A ‘good death’ – The ultimate paradox

The concept of a ‘good death’ is a philosophical ideal within palliative care, but in practical terms it is paradoxical. Discussing issues about death and dying is difficult in today’s society and yet there is a demand for improving the care of people who are dying.  Within this paradox there is the elusive notion that death can indeed be ‘good’.

This qualitative study explores the perceptions and understanding of the concept of a ‘good death’ with eight palliative care volunteers from a specific palliative care setting in South Australia. The selection criteria for participants were for the volunteers to be associated with the palliative care setting, that they had experienced the death of a close friend or relative and that they spoke English as the first language. The aims of the study were to identify what features were important in determining if the death was a ‘good death’, how the circumstances of the death of a close friend of relative impacted on the volunteer and if the concept of a ‘good death’ was helpful.

The participants spoke about 22 deaths which were predominantly from their personal experience. Nine features emerged from the data. The features were – pain, control, awareness and preparedness, acceptance, information, timing, place of death, "not so good" features and spirituality. The results confirmed the findings of other empirical studies in the palliative care literature.

The insights that emerged from the study centre on the notion of a ‘good death’ being both a concept and a label that has prospective and retrospective aspects, depending on whose viewpoint is sought. The data also revealed the difficulty people have with language associated with death and dying. The participants questioned the appropriateness of the concept of a ‘good death’ for bereaved relatives and friends, they preferred the term a ‘good way to die’. This perspective is supported by the postmodern paradigm that focuses specifically on the individual and generally on how the issue appears on the surface.

The participants with the most experience in palliative care questioned the meanings behind the ‘good death’ concept and its helpfulness. The challenge to social workers in palliative care center on the collective nature of death and not the exclusive focus on the person who is dying. There is a need for social workers to de-construct and re-construct the meaning of a ‘good death’ for each individual family.