What is a Good Death?

Every person might have a different idea of what constitutes a “good death.” Perhaps a good death would center on emersion in the love of family or reconciling conflicts with those who were once important to us. Our culture’s discomfort in frankly discussing death is a theme we return to often at SevenPonds, as we are convinced that the more at ease we are with the subject, the more empowered we will be in ultimately confronting and accepting it. So what do most Americans think makes a good death? Do we even believe that there is such a thing?

Remember Elizabeth Edwards? An intelligent, principled, shrewdly ambitious woman whose name will likely be overshadowed forever by that of her husband, John, whose long political career, in turn, will be remembered by its spectacular implosion following his failed bid for the Presidential nomination in 2008, and the subsequent revelation that he had been unfaithful to his wife. Elizabeth Edwards died of breast cancer in December of 2010. She had been first diagnosed in 2004, and in 2007 the cancer metastasized, spreading to other organs in her body, and crossing a threshold that many doctors agree leads to inoperability. At this point, treatment becomes largely palliative. In other words, she knew she was dying, but her death could be long in the making.

So the question arises, what should she do now? How best to approach the inevitable after it has been made so explicit? A 2000 survey of patients, nurses, and doctors, conducted by a group of healthcare professionals led by Dr. Karen Steinhauser, identified the six most commonly accepted components of a good death: 1) pain and symptom management, 2) clear decision making, 3) preparation for death, 4) completion, 5) contribution to others, and 6) affirmation of the person as a whole (this last point largely for the care provider). Once people know that their lives have a deadline, they want to remain in comfort and control, they want to prepare themselves mentally, emotionally and spiritually, and they want to seek a sense of closure, both for themselves and for their loved ones. Perhaps they become intrinsically aware that they have been granted a perspective not shared by the general population, and that it shouldn’t be put to waste. A good death becomes a personal goal, rather than a futilely avoided end.

To this writer’s mind, Elizabeth Edwards met this challenge with aplomb. She wrote two best-selling books about her battles with cancer and her husband’s infidelity, embracing rather than denying her prominent place in celebrity culture by revealing intimate details of a painful experience. She continued to act as a driving force behind her husband’s political career, a constant advocate for healthcare reform and for the poor. Barely a week before her death, she and her doctors agreed to stop treatment. She returned to her home to be surrounded by friends and family; death in the home, supported by those you love, is a consistent unifying thread in many cultures’ good deaths. She even reconciled with her disgraced, now-former husband, requesting that he join her and the rest of their family and friends in her North Carolina home for her final hours. According to those present in the Edwards home, she died painlessly and in peace, earlier posting this poignant, even uplifting message on her Facebook page (scroll to the bottom of the article, click “Show More Text”).

Even if belatedly, we should all thank people like Elizabeth Edwards for showing us that there is such a thing as a good death; that it can be accomplished, and, indeed, why it should be.