A Good Death: One Woman’s Reflections

I have been interested in death for a long time. I am not a morbid person or even a pessimistic one, but I like preparing myself for what is to come.

My interest started 30 years ago when I became close friends with a very reflective young man dying from AIDS. We ended up writing a book together, based on interviews with others in the same situation. My interest continued when I worked as a volunteer in a hospice over four years and then wrote a book based on interviews with hospice staff.

And meanwhile, I grew older and older and am now 84. It’s hard not to be aware of what’s around the corner. Especially when you’re 84 and 85.

A key question is what comprises a ‘good’ death.

Examples of Good Deaths

This issue arose most recently for me in the death of my friend Grace, age 101, who I wrote about over a year ago. I felt that she had a good death. She was active for as long as she was able, continued to see friends as she became increasingly slow, felt that she was ready to go and was able to stay in her home to the very end.

She and her husband lived in a block of flats immediately above a major centre for music and drama in London (The Barbican). She loved music (we met through our choir), went frequently to concerts and was able to attend a concert one a week or so before she died.

Grace just increasingly slowed down, eventually being cared for only by family (children, grandchildren and great grandchildren) as well as paid carers. It became obvious that the end was close, and she died peacefully at home with her family around her.

A very good ending, in my view.

I was also impressed by the death of her husband a few years before, then 97, but it was much less extended. He and Grace had attended a concert in a local church, followed by a restaurant lunch, but later that day, he felt ill. At first, they thought it was something he had eaten.

But as his pain got worse, an ambulance was called, he was taken to hospital, was visited by Grace and other members of the family and died shortly after.

No prolongation of pain. Just a lovely day with his wife and goodbye.

I might throw in here another death – of the father of a friend of my son. He was walking on a beach somewhere nice (the Caribbean?) with his wife, when he had a heart attack and immediately died. Super quick. Life was lovely until it was no more.

The quickest of them all.

Take your choice – slow or quick, but all avoiding any prolonged pain or difficulty. The impact on the spouse and other relatives is another matter, of course.

The View of Hospice Workers

The question of what makes for a good death was also explored in the interviews carried out with hospice workers. These discussions were mainly around the moment of death, rather than the period leading up to it.

A good death was commonly seen as being peaceful and pain-free:

“A good death is both physical and emotional. If people are physically in pain, often they are emotionally in pain or turmoil. So, the good scenario would be that you resolve that, and then they start to relax and are not in pain. That does happen. They come in here and they feel safe – they are able to let go and get their life sorted at the end.”

This was made most clear by some workers contrasting it with deaths they had seen elsewhere:

“I’ve worked in a Casualty Department, where there’s been traumatic death – where relatives are not expecting it, they haven’t spoken to that person, they haven’t told them that they love them – that’s horrendous and people are left unsatisfied.”

“On my last job, a hospital palliative care ward, we had a young girl with a determined mother who knew far better than we did. The girl wanted to get onto a chair. We said we would come shortly, but the mother tried to move her herself and the girl ended up falling on the floor and was killed from the impact. There was blood, faeces and vomit everywhere… Later, I went home and burst into tears.”

It was also important that relatives perceived it as peaceful:

“For me, a good death is no distress, no pain and they’re dignified. But it’s not just for the patient, a lot of it is for the relative, because this is what’s going to stay with them. From their viewpoint, a death may appear horrendous, because this is the first death they’ve seen. The patient may have had a very slight rattle and to the relative that could be the most horrendous thing they’ve ever heard – they could walk away feeling like that person has suffered. So, a ‘good death’ is a case of personal perceptions.

Essentially, a good death could not always be planned for:

“I think the idea of a good death is very problematic. You have to plan for the worst and hope for the best. You don’t always have control over everything. It’s a bit like making a birth plan – it isn’t necessarily going to go the way you want. Some make a careful plan – and then they have emergency caesareans. It’s a little bit like that with death.”

I found these discussions very thought-provoking. Indeed, I asked my husband what he would like, and he just wanted to be hit by a bus and be gone. One minute here, one minute not, although he did not like the idea of leaving a mess someone had to clean up.

Whereas, I prefer what I called a “Victorian death”, surrounded by family and dishing out wisdom to everyone in turn.

Let’s Have a Conversation:

What sort of death would you like? Do you find it difficult to think about at all?