2 Exploring Western ideas about ‘a good death’

What is a good death? If you were tasked with improving the experiences of dying or bereaved people, what would you aspire towards? This question may leave you wondering what makes one dying experience ‘good’, and another ‘bad’. You may speculate on what has shaped your own personal views concerning a ‘good death’ and how your perspective on a good death might differ from family and friends, or people in different communities or countries. And you may wonder whether any death can be inherently ‘good’.

The concept of the ‘good death’ has been central to the development of the modern hospice movement. It presents a view of death that is peaceful, gentle, and anticipated, free of unnecessary medical intervention. In many ways it connects with the natural birth movement. But the notion of a good death is one that needs to be explored in its social, historical and cultural context.

Figure 3 In this painting (‘The Triumph of Death’) by an anonymous painter from Sicily around 1445, Death is depicted as a skeleton on a skeletal horse who is picking off victims, which indicates ideas about the role of fate or luck in death and dying at this time.

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An image of a painting of a skeleton riding a skeletal horse through a garden where many people are lying dying or dead.

Figure 3 In this painting (‘The Triumph of Death’) by an anonymous painter from Sicily around 1445, Death is depicted as a skeleton on a ...

Figure 4 Demonstrating how death is managed medically in the modern age, this image shows how the body is subject to scientific examination as part of an autopsy to understand cause of death.

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An image of three pathologists examining and dissecting a corpse during an autopsy.

Figure 4 Demonstrating how death is managed medically in the modern age, this image shows how the body is subject to scientific ...

The backlash to what has been described as the ‘medicalisation of death’ has been the modern hospice movement. Emerging from that movement was a new articulation of a good death. In their extensive reviews of the academic literature, Erica Borgstrom (2014) and Cottrell and Duggleby (2016) have suggested there are a number of key features that have become synonymous with ideas about a ‘good death’ in contemporary Western societies. These include:

• awareness and acceptance of dying (viewed as a positive)
• preparedness (getting one’s affairs in order)
• comfort (minimisation of pain)
• closure (addressing and resolving difficult issues)
• peacefulness and dignity
• presence of family and being in familiar home (or ‘home-like’) surroundings
• personhood (a sense that an individual’s wishes and preferences have been accounted for)
• timeliness (dying at an older age; and a dying process that is predictable, with an identifiable start and end point).

Central to all of these components is control – control over dying activities (like preparing for death); control over the time and place of death; and control of unpleasant symptoms.

Figure 5 Lack of control over their bodies forms the basis for the dark humour, focused on death, in the black comedy film Death Becomes Her in which Meryl Streep and Goldie Hawn play characters who take a magic potion that promises eternal youth but suffer unpleasant effects which they cannot control when their bodies physically die.

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An image from the film Death Becomes Her (1992) with Meryl Streep, Bruce Willis, and Goldie Hawn.

Figure 5 Lack of control over their bodies forms the basis for the dark humour, focused on death, in the black comedy film Death Becomes ...