The Good Death Ideal: Happy Endings in the United States
The Good Death Ideal: Happy Endings in the United States
Issue Date
2004
Authors
Hart, Cheryl O.
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Abstract
The objective of this study is to discover the components of the current (2004) United States dominant culture's good dying or good death ideal. Participants were a convenience sample of 26 professional providers of direct EOL (EOL) care to terminally ill individuals. Respondents in roles including nurses, hospice founders, psychotherapists, social workers, bereavement counselors, chaplains, physicians, respiratory therapists, nurse practitioners, professors of surgery, patient's rights activists, and bioethics committee members; respondents had work experience in a variety of venues including acute care hospital facilities in the palliative care, oncology, intensive care, and emergency room departments; skilled nursing facilities; inpatient and outpatient hospice programs; and outpatient oncology treatment centers. The design was a single interview; the analysis used the qualitative method of grounded theory. A preliminary conceptual framework of good dying is presented with the overarching themes of good dying being the honoring and privileging of both the dying patient and the EOL process by all participants in the EOL scenario. Accommodation of the patient and the dying process, service provision focused on the patient and the process, and preparation for the EOL process are all strategies present in the ideal patient- and EOL process-honoring EOL scenario. An evaluation of good dying has been shown in this study to be a contextually-defined fluid construct that is unstable across roles, within individuals across time, and across individuals; it is arrived at via a holistic evaluation of variables in the EOL process, the most influential of which involve honoring and privileging the dying individual and honoring the dying process itself. These findings have implications for future research, the practice of clinical psychology, healthcare reform with regard to EOL service provision, and socio-cultural reform with regard to EOL.