaths is partly expressed via contrasting metaphors. A good death was described as involving \u2018peace\u2019 and the patient being \u2018free\u2019 from pain, because the hospice staff have managed to get symptoms \u2018under control\u2019. In addition, a good death involves patients and families accepting death as the end of a \u2018journey\u2019, and the decision to \u2018let go\u2019. In contrast, in a bad death the patient sees death as an opponent against which to \u2018struggle\u2019, \u2018battle\u2019 or \u2018fight\u2019 in order to \u2018keep going\u2019. A good death is also described as involving many \u2018open\u2019 conversations, in which patients and their families explicitly acknowledge that death is imminent. In contrast, a bad death is described as involving problems \u2018in the background\u2019 or in a \u2018place\u2019 inside the patient that hospice staff are not allowed to \u2018reach\u2019.\u00a0 In some cases, a bad death is caused by \u2018conflicts\u2019, \u2018tensions\u2019 and \u2018struggles\u2019 within families, which prevent the hospice staff from getting everyone to be \u2018in the same place\u2019. When a bad death occurs, staff are sometimes left to \u2018pick up the pieces\u2019 and need \u2018support\u2019 themselves.<\/p>\n
Almost all interviewees told stories involving specific (although unnamed) individuals. The \u2018good death\u2019 stories mostly involved a successful intervention on the part of the hospice staff. They begin with a description of a problematic situation, such as a man with stomach cancer who has suffered from continuous hiccoughs for a long time and cannot therefore go home to enjoy his wife\u2019s cooking for a little longer. In the next stage of the story, the patients are referred to a hospice, and the staff work as a team in order to: tackle the problems that can be solved in some way; establish as much normality as possible; and prepare the patient and the family for what is to come. For example, acupuncture was used to treat the man\u2019s hiccoughs, so that he could go home and enjoy his wife\u2019s cooking for as long as possible.<\/p>\n
In contrast, in \u2018bad death\u2019 stories the hospice team\u2019s attempts at intervention are frustrated by circumstances beyond their control. In some cases, the patient is described as having been referred to the hospice at a very busy time, or too late for the staff to establish a relationship with them. In other cases, the hospice staff\u2019s efforts are frustrated by the attitudes of patients, their families, or both. For example, one woman is described as dying in great physical and emotional distress after she:<\/p>\n
\u201cdid battle with everyone. Nothing was ever right, nothing was good enough, nothing. You couldn\u2019t physically get her comfortable. You couldn\u2019t get in a good place to meet her psychologically. I think she felt that being comfortable was being patronised and that made it really difficult to offer her any support.\u201d<\/p>\n
Several interviewees stressed that, in their professional experience, bad deaths are outnumbered by good deaths. All interviewees use the words \u2018we\u2019 and \u2018team\u2019 to refer to themselves and their colleagues as they work tirelessly and professionally as one. The interviews therefore conveyed a strong sense of professional loyalty: hospice managers took the opportunity to make the case for their professional role, and for hospices and hospice care.<\/p>\n","protected":false},"excerpt":{"rendered":"
(Originally on the European Association for Palliative Care blog on 26 May 2013) by Elena Semino, Veronika Koller and Zs\u00f3fia Demj\u00e9n What is a \u2018good\u2019…<\/p>\n","protected":false},"author":1132,"featured_media":297,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"jetpack_post_was_ever_published":false},"categories":[7],"tags":[],"class_list":["post-292","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-latest-posts"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"http:\/\/wp.lancs.ac.uk\/melc\/files\/2019\/04\/EAPC-blog-post-3.jpg","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/paVrlZ-4I","jetpack_likes_enabled":true,"_links":{"self":[{"href":"http:\/\/wp.lancs.ac.uk\/melc\/wp-json\/wp\/v2\/posts\/292","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/wp.lancs.ac.uk\/melc\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/wp.lancs.ac.uk\/melc\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/wp.lancs.ac.uk\/melc\/wp-json\/wp\/v2\/users\/1132"}],"replies":[{"embeddable":true,"href":"http:\/\/wp.lancs.ac.uk\/melc\/wp-json\/wp\/v2\/comments?post=292"}],"version-history":[{"count":3,"href":"http:\/\/wp.lancs.ac.uk\/melc\/wp-json\/wp\/v2\/posts\/292\/revisions"}],"predecessor-version":[{"id":300,"href":"http:\/\/wp.lancs.ac.uk\/melc\/wp-json\/wp\/v2\/posts\/292\/revisions\/300"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/wp.lancs.ac.uk\/melc\/wp-json\/wp\/v2\/media\/297"}],"wp:attachment":[{"href":"http:\/\/wp.lancs.ac.uk\/melc\/wp-json\/wp\/v2\/media?parent=292"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/wp.lancs.ac.uk\/melc\/wp-json\/wp\/v2\/categories?post=292"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/wp.lancs.ac.uk\/melc\/wp-json\/wp\/v2\/tags?post=292"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}