THE GoOD DEATH - 8:24:24, 10.58 AM

The author discusses the concept of a "good death" and challenges the idea that dying should be pain-free. They question the reliance on medication to numb pain and suggest that the fear and lack of understanding of the dying process may make pain seem more significant than it actually is. The author also explores the contradictions and conflicts surrounding end-of-life wishes, such as religious beliefs and family dynamics. They emphasize the need for flexibility in adapting to shifting goals and wishes of dying individuals. The author reflects on their own experience with their mother's death and questions whether the focus on control, choice, and comfort in end-of-life doula work can be a disservice. They highlight the messiness of death and the need to constantly re-evaluate ideas about a good death. The author suggests that being present with dying and accepting uncertainty is crucial. They caution against overpromising and fabricating stories about a good death, as this can detrac Pain and the good death. It is a common assumption that people should not be in pain when they die, that we have the right, if possible, to die free of pain. I want to make clear I resonate with this idea. I'm troubled by what I see as a uniformity in how people have been medicated. Barbara Carnes, a leader in our field, has invited us to reflect on routine sedation and anti-anxiety medication in the last days or weeks of life. She explains that death often is not painful, but pain can be part of certain disease processes. She wonders whether we rely too much on medication to numb different kinds of pain, both physical and psychic. She cautions, what I really believe is that most often the issue of pain during the dying process is more of a concern for us, the watchers, because we are afraid and not understanding what is happening, and less a physical reality of the dying person. That natural, normal labor we are watching is then translated into the belief that physical pain is occurring. The explanation of the good death becomes more of a justification than a caring reason. The good death, monolith or evolving contradictions. End-of-life doulas often talk about the goals of their work as if they are singular and clear, but in reality there are often contradictions, evolving wishes and conflicts about the good death. Take the individual who wants to be cremated when it is against their family's religion to not bury the body, or the hospice that allows only six people in a room when a very large family arrives to sit vigil. There is always slippage or tension about dying and death at the personal, familial, communal and cultural levels, and facilities that do not allow for virtual visitation. Additionally, people's ideas for the dying and death they hope to have continue to evolve and change depending on levels of pain, closeness to death, spiritual moments, a recent new clinical trial, or an unexpected return to cultural practices of childhood. The end-of-life doula needs to be agile and active to adapt to shifting wishes and goals of their dying clients. This entails gracefully surrendering our previous maps, not always easy when we are wed to our ideas of the good death. Death doesn't cooperate with our plans. It may be obvious, but we often forget or don't anticipate that the biggest impediment to the good death is death itself. Eve Joseph writes, There is no promise of a good death. The idea of a good death, the planning and anticipation central to a doula's skill set may have unintended impacts when the death is not what we or the As end-of-life doulas are sitting vigil, how much we are able to be present rests on whether we are troubled by the gap between the death we wish was happening and the death that is unfolding. When I sit with a dying person, if I allow one single thought of outcome to rear its head, the truth of the moment dies. I've stopped being with what is and I've started to have ideas about the way I think it should be. There is no good or bad death. Being with dying is simply being with dying. Each being does it his or her way, states Joan Halifax, in Being with Dying, Cultivating Compassion and Fearlessness in the Presence of Death. The Aftermath of Death. I have an unsettling question. Do end-of-life doulas do a disservice to our kinds through a focus on control, choice and comfort? Through our focus on the good death? It is not uncommon for the best laid plans to be dashed by reality. Given my mother's long life, it didn't occur to me that she wouldn't have a slow decline where we would gather and see her off. I was fortunate to make a trip to see her and was there for her final breath. It gave me closure to be there. She died in a nursing home against all she had asked of me. I was not the decision-maker. My ideas about the death I wanted her to have were shattered by reality and my holding on to those ideas made my grief harder. So what does this all mean? An end-of-life doula reflected in the doula world, we often have the vision of ideal death, but death is messy. As I am growing as a doula, I am more aware that it's essential that I am constantly re-evaluating my ideas and feelings about a good death, which can, without my conscious knowledge, lead me to shape a person's dying, although I believe I am only fostering their own wishes. We cannot avoid having ideas about desirable or good deaths, but being committed to bringing them to the light of day counterbalances their possible negative influence and painful consequences. I also have begun to build in uncertainty. I have also begun to build in uncertainty in the maps and perspectives I create with people I serve. The best-laid plans may not happen. We'll do all we can while letting go of the outcome. In At Peace, Choosing a Good Death After a Long Life, Samuel Harrington writes about the recognition and acceptance of the inevitable and, most important, an image of the possible. Ann Newman, in The Good Death, an Exploration of Dying in America, writes, There is no good death. There are many kinds of good enough death, each specific to the dying person, as they wish best they can. The possible, not the guaranteed. Don't overpromise. Perhaps our greatest gift to the dying and their loved ones is our capacity to be with a death that is theirs. Vaclav Havel believed that hope was not the same thing as optimism. It was not, he believed, the conviction that something would turn out well. Rather, it was the certainty that something makes sense, regardless of how it turns out. Rashi Joan Halifax puts it most strongly. The concept of a good death can put unbearable pressure on dying people and caregivers and take us away from death's mystery and the richness of not knowing. The stories we tell ourselves, good death, death with dignity, can be unfortunate fabrications that we use to try to protect ourselves against sometimes raw and sometimes wondrous truth of dying. The stories we tell ourselves, good death, death with dignity, can be unfortunate fabrications that we use to try to protect ourselves against the sometimes raw and sometimes wondrous truth of dying. I did not consider a good death that is hastened and not natural, including dying with dignity and medical aid in dying. The dominant popular narratives about a good death rarely address a planned exit because of legal constraints or religious beliefs. Many conversations and actions about choosing a good death happen in the margins or shadows, if they occur at all. Unfortunately, when they are public, we know these conversations are often reactive and polarized. I did not consider a good death that is hastened and not natural, including dying with dignity and medical aid in dying. The dominant popular narratives about a good death rarely address a planned exit because of legal constraints or religious beliefs. Many conversations and actions about choosing a good death happen in the margins or shadows, if they occur at all. Unfortunately, when they are public, we know these conversations are often reactive and polarized.