Is there a good death in contemporary Western societies? If so, what form might this take?

Quotations:¹

» Alles Warten ist Warten auf den Tod. «

All waiting is waiting for death.

Abbildung in dieser Leseprobe nicht enthalten²

Franz Werfe l (1890-1945)³

» Da die Menschen kein Heilmittel gegen den Tod, das Elend, die Unwissenheit finden konnten, sind sie, um sich glücklich zu machen, darauf verfallen, nicht daran zu denken. «

Because Humans didn’t find any remedies against death, miserable, lack of knowledge, they are, to make themselves happy, hitting upon the idea ofnot thinking about it.

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Blaise Pascal (1623-1662)⁵

Intro:

In this essay about ‘The Good Death’ I want to figure out different opinions, definitions and theories towards this topic and how sociological aspects like sex, social status or tradition have an impact on it. Antithetic I want to take a closer look to the personal view of people and their own definition about the ‘Good Death’ and if it is possible in reality, in the social life that surrounds them, to fulfill theirwishes and ideas.

So all in all, I do not want to talk about sudden death in this essay. I want to talk about a ‘normal’ death and what people think about this last step in life and death in case of illnesses and how people get along with the topic of death during this procedure.

In the end I’m going to put my own attitude into this discussion.

Definition ofa ‘Good Death’:

First of all I try to define ‘the good death’. Different theories exist and every single individual defines a good death by himself in another way.

But there is for example a conclusion of the important aspects that go along with this topic. This conclusion was identified by the debate of the Age Health and Care Study Group under the title ‘The Future ofHealth and Care ofOlder People’. They pointed out twelve different principles:⁶

- To know when death is coming and to understand what can be expected.
- Tobe able to retain control of what happens.
- To be afforded dignity and privacy.
- To have control over pain relief and other symptom control.
- To have choice and control over where death occurs (at home or elsewhere).
- To have access to information and expertise of whatever kind is necessary.
- To have access to any spiritual or emotional support required.
- To have access to hospice care in any location, not only in hospital.
- To have control over who is present and who shares the end.
- To be able to issue advance directives which ensure wishes are respected.
- To have time to say goodbye, and control over other aspects of timing.
- To be able to leave when it is time to go and not to have life prolonged pointlessly.

To take everything into consideration, we can summarize the most important facts as: knowledge about when (control over timing, not prolonging), where (at home or hospice) and with whom; privacy, control over pain; to be aware; access to information; religion; respect ones wishes.

In the following I want to single out different aspects (mainly belonging to modern western societies) and discuss them. Sometimes there are even new aspects, because this definition is just to have an overview. I do not want to make no claims of being complete.

The aspect about control:

The aspect of control seems to be very important. The feeling about losing the control over the own life and the quality of life is not going along with the imagination of ‘a good death’ for many people. Statistics show, that the fact about the ‘control’ is more important for men than for woman. This goes along with the social role of men - to be the one, who takes care about the family and being strong, having everything under control. So it is more important for men to control also their own death.

The first thing coming in my mind when thinking about ‘control over death’ is euthanasia. Independent of the Pros and Cons, where is it aloud?

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It is obvious, that the different opinions about the legality of euthanasia do not arrange - but why? Despite the fact, that passive euthanasia often means, that you have the right to decide about your life with a kind of expression of patient autonomy, it is very hard to decide for active euthanasia, because of difficult situations. What is about the situation, that the patient isn’t longer possible to inform his environment about what he wants? How can you be sure, that the patient wants to die in this special situation, even if he told so in the past? I think this topic is a very complex and sensitive one.

In my opinion, independent from the law, everyone should be possible to decide for himself. I understand the medical position that the doctors want to save lives and not to ‘kill’ patients. But all in all it is also unfair to go over the will of the patient and decide for him, that he has to live, no matter how, if he doesn’t want it anymore. Personally, I don’t like the imagination to be viable just with the help of machinery, for example. My grandmother, having Alzheimer’s over ten years, died last year in autumn.

She just kept on living over five years with a feeding tube. Before this started, she doesn’t move any longer, she doesn’t want to walk, although she was able to. And she stopped eating, although she was able to. So the doctors decide to feed her extern. I do not know what is right and wrong. It doesn’t matter what is right or wrong for me, it is just important what was right for my grandmother. She couldn’t decide. So who can tell me, what is right for her? I do just know, that I do not want this situation for me. I do not want to lengthen my life, if it is not worth living for. I know, that this sounds hard. And may be, when I’m getting older, I will change my mind. But it is not the point, that I do not love life. But I am afraid of living without any sense, without realizing my environment and just waiting until death is coming. I do not like this idea. That’s my personal view and everyone should decide for himself. And this is not possible in every country of the world. I know that intelligent persons, who decide against active euthanasia, just want to save people, even for themselves.

“Groups who oppose euthanasia do so for a range of reasons. Religious adherents, particularly those of the Christian faith, may oppose euthanasia on the grounds that life is the gift of God and it s, therefore, only God who may take it away. Medics and health care professionals may reject it on the Hippocratic grounds that they have a duty to care for and preserve, rather than to end, life. Furthermore , many argue that the adequate provision of palliative care, with its objective of relieving total pain, should enhance quality of life for dying people and reduce the attraction ofeuthanasia (Saunders,1988). Those in favourof euthanasia primarily emphasize the need to address suffering and to put an end to physical and emotional pain and distress. For them, the issue rests on the rights of the individual to take control over their dying and to enable them to die with dignity (Kennedy, 1994; Singer, 1993; Kuhse and Singer, 1997).”⁸

All in all I prefer active euthanasia. I couldn’t manage the legal rules and the borders, how this should be possible. I think this is a very hard theme. But for some people I think, active euthanasia would help them more, than living a life, they didn’t choose. In the end there is always the controversy ofthe right to have a good death and the right to live. But what is about the right to chose?!

I think if we want, we can - with our high technology - keep everything and everyone alive. But does this life be worth for the patient? Does it have any quality and meaning to him?

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The aspect of ‘social death’:

Often euthanasia is connected to the point, that the patient has unsufferable pain. But this is just a biological view. What comes first, when you get ill, is a social death. You change your own identity and life’s meaning. Often ill people stop taking place in social life, because of their illness or because of their own decision, because of being aware of this new situation and do not want to show others. Sometimes it is also the feeling of shame, I think, that people no longer feel comfortable in their ordinary environment, because being no longer a part of them - or that ‘the others’ stop contacting the ill person because not feeling comfortable with this new situation. Also the social relation with the partner, the children and family members can change. It is a social process, where everyone surrounding you and also yourself has to learn how to get along with the disease and how it can change your ordinary life.

So bringing together the social and the biological death can also be a definition for ‘a good death’.

[...]

¹ http://www.zitate-aphorismen.de/zitate/thema/TodZ118

² http://www.wdr3.de/zeitzeichen/details/artikel/10-september-1890.html

³ http://de.wikipedia.org/wiki/Franz_Werfel

⁴ http://de.wikipedia.org/wiki/Blaise_Pascal

⁵ http://de.wikipedia.org/wiki/Blaise_Pascal

⁶ http://dying.about.com/od/deathdyingandculture/qt/gooddeath.htm

⁷ http://www.welt.de/politik/article2167135/Welche_Laender_erlauben_aktive_Sterbehilfe.html

⁸ Howarth (2007): p,150f.

⁹ http://www.euthanasia.ee/97-ldvd.html