In search of a good death: Spiritual care of dying patients needs to be well prepared

Abstract

In search of a good death Doctors need to know when and how to say die Editor-One of the main obstacles to the care of dying patients is the taboo against speaking or writing about impending death. Here are a few simple tests to see how you or your colleagues are doing. Try reading a selection of charts of patients who have died. Patients do "poorly," "fail to respond," or are "palliative," but I would wager that you will find few patients described as "dying" or "near death." Some dying patients even "demand" futile treatment such as cardiopulmonary resuscitation in the event of a "cardiopulmonary arrest," when asked to "consent" not to receive it. You should also see how often and how vigorously you avoid talking about death when speaking to a patient likely to die. I am always surprised at how difficult I find it to talk openly about death and dying, even when it clearly is necessary and appropriate and I have carefully thought out what I am going to say. If compassionate care of dying patients is to occur doctors need a structured and consistent approach to talking with patients about death and dying.

Moving Toward Peace: An Analysis of the Concept of a Good Death

“…Bosek et al 5 Cohen et al 30 Hopkinson and Hallett 3 Kristjanson et al 31 Leichtentritt and Rettig 32 Low and Payne 33 Pierson et al 34 Schwartz et al 4 Steinhauser et al 35 Tong et al 37 Curtis 43 El-Nimr et al 44 Grogono 45 Jones and Willis 47 Kittel 46 Smith 42 Essay or editorial Ayers et al 48 Erlen 56 Feinmann 57 Gazelle 59 Hart et al 54 McNeil 58 Neuberger 61 Winslow and Jacobson 55…”

“…Authors cited the importance of honoring beliefs, values, and practices of a personal, cultural, and spiritual nature. [2][3][4]6,7,10,[32][33][34][35]37,42,44,56 This was especially important in minority patients who might have desires different from the dominant culture. 37 Burden minimized.…”

Ideals and Compromises in Palliative Care

“…Consistent with oft stated policy, 2 palliative care must now consider what is good care earlier in an illness trajectory. In doing this, it is possible to draw on the accomplishments of the literature examining a good death, which highlights the importance of symptom control [3][4][5] , psychological preparation, [3][4][5] completion, 5 lack of fear and distress, 3 , 6 sense of control, 3,7 open communication, 8 rational decision making, 5,8 contributing to others, 5 affirmation of the whole person, 5 attention to spiritual well being, 9 and family and staff involvement. 3,7 Elaboration of the elements of good care in the broader context will lead to the identification of the goals of palliative care.…”