A "Good Death"

Proposed health-care reform legislation includes a provision that allows Medicare to pay for "end-of-life" counseling for seniors and their families who request it. The provision -- which Sarah Palin erroneously described as "death panels" for seniors -- nearly derailed President Obama's health-care initiative. Some Republicans still argue that the provision would ration health care for the elderly. Does end-of-life care prolong life or does it prolong suffering? Should it be a part of health-care reform?

A “good death” sounds like the ultimate oxymoron but I can say that I’ve personally witnessed a few as a student chaplain in a hospital. Two stand out in particular. In one case the patient was a woman nearly 100 years old but in relatively good health given her age. In fact the only thing really wrong with her was that she was old, but that was enough. The end was around the corner and the patient was ready, although her family was not. As she explained to me, she was tired and wanted to use the last bit of energy she could muster to make sure that her wishes were followed, despite the fact that they might well contradict the wishes of her beloved family. She was ready to go and she wanted end-of-life counseling for her children and grandchildren to help them let her go peacefully. She had lived a good life and now wanted a good death.

The other case was much tougher because it was a trauma patient who had been in a car accident and suffered severe injuries which would likely eventually prove fatal. The patient had not been at all prepared for death and therefore had expressed no wishes, and his wife was at a complete loss as to what do next. Thanks to modern medical technology he did not appear to be suffering but his state of existence could hardly be called living. And his wife was clearly suffering. The doctors quoted medical statistics that gave only infinitesimal chances for him regaining consciousness and no hope of him ever being able to return to any semblance of “a normal life”. End-of-life counseling helped his wife thoughtfully, and prayerfully, discern how he would want to die based on how he had tried to live. She was empowered to help create the type of death that he might have defined as “good”.

Death is a natural phase of life, and therefore should be naturally addressed as a part of healthcare. There are often not many choices in death, but end-of-life counseling and care does offer one way to help take some of the sting out of the experience for all affected, and give them one last choice. The definition of a “good death” is individual and subjective; historically those with money had an advantage in trying to create a good death, much as they had an advantage in creating a good life. Healthcare reform can and should bring that option to more people by provides end-of-life care options for all.