What is a good death?
An open conversation on a difficult subject between two academics and an alumnus.
It’s a question many people find very hard to answer. In fact, talking about death is hard, full stop. And yet, the more open we are about it, the more likely we are to accept it as a natural part of life. To kick-start the conversation, we asked a senior palliative nurse, retired lawyer and cultural historian to share their professional and personal insights into what dying well means to them.
By Dr Chris Harding, Norman Stewart and Jo Hockley
Senior Nurse Research Fellow
Usher Institute of Population Health Sciences & Informatics
Back in the mid-1970s, having qualified as a nurse and midwife, it was not until my father asked me “Jo, am I dying?” that I realised the humanness of being asked such a question. I floundered; but luckily, after trying to fob off the question, the oncology registrar arrived and Dad repeated the question. The registrar’s simple and gently honest response – “Yes, Mr Hockley, you are” – was all my dad wanted. He died peacefully the next day having spoken to each of the family individually.
Whether this personal encounter with death/dying was anything to do with my going to work at St Christopher’s Hospice in 1978 I really don’t know. All I do know is that what I learnt there has underpinned my whole career, namely: the importance of good symptom control in advanced disease, which then enables people to deal with any emotional, psychosocial and, importantly, spiritual issues they might have, which can’t be done if people are in physical distress. For this, we need a relationship-based approach stressing the importance of the patient/resident, family and friends, and staff – across the whole multidisciplinary team.
The work I do now in promoting a good death is solely in care homes with a vision to do for care homes in South East Scotland what hospices have done for cancer. As David Roy – a palliative care physician/ethicist – said: “Dying with dignity is dying in the presence of people who know how to drop the professional role mask and relate to others simply and richly as a human being.”
Retired Consultant Solicitor and law alumnus
I am an old (and very retired) practising solicitor who was at the ‘coal face’ for nearly 50 years, including being the President of the Law Society of Scotland 1985/86.
I recall, as a very young green solicitor, being newly released from Edinburgh’s relative protection in numbers to the total exposure of being on your own in an isolated northern community. The sole principal whom I had joined, had, on my first day, departed on an “exhaustion” holiday.
An urgent call came in to visit a very sick gentleman in a village some 10 miles away, who wished a will done. So off I went, by bus (as young lawyers then had to do), my objective being to take instructions and return to the peace of the office and prepare the will. I reached my destination and found the house. I was ushered into the bedroom where I immediately saw a very sick man who might depart this life very soon. It therefore had to be plan B.
I had my pad and my pen and after putting the man at ease (he spoke Doric, which in my years of absence I had not forgotten), he was clear in his instructions and I wrote. He read the document, signed and lay back, relaxed and obviously pleased.
I left and returned to the office. A few hours later the phone rang with the message that the gentleman had died. That image followed me through my practice life. That was a good death or, in his eyes, mission accomplished.
Dr Chris Harding
Senior Lecturer in Asian History
School of History, Classics & Archaeology
In my work as a cultural historian I explore the connections between mental health and spirituality around the world, including at the end of life. I’ve been struck by the enormous diversity of answers to this question – what is a good death?
So my first response would be that a good death is one where the company of others is a true consolation rather than a source of pressure or anxiety about what a good death ought to look like.
The second thing that impresses me is an insight central to acceptance and commitment therapy, found too in some of Asia’s religious traditions: that many of the frustrations and regrets associated with living and dying alike are bound up with our deep-seated tendency to root our sense of meaning and identity in ‘doing’ rather than ‘being’.
Someone reaching the end of life may want nothing more than to complete a cherished project. But for others pain, tiredness, or physical incapacity might mean that most sorts of doing are beyond them. Here, one element of a good death might be coming to appreciate the value and to experience the consoling power simply of being, however little time may be left.