Table of Contents
What defines a good death?
Being around death is a certainty in life, whether it is a family pet, friend, extended family member or close family member. Death is a certainty in all our lives, but how someone dies can leave a lasting picture of them in relatives’ memories forever, Dame Cicley Saunders (1918-2005) (Appendix i) said ‘How people die remains in the memory of those who live on’. In some instances the way someone dies – animal or person – cannot be controlled. However, some deaths can be controlled, this occurs when a death is predicted, for example deaths of those with a terminal illness can be predicted and care and treatment needed to help the patient die a good, peaceful and dignified death can be given. Each year around 33,000 people die in Wales and this figure is set to increase to 36,500 by the year 2039.
Many of these deaths occur in the persons residence, however 55% of theses deaths occur in National Health Service (NHS) hospitals (Welsh Government, 2017). Within this essay three viewpoints will be evaluated to find out what contributes to and defines a good death. The first viewpoint will examine how spirituality and religion can contribute to a person’s passing. The second viewpoint will look at prominent messages from guidance, framework and pathways available to a support a person whom is deemed to be in need of palliative care. Thirdly, the views of relatives will be evaluated.
The Oxford Dictionary defines dignity as ‘the state of being worthy of respect…’
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Firstly looking at spirituality and religion and the impact it can have on a person who has been deemed palliative and whom may be entering the final months, weeks or days of their lives, and also the impact could have on their families and their loved ones.
There are many different spiritualities, religions and cultures that all have different yet similar perspectives on a good death. Coward and Stajduhar (2012) wrote about Dame Cicely Saunders and how she introduced a new way of treating the terminally ill by opening a Hospice in London. Dame Cicley was a devout Christian and she believed that spirituality and faith had a major influence over a person dying with dignity. The Hospice did not only cater for Christians but to all manner of faiths, including atheists. ‘We do not assume that an atheist, agnostic or someone practicing spirituality outside a religious tradition cannot die “with dignity and peace”‘.
Recommendations for professionals and providers should ‘Identify and respond to the spiritual and cultural needs that are important to the person and their carers’ SCiE (2013). Spirituality is also covered by the Welsh Government in their Annual Statement of Progress, stating that ‘Palliative care aims to enhance quality of life for patients and their families facing life threatening illness, through early identification and management of pain, and all physical, social, psychological and spiritual symptoms’ Welsh Government (2017).
Communication
‘Establish the communication needs and expectations of people who may be entering their last days of life, taking into account:…any cultural, religious, social or spiritual needs or preferences’ (Nice.org.uk, 2011). It becomes clear that the importance of spiritual interventions at the end of life can contribute greatly to the person dying and possibly even more so to the family and loved ones left behind. (book from fishguard library)
Secondly, there are a number of frameworks, guidance and pathways to help a person and their families cope with the impeding passing.
According to Morris and Collier 2012, The Gold Standards Framework, The Liverpool Care Pathway (LCP) and the Preferred Priorities for Care document are the most well known end of life care tools. The Liverpool Care Pathway was quite controversial as the media portrayed it as a ‘death pathway’ with families telling stories of the pathway being put in place without their knowledge and consent, claiming the persons human rights were being ignored.
However, A general practitioner wrote a journal article regarding its failings and stated ‘The Liverpool care pathway and committed district nursing teams are transforming care. We talk about death in an open way and decide where patients die. Used properly with senior supervision, the pathway offers structure to a peaceful, pain-free, dignified death at home—a good death’ Spence, (2012). The LCP was phased out and new end of life care guidelines were published by the National Institute for Health and Care Excellence (NICE) and recommendations were made to improve the care given to the person dying and their families.
Presently in Wales Advance Care Planning and Care Decisions of the Last Days of Life documentation is used, to encourage healthcare workers to define the wishes of the person and their families and loved ones. Communication is a vital tool that can enable a person die a good death. It is important for healthcare workers, multidisciplinary teams, primary care services and the family all work together by communicating clearly. When a person is entering the final stages of life, communication is key to ensure that the person remains without pain and comfortable enabling him or her to pass gracefully.
