I want my tombstone to offer free WiFi, so people will visit more often.
August 7, 2019 8:30 PM   Subscribe

I was thinking about dying (as you do!) and about how the majority of people I know have not enjoyed a ‘good death’ so to speak. Lingering suffering with cancer, Parkinson’s, horror car crashes, diseases, suicides. In fact the only person I know who has died quickly and hopefully not too painfully was my Grandma, from a heart attack. I know most of us hope for something like that or maybe dying in our sleep, (or some other quick, pain free non-terrifying way). I’m not sure if this can even be answered, but here goes, what is the likelihood of having a ‘good death’?
posted by Jubey to Grab Bag (16 answers total) 17 users marked this as a favorite
I was looking up causes of death (U.S. and worldwide) recently - you might be interested in those charts.

Some of it is up to chance but you also have some agency even with a disease like cancer. This article has some good information.
posted by bunderful at 8:48 PM on August 7, 2019 [2 favorites]

“When I die, I want to die like my grandfather who died peacefully in his sleep. Not screaming like all the passengers in his car.” Will Rogers

Aaaaaanyway... good luck with this. Given the current state of medical intervention, dying can be a long, involved process. It can spiral far from a simple at-home farewell with family and friends into a complex tangle of legal, ethical and financial issues.
No one is getting out of here alive. Have that power of attorney, advanced healthcare directive, and current will and testament in order. Sign the donor box on your driver's license, if you'd like. And enjoy life to the fullest while you can.

I want my tombstone to be a pleasant bench seat, so visitors can drop by and rest awhile. Unfortunately, that runs counter to the "flat marble stone we can mow around, and no vase of flowers, either" aesthetic of the modern cemetery.
posted by TrishaU at 12:19 AM on August 8, 2019 [2 favorites]

I would recommend the podcast The Griefcast, which deals with end of life, death and grief issues. The question of what constitutes a good death is something they consider often.
posted by JJZByBffqU at 12:25 AM on August 8, 2019 [2 favorites]

I would recommend the book Being Mortal by Atul Gawande. It’s all about exactly this subject.
posted by rd45 at 12:37 AM on August 8, 2019 [11 favorites]

Increasing the liklihood of having a good death is really what good palliative care is all about. Looking up your local hospice will often give you links to what is available locally.

I'm less negative than TrishaU about medical intervention, but that might be because I live in the UK (I'm presuming they live in the USA because of the financial issues note). But letting everyone know what your wishes are for end of life, and having this down in writing/legal form really helps.

And you also have a presumption about what makes a 'good death'. If you went back 700 years in the UK, a 'good death' would be one that allows you to confess your sins and have the last rites - dying in your sleep was not 'good'. Even now, different people make different choices - for example, though they are in the minority, some people receiving palliative care do decide to have minimal pain relief because they want to keep clear consciousness as long as possible. A 'quick' death may not allow you to make your peace with friends and family.

If you want to approach this from a totally different direction, Irvin Yalom's Staring At The Sun: Overcoming the Dread of Death comes at this from the standpoint of existential psychotherapy - to horribly over-simplify, we all die alone and afraid, and dealing with this fear of death helps you live your life.
posted by Vortisaur at 1:34 AM on August 8, 2019 [2 favorites]

You might be interested in learning about death doulas. (I was very comforted by this video and the idea of having a calming presence ensuring that my wishes for my last moments are carried out. Obviously this isn't going to be possible in all circumstances, but it's nice to think about.)
posted by Gordafarin at 3:53 AM on August 8, 2019 [3 favorites]

This is something I've also been thinking about a lot lately. I started to write a laundry list of all the folks close to me who've passed or are ill, but suffice it to say - in the U.S. I think a "good death" as you describe it is rare. And we have no good means of ending a person's suffering if they are terminally ill or their quality of life has declined greatly but there are no health problems that are likely to outright kill them.

As others have said, the best you can do is plan ahead and hope for the best. And maybe don't live in the U.S. if you want a sane healthcare system and humane laws for people who have terminal illnesses.
posted by jzb at 5:07 AM on August 8, 2019 [1 favorite]

I like to think that as time passes, society will be more accepting of people choosing to die when they want to and of humane procedures to do so. My wife thinks I'll probably be killed on my bicycle, but if not, I'm definitely hopeful there'll be a path out when I'm older as quality of life declines and I start to become a burden on my family and unable to do the things I love.
posted by M.C. Lo-Carb! at 6:12 AM on August 8, 2019 [2 favorites]

You might also be interested in reading some of the Stoics, who thought a lot about preparing for a good death by improving your own character while you're healthy. IIRC, for them the big deal things were learning to accept loss and to be content even in stressful and painful situations.

In a slightly related vein, something I'm doing to increase my chances of a good death is that I'm practicing asking for help early, accepting help and care even in embarrassing situations, and being gracious about the loss of autonomy that can come with being helped. I've seen so many people die worse than they needed to because they found it humiliating to be a patient, they didn't want to admit they were old and sick, they acted those feelings out by mistreating and antagonizing their caregivers or straight-up refusing care, and so they ultimately didn't get what they needed to make their last few years easier. I want to practice asking for help now so that I don't end up like that myself.
posted by nebulawindphone at 7:28 AM on August 8, 2019 [11 favorites]

​Here's a link to a recent talk by Karen Smith, (youtube). She's a LISCW, president of the national (U.S.) Funeral Consumers Alliance, and principle clinical ethicist of the Henry Ford Hospital system in Detroit, and she gives presentations and talks on how to get the death you want. A lot of it is, as TrishaU states, making sure your legal forms are in order. Keep in mind that if you feel strongly about being an organ donor and strongly about dying peacefully at home, these values would be in conflict and you should talk more deeply with your health care agent about your feelings if it comes to choosing between two routes. A lot of end-of-life choices can be forks in the road where choosing one thing means not getting other things. You can and should, as recommended up-thread, reach out to local hospices and death midwives/doulas to talk with them about how to navigate this. If practical, bring along the person who would have legal decision-making power with you so they get a sense of your priorities, fears, wants, and options.
posted by cocoagirl at 8:22 AM on August 8, 2019 [2 favorites]

Not directly an answer to your question, but I think having some sense of agency over your departure from this mortal coil can increase the odds of having a "good" death. Toward that end, you might want to check out Compassion and Choices, which offers resources (as well as advocacy) on this very subject.
posted by DrGail at 9:03 AM on August 8, 2019

Data! from 2013:

"People who were 65 in the 1991-1993 period could look forward to 17.5 more years of life on average, with 8.8 of those years being disability-free and 8.7 years being spent with some disabling health conditions. By the 2003-2005 period, average life expectancy was 18.2 years, but the healthy-unhealthy split had shifted to 10.4 disability-free years and 7.8 disabled years. Wellness results were more favorable for women than men (although men made greater overall longevity gains during the period), and more favorable for whites than non-whites."
posted by alittleknowledge at 10:53 AM on August 8, 2019

I don't have any real data on this but I'm a white male with insurance who hangs out mostly with middle class people in the US who also have health insurance. I have probably seen about 30 people die in my life (meaning, I have known them, known their stories, and have been in at least some contact with them while they were dying). One jumped off a building and died quickly. One (my grandfather) died in his chair watching cartoons. All of the others died protracted, scary, painful deaths.

So this is anecdotal, but it seems to me that a peaceful and somewhat pain free death is not common. In my very limited experience most people know they're dying for months, decline slowly and painfully, then die in a haze of drugs.

Sorry - not a fun answer, but that's my experience. I think we need to rethink death in our culture. When I get sick and know that I'm at the end, I want it to end! Like right away!

(Book recommendation: If you're interested in this, read When Breath Becomes Air. It's amazing.)
posted by crapples at 12:20 PM on August 8, 2019

I forgot to link The Order of the Good Death.

Previously on the Blue.
posted by bunderful at 3:34 PM on August 8, 2019

The odds are not that great, to be honest. Pretty much nobody would say they want to die in a hospital, but something like three-quarters do. Unfortunately, even doctors are just about as likely as the general population. As a lay person you would think that doctors, of all people, would be maximally empowered with the knowledge and authority to have a "good" death.
posted by wnissen at 4:03 PM on August 8, 2019

The article linked by wnissen really highlights the differences between countries - most recent data from England is that just under half of all deaths happen in hospital, and the percentage has been dropping for several years.
posted by Vortisaur at 11:50 PM on August 10, 2019

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