Admit it, you’re morbidly curious.
Philippe de Champaigne's Vanitas. Credit: Wikipedia
Most normal people spend a lot of time thinking about the worst ways to die. Death by incineration, drowning, bear attack, and the slow consumption of my head by fire ants while the rest of my body is buried underground all make the cut for me. But a group of medical researchers at the University of California, San Diego School of Medicine just released a much nicer, much more useful list of 11 things that define a "good death"—the elements, in other words, that make up the best ways to die.
Published in the American Journal of Geriatric Psychiatry, the paper reviewed 32 qualitative and quantitative English-language studies that addressed various preferences for how to die, according to three groups of what the researchers called "stakeholders": patients, family members (before or during bereavement), and health care providers.
The scientists discovered that all three of these stakeholder groups believed that 11 distinct elements contributed to a person's well-being at the end of their life.
According to the study, the indicators were: "preferences for a specific dying process, pain-free status, religiosity/spirituality, emotional well-being, life completion, treatment preferences, dignity, family, quality of life, relationship with the health care provider, and 'other.'"
These indicators aren't achievements that need to be unlocked to have a pleasant death, but one might think of them as guidelines or themes to be considerate of when dealing with a person who's near the end of their life.
"Death is obviously a controversial topic. People don't like to talk about it in detail, but we should. It's important to speak honestly and transparently about what kind of death each of us would prefer," said the study's senior author Dr. Dilip Jeste, director of the Sam and Rose Stein Institute for Research on Aging at UC San Diego School of Medicine, in a statement.
Among the 11 indicators of a good death, patients, family members, and health care providers cared most about how a person dies, whether that person is pain-free, and what their emotional well-being is like. But not all of these groups valued the same things, said researchers. For example, patients tended to emphasize religiosity and spirituality more heavily than their family members. In turn, relatives of those who were dying expressed more concern with dignity and life completion. Health care providers fell somewhere in between patients and family members in terms of what they found important.
"Clinically, we often see a difference between what patients, family members and health care providers value as most important near the end of life," said co-author Dr. Emily Meier, psychologist at Moores Cancer Center at UC San Diego Health. "Ultimately, existential and other psychosocial concerns may be prevalent among patients, and this serves as a reminder that we must ask about all facets of care that are essential at the end of life."
Studies like this can be reassuring to those of us who are young and healthy, because they provide some indication that when our time comes, death does not always need to drag us kicking and screaming from the world of the living. But research and discussions about end-of-life quality are also crucial to the terminally ill, hospice providers, and medical practitioners.
Advance care planning, which is when someone talks to family members and legal representatives about how they wish to account for their effects at the end of their life—and in some cases, even specifically how they want to die—is one of most important things someone can do as they grow older. According to research carried out at John Hopkins School of Medicine, cancer patients who created living wills and had end-of-life discussions with their healthcare practitioners avoided having to endure treatment they did not wish to receive. Those patients without living wills were often incapacitated and ended up receiving potentially unwanted last-minute care.
"Usually, patients know what they want or need and there is relief in talking about it. It gives them a sense of control. I hope these findings spur greater conversation across the spectrum. You can make it possible to have a good death by talking about it sometime before," said Dr. Jeste.
Talking about death can be all sorts of things. Most often it's scary and unpleasant, but sometimes telling a loved one that you don't want to be eaten alive by ants, oh and maybe also pull the plug if you ever have to get put on life support, can pay off when the ol' Reaper comes calling for you.