Monday, May 23, 2011

THE "GOOD DEATH" PANEL

Which phrase reflects your wishes?


I don’t want to die in a hospital.

I don’t want to die in pain.

I don’t want to die as a burden.

I don’t want to die.


Death isn’t a choice, but the circumstances can be. To understand options and have a say when the time comes, however, requires communication between doctor and patient, among others, while the patient can still comprehend. It requires, if you will, a "death panel."

Dr. Suzanne Koven addresses this in “A (good) death panel,” an insightful Boston Globe column about medical support at the end of life. She uses the lonely and painful death of a Tolstoy character to begin the piece, and fiction is an interesting choice, as so much of the contemporary “death panel” phobia is fabricated.


Koven notes that death is often seen as failure by doctor and patient alike, and yet it remains inevitable no matter how adept medical science gets at prolonging life. Pretending otherwise helps no one, certainly not the unreachable patient on life support or the nurse whose wrenching task it is to repeatedly change dressing on skin that no longer heals.


Koven tells a moving true story of a “good death,” in hospice, of a terminal patient after a process in which she and her spouse were engaged in conversations with an oncologist, a palliative care specialist, clergy and a psychologist. This patient was surrounded by a an extended support community at the time of death. We should all be so lucky.


To read the Koven’s column, see http://bo.st/kGrmh5


So, can there really be such a thing as a "good death" panel?


4 comments:

  1. It's all in how you define your terms, right? A "good death" follows a "good life" and that means viewing the entire continuum as a whole - "holistically", if you will.

    It is interesting that couples exercise as much control as possible over when they will get pregnant - after grad school, after the house is purchased, after the jobs and careers are settled. And then, as new parents (should they be so fortunate as to have control and actually get pregnant!), they often enter the birthing experience of their offspring with all the sense of control our age offers - just the right obstetrical practice, with just the right nurse midwifery supports, at just the right hospital or birthing center, with just the right music playing . . . Exercising as much control as possible for that magical entrance of Baby!

    And yet, we cannot acknowledge our ending nearly so well. We want control but certainly not for a "good death" - we want control not to die at all! My hope is that our generation can transition, ever so gently, to give equal effort and careful consideration to the end of our lives . . . that we can get the right palliative care practice, with the right social and spiritual supports, with friends and family surrounding us at just the right moment, so that our deaths can be "good", so that our mystical entrance to another realm (or the final end of biological function, if you are of that persuasion) is "good" as that term is defined by you.

    For me, a good death will occur with little fanfare, with absolutely positively no mechanical supports, and with my loved ones by my side to help me cross that threshold - to untie the lines that bind me here and allow me to pass into the blessed hereafter with joy and anticipation of a glorious life hereafter!

    Even though advance directives are not technically part of the legal landscape here in Massachusetts, I have written out my very definite wishes in this regard and I have spoken to my loved ones (repeatedly, they will tell you!) about my wishes for a good death. I want to exercise control as much as I possibly can - that my passing will be "mine" and not medicalized beyond all recognition. May it be so!!

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  2. “A (good) death panel,” an insightful Boston Globe column about medical support at the end of life. She uses the lonely and painful death of a Tolstoy character to begin the piece, and fiction is an interesting choice, as so much of the contemporary “death panel” phobia is fabricated. http://findmybud.com/

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  3. The Sanford-Burnham Medical Research Institute, previously Burnham Institute for Medical Research, andriol online

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  4. Community voices and medical issues discussed in this blog, group of citizens giving feedback on medical ethics policies to the teaching hospitals of Harward. Its assignment writer, community voices and issues give the multiple reasons to communities a voice in the care they depend for others. Investigate the blog, read our reports and add your voice.

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