Can there truly be such a thing as a good death? If the patient's wishes are honored, there can be grace in saying good-bye to one's own life.
Addressing emotional fears and anxieties, tying up loose ends with friends and families, and having a chance to leave memories for loved ones can all contribute to a good death.
Long before patients and their families reach that point, though, there are early processes and decisions that can help to ease the transition.
It is tough to imagine your own death, but discussions about death often give patients added strength to face their illness, and peace of mind that their family understands and supports them.
Most states recognize documents known as advance directives. These include:
- Living will—This is a document that states what your medical wishes are in the event that you cannot make decisions.
- Durable power of attorney—This is a document that designates someone to try to implement these decisions on your behalf if you cannot make them yourself. It need not be a family member. You can designate a friend, pastor, or caregiver.
Make sure that these documents are witnessed appropriately and that copies are placed in your medical chart at your doctor's office, your hospital chart if you have one, and at home in a fireproof, safe place. Advance directives are not only intended for the elderly or those facing terminal illnesses. Anyone over the age of 18 can have a set of directives written and legalized.
A signed durable power of attorney implies that you and your designee have discussed such issues as:
- Religious or spiritual beliefs that might influence your end-of-life care
- Where quality of life fits into those beliefs
- Whether you believe life is worth extending at all costs
- Whether you want your life extended if you no can longer function physically or mentally without life support
It is helpful to have decided beforehand where you want to spend your last weeks. Some people feel more comfortable surrounded by healthcare professionals in a hospital setting, while others would rather be at home if possible.
The most important thing is to make your wishes known to people you trust and who agree to honor your wishes. Give careful thought to your decisions, perhaps before you ever become terminally ill. Be specific about such life-extending treatments as artificial ventilation, nutrition, and hydration. Making these wishes known formally and in writing may help families cope better.
It is difficult for family members to decide which healthcare measures should be provided to someone in the last stages of life.
In most instances, pain can be managed with medication taken orally. When that is no longer possible, there are other options, such as a skin patch, to deliver the pain medication.
More stressful are the issues of eating and drinking. Should a patient in the last stages of life be forced to take nutrition and water? The answer, according to a growing consensus of end-of-life experts, is no. Although it sounds cruel to withhold food and water, it is not if the intention is to alleviate suffering.
Lack of nourishment allows the body to shut down in a peaceful way.
Force-feeding, on the other hand, can cause indigestion, nausea and vomiting,
in a person who is near death and can contribute to
pneumonia. Giving unwanted liquids can cause difficulty in breathing.
Patients can qualify for hospice care as soon as a terminal diagnosis has been made and emphasis has changed to quality of life, rather than a cure.
All hospice patients do not travel to a separate facility; most die in their own homes. Hospice care also can be given in nursing homes and hospitals, and the patient can be moved from one setting to another, depending on need. Hospice care begins with a referral from one's doctor and includes nursing, social work, pastoral care, medications, supplies, and equipment, such as a hospital bed.
Choosing a hospice is similar to choosing any other healthcare provider. People should ask what the hospice will do to ensure good comfort care.