Expanded definitions of the ‘good death’? Race, ethnicity and medical aid in dying

Abstract

The range of end of life options is expanding across North America. Specifically, medical aid in dying, or the process by which a patient with a terminal illness may request medical assistance with hastening death, has recently become legal in eight jurisdictions in the U.S. and all of Canada. Debates about aid in dying often rely on cultural constructions that define some deaths as “good” and others as “bad.” While research has found commonalities in how patients, family members, and health care providers define good and bad deaths, these constructions likely vary across social groups. Because of this, the extent to which aid in dying is seen as a route to the good death also likely varies across social groups. In this article, we analyse qualitative data from six focus groups (n=39) across three racial and ethnic groups: African American, Latino, and white Californians, just after a medical aid in dying law was passed. We find that definitions of the “good death” are nuanced within and between groups, suggesting that different groups evaluate medical aid in dying in part through complex ideas about dying. These findings further conversations about racial and ethnic differences in choices about end of life options.

Nurses’ decision-making about cancer patients’ end-of-life skin care in Wales: an exploratory mixed-method vignette study protocol

“…32 34 The term good death serves as an organising construct which can be understood in different ways depending on the socio-cultural, philosophical and intellectual perspective that is adopted. [35][36][37] Given that dying well and a good death are socially constructed, we have adopted a philosophical position that we feel is the most appropriate to inform the design of this study. This study will be undertaken in the critical realist paradigm with a realist ontology and abductive epistemology.…”

Valuing Black lives and the ‘Good Death’ in the United States

“…Even calling hospice care the 'gold standard' suggests that there is a singular vision of the 'good death' that is universally held. Western definitions of the 'good death' include peace, control, acceptance and dignity (Hart et al, 2010), but research has shown that these ideals are raced, classed and gendered (Broom & Cavenagh, 2010;Cain & McCleskey, 2019). For example, in my previous research, I found that Black Americans were more likely than whites or Latinos to construct a good death as not losing one's sense of self, including independence, strength and faith (Cain & McCleskey, 2019).…”

“…While sociologists have long identified race-blind perspectives as problematic (Bonilla-Silva & Dietrich, 2011), some of our concepts continue to be shaped by the assumption that race can be ignored. For example, in the end-of-life context, the idea of the 'good death' is ostensibly not racialized, but in practice, what is considered a good death is patterned by institutional and generational experiences of inequality (Cain & McCleskey, 2019;Conway, 2012). The idea of the 'good death' is implicated in two critical end-of-life issues: use of hospice care and requests for care-deemed futile by medical professionals.…”

“…Western definitions of the 'good death' include peace, control, acceptance and dignity (Hart et al, 2010), but research has shown that these ideals are raced, classed and gendered (Broom & Cavenagh, 2010;Cain & McCleskey, 2019). For example, in my previous research, I found that Black Americans were more likely than whites or Latinos to construct a good death as not losing one's sense of self, including independence, strength and faith (Cain & McCleskey, 2019). Perhaps Black Americans with this definition of the good death see hospice as less likely to align with their deep-seated vision of dying well (Payne, 2016).…”

The Relationship between Practitioners and Caregivers during a Treatment of Palliative Care: A Grounded Theory of a Challenging Collaborative Process

“…These can refer to very different expectations. For instance, Cain and McCleskey [9] argue that the definition of the "good death" revolves around some principles that remark a set of heterogeneous social expectations: "pain relief, acceptance, mending of familial and other important relationships, and not being a burden to others" (p. 1176).…”