What is a Good Death?

 

Everyone from Aristotle to Kanye West has pondered the good life (they don’t quite agree, incidentally). But few have considered a good death.

“It’s impressive you came out to hear about the end of life,” moderator Michael Wilkes said to a full house at NPR West in Culver City. Wilkes, Vice Dean for Medical Education at UC Davis and a constant contributor to KCRW and the New York Times, talked about the much-feared d-word with Susan Stone, Los Angeles County Medical Center’s award-winning Director of Palliative Care and Betty Ferrell, a cancer nurse for 21 years with a doctorate and five books (one of which she shipped to president-elect Barack Obama) to her name. The panelists were eager to discuss the subject they have pursued throughout their careers but one that is just gaining wide attention. The conversation, made possible by a generous grant from the California HealthCare Foundation, was largely about the difficulty of conversing about death, and why families and medical professionals should take on the topic.

Not knockin’ on heaven’s door

What is a Good Death? guestsDeath, Stone noted, has long been “taboo in the house of medicine.” Medical students are trained to consider it a failure, she said. Because intensive care exists, to allow death to arrive seems cruel. But for centuries, death arrived without planning, suddenly and at homes rather than hospitals. It was unpredictable and impossible to postpone. As Ferrell said, “Not so long ago, if someone became ill, they either got well pretty quickly or they died. Somewhere along the way we invented ICUs and antibiotics and renal dialysis and organ transplants. Over the decades we have come to believe that death is avoidable.” Wilkes pointed out that the delaying of death is costly, as 30% of Medicare funds are spent on the last 30 days of life. The concept of a “good death,” unlike a good life, is a recent invention. And so the vocabulary for discussing it is narrow: Wilkes said that power of attorney forms taper countless options and wishes to checking one of two boxes.

Martinis, please

So Stone asked the crowd a question rarely if ever asked at Zócalo: Have you thought about your perfect death? About half raised their hands, and chuckled in agreement when Stone asked if martinis were involved. But Stone stuck to the basics of a good death, ones that doctors, social workers, nurses, chaplains, and perhaps bartenders can help provide: “A good death means you’re peaceful, you’re comfortable, you have expert pain and symptom management.” She urged the crowd to think about it deeply, as she did when she battled cancer, and to talk about it even if it has to be at Thanksgiving: “I don’t want dialysis but I would like some stuffing.” Ferrell added to the basics of a good death – the absence of fear, anxiety, and depression, and the inclusion of family and spirituality, and sometimes, being unafraid to make simple requests. “Many patients just say, ‘Could you roll me out of the ICU and let me feel the sun on my face?'” she said. Ferrell listed other requests patients might make: to live till a child’s high school graduation, to simply go home to a pet, to live until Christmas with the family, to stop treatment if treatment meant no longer being able to hold a new baby.

Death by semantics?

What is a Good Death? guestsBut a good death isn’t always so easy to define or understand, the panelists noted. Stone offered her own experience of offering comfort foods to a cancer-stricken friend, not knowing then that cancer kills appetite. Both panelists mentioned doctors asking patients, “Do you want us to do everything?” without explaining what everything means, and what other options there are. Families often argue over care options, and legal forms don’t always give clear guidance. As Stone said, “Family dysfunction reigns in crisis. Most families crumble under this pressure.” Audience questions raised still more difficulties with a good death. One asked when to stop hydrating or feeding patients (the panelists answered with an “it depends”), and another asked how to ease anxiety about the process of dying (to which the panelists had a somewhat more reassuring answer – that there is no pain medicine can’t treat, even though doctors sometimes fail to treat it).

And in case a good death wasn’t hard enough to define, one audience member wisely noted that death itself isn’t well-defined. He asked the panelists whether there should be a definition of death. The question roiled national politics in the last election, when Terri Schiavo became a household name, and more recently, a family is fighting on religious grounds a hospital’s decision to take their son, declared brain dead, off a respirator. Ferrell answered the question with an “I hope not.”

Watch the video here.
See more photos here.

*Photos by Aaron Salcido.

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