A good death is hard to find. Family members tell us that loved ones die in the wrong place—the hospital—and do not receive high-quality care at the end of life. This issue of the Hastings Center Report offers two articles from authors who strive to provide good end-of-life care and to prevent needless suffering. We agree with their goals, but we have substantial reservations about the approaches they recommend. Respect for the decisions of patients and their surrogates (...) is a relatively new and still vulnerable aspect of medical care. For thousands of years, patients and surrogates had no say in medical decision-making. Today, standards support shared decision-making, but these articles both carve out exceptions to those standards, limiting the rights of patients and families in decisions about specific end-of-life treatments. As bioethics consultants in an acute care setting, we frequently confront conflicts similar to those described by Jeffrey Berger and by Ellen Robinson and colleagues. In such cases, our service emphasizes redoubled efforts at communication and mediation. Focusing on goals and values, rather than interventions, produces the best possible collaboration in health care decision-making. Cases in which we would overturn a surrogate's recommendations regarding palliative sedation or do-not-resuscitate orders are rare and require careful processes and clear evidence that the surrogate's choice is contrary to patient values. (shrink)

Subjectivity: exposure, care, response -- On self, others, goods, and final faith -- On style and pseudonymity -- A faith that defies self-deception -- On reflexivity, vision, and the self -- On faith, the maternal, and postmodernism -- Socratic self-sufficiency, Christian dependency -- On authenticity -- The garden of death: faith as interpersonal -- When is death?.

Jeffrey Bishop’s The Anticipatory Corpse exposes a functional metaphysics at the root of contemporary medical practice that gives rise to inhumane medicine, especially at the end of life. His critique of medicine argues for alternative spaces and practices in which the communal significance of the body, its telos, can be restored and the meaning of a “good death” enriched. This essay develops an alternative epistemology of the body, drawing from Christian theological accounts of the communal or Eucharistic body (...) and linking liturgical practices to the cultivation of solidarity. It argues for an epistemology of the body that makes visible the invisible bodies at medicine’s margins and illumines the disparate worlds of health care globally. (shrink)

The problem of physician-assisted death, assisted suicide and active euthanasia, has been debated predominantly in the ethically familiar vocabulary of rights, duties, and consequences. Patient autonomy and the right to die with dignity vie with the duty of physicians to heal, but not to kill, and the specter of “the slippery slope” from voluntary euthanasia as a last resort for patients suffering from terminal illness to PAD on demand and mercy killing of “hopeless” incompetent patients. Another dimension of the (...) debate over PAD concerns the evaluative question of what constitutes a good death. At stake are Issues of character and virtue in the face of death and dying and their Implications for legitimizing the practice of PAD. Critics of PAD argue that “natural” death in the context of comfort care, as provided by hospice programs, is the good death. In contrast, PAD amounts to an easy way out, an evasion of the ultimate human challenge and task of dying. Because hospice care is clearly preferable to PAD, the former should be encouraged and the latter remain prohibited. (shrink)

This interdisciplinary collection presents valuable discourse and reflection on the nature of a good death. Bringing together a leading judge and other legal scholars, philosophers, social scientists, practitioners and parents who present varying accounts of a good death, the chapters draw from personal experience as well as policy, practice and academic analysis.Covering themes such as patients' rights to determine their own good death, considering their best interests when communication becomes difficult and the role and (...) responsibilities of health professionals, the book outlines how ethical healthcare might be achieved when dealing with assisted suicide by organizations and how end of life services in general might be improved. It will be of interest to students and academics working the area of medical law and ethics as well as health professionals and policy-makers. (shrink)

The philosophical literature on well-being and the good life contains very little explicit discussion of what makes for a better or worse death. The purpose of this essay is to highlight some commonly held views about the good death and investigate whether these views are recognized by the leading theories of well-being. While the most widely discussed theories do have implications about what constitutes a good death, they seem unable to fully accommodate these popular (...) good death views. I offer two partial explanations for why these views have been neglected in discussions of well-being and make two corresponding recommendations for future work in the philosophy of well-being. (shrink)

This narrative symposium examines the relationship of bioethics practice to personal experiences of illness. A call for stories was developed by Tod Chambers, the symposium editor, and editorial staff and was sent to several commonly used bioethics listservs and posted on the Narrative Inquiry in Bioethics website. The call asked authors to relate a personal story of being ill or caring for a person who is ill, and to describe how this affected how they think about bioethical questions and the (...) practice of medicine. Eighteen individuals were invited to submit full stories based on review of their proposals. Twelve stories are published in this symposium, and six supplemental stories are published online only through Project MUSE. Authors explore themes of vulnerability, suffering, communication, voluntariness, cultural barriers, and flaws in local healthcare systems through stories about their own illnesses or about caring for children, partners, parents and grandparents. Commentary articles by Arthur Frank, Bradley Lewis, and Carol Taylor follow the collection of personal narratives. (shrink)

Outcomes research is topical in discussions about health-related research. Its emphasis on effectiveness creates an important opportunity for nurse researchers to strengthen the linkages between theory, outcomes research and nursing practice but, before care can be more effective, it is logical to establish patients’ desired outcomes. A thorough review of the implications of this requirement for the care of hospice patients is needed, but is lacking in the literature. Therefore, the literature on a ‘good death’ is reviewed as (...) a step towards assisting hospice patients to achieve what they regard as an acceptable death. The starting point is to define more clearly what it means to die a good death. The relationship between hospice care and achieving a good death is then examined. (shrink)

Spirituality and storytelling can be resources in aging successfully and in dying well given the constraints of modern day Western culture. This paper explores the relationship of aging to time and the dynamic process of the life course and discusses issues related to confronting mortality, including suffering, finitude, spirituality, and spiritual closure in regard to death. And, finally, the role of narrative in this process is taken up.

This article discusses two views associated with narrative conceptions of the self. The first view asserts that our whole life is reasonably regarded as a single unit of meaning. A prominent strand of the philosophical narrative account of the self is the representative of this view. The second view—which has currency beyond the confines of the philosophical narrative account—is that the meaning of a life story is dependent on what happens at the end of it. The article argues that the (...) connection between these two views is more tentative than often supposed: philosophical narrativists that see life as a single unit of value and meaning nonetheless provide grounds for arguing that the end of life is not the best and may be a particularly bad time to approach and intervene in the matter of how well one's life as a whole has gone. (shrink)

This paper studies the connections between the notions of prolonging life and a good death in Antiquity. It is demonstrated that while prolonged life generally meant forestalling the human constitution’s death, ancient philosophers also pointed to the limitations of prolongation. The paper shows how philosophers welcomed prolonged life when it was shown to foster movement toward the good, such as self-realization and social usefulness. Yet, they rejected prolongation when it led to the perpetuation of evil, such (...) as social uselessness and suffering. We ask whether a contemporary good death is a mercy killing or an improvement of prolonged life, as the ultimate end of “goods practicable for man”. (shrink)

The paper outlines several forms of ethical attitude to good life and good death in the Socratic literature of the fourth century BCE. A model for the Socratic discussions could be found in Herodotus’ story about the meeting between Croesus and Solon. Within their conversation, Solon shows the king of Lydia that death is a place from which the life of each man can be seen as the completed whole. In his Phaedo, Plato depicts Socrates’ last (...) day before his death in a similar spirit, as the completion of his beautiful life. However, there is no consensus regarding opinions on death among the Socratics. The final part of the paper outlines various meanings of death in the writings of the first generation of the Socratic authors, which arise from different attitudes that the individual philosophers hold regarding the soul as well as other topics. This part puts the principal emphasis on Aristippus, who is considered as the most controversial figure of the Socratic movement. Aristippus makes an interesting opposite to Plato concerning death, since he associates the philosopher’s endeavour for a good life solely with that which is here and now. (shrink)

Debate continues over the acts/omissions doctrine, and over the concepts of duty and charity. Such issues inform the debate over the moral permissibility of euthanasia. Recent papers have emphasised moral sensitivity, medical intuitions, and sub-standard palliative care as some of the factors which should persuade us to regard euthanasia as morally unacceptable. I argue that these lines of argument are conceptually misdirected and have no bearing on the bare permissibility of voluntary euthanasia. Further, some of the familiar slippery slope arguments (...) against voluntary euthanasia compromise the principle of autonomy to which both supporters and opponents of euthanasia adhere. I discuss a model for doctor/patient relationships which can be applied to cases which would be seen by all disputants as strong prima facie cases for euthanasia. I argue that in certain cases it will be ordinary medical practitioners who are duty-bound to assist death. (shrink)

Euthanasia has been a subject of debate worldwide. It has brought up multiple controversies in different countries and among different societies. Over the years, euthanasia has been an active topic of research in the field of bioethics, owing to its numerous ethical and legal implications. In this article, we take a brief look into the laws and legislation surrounding euthanasia in different parts of the world.

Standard views of good death in human and veterinary medicine considerably differ from one another. Whereas the good death ideal in palliative medicine emphasizes the positive aspects of non-induced dying, veterinarians typically promote a quick and painless killing with the aim to end suffering. Recent developments suggest a convergence of both professions and professional attitudes, however. Palliative physicians are confronted with patients wishing to be ‘put to sleep’, while veterinarians have begun to integrate principles and practices (...) from hospice care. We will argue that the discourses on good human and animal deaths are not distinct, but that they interact and influence each other. On the one hand, veterinary medicine adapts techniques like chemotherapy or sedation from palliative end-of-life care. On the other hand, philosophers, veterinarians, pet owners, patients and the general public alike make certain assumptions about the analogy of human and animal dying or killing. Unfortunately, these interactions have only scarcely been reflected normatively, especially on the part of human medicine. Conflicts and misattributions with potential serious negative consequences for the patients’ wellbeing are provoked. For these reasons, palliative physicians and veterinarians are invited to engage in the debate around human and animal end-of-life care. (shrink)

My main purpose in this article is to establish the meaning of a ‘good death’ when death is self-chosen. I will take as my point of departure the new notion of ‘self-euthanasia’ and the corresponding practice that has evolved in the Netherlands in recent years. Both physician-euthanasia and self-euthanasia refer to an ideal process of a good death, the first being ultimately the physician's responsibility, while the second is definitely the responsibility of the individual choosing (...) to die. However, if we also accept the existence of a fundamental moral difference between ending another person's life and ending your own life, and if we accept this moral difference to be also relevant to the normatively laden good death, then this difference represents a strong reason for preferring self-euthanasia to physician-euthanasia. (shrink)

In response to a global population with increasingly complex issues at the end of life, a movement in the U.S. has emerged incorporating doulas into end-of-life care. These end-of-life (EOL) doulas are not just focused on the quality of life, but also the quality of death. Like birth doulas, who provide support for pregnant patients and their families, EOL doulas help alleviate physical and mental discomfort in those who are dying. In this paper, we explore the role of EOL (...) doulas in improving the care of unrepresented patients, who lack decision-making capacity and have no surrogates or documents to guide their healthcare decisions. We argue that EOL doulas may help this traditionally underserved population experience a “good death” by answering several ethical and procedural challenges. As quasi-independent, non-medical members of the healthcare team, they provide a balancing, advocating voice on behalf of the patient, and may also help reduce inappropriate treatment, delays in care, and the overburdening of the public guardianship system. As such, attention should be given to formally defining their place within the healthcare infrastructure. Ultimately, we contend that EOL doulas are key to ensuring optimal, ethical care for unrepresented patient populations. (shrink)

In this article, I sort through some of the confusion surrounding what constitutes the controversial notion of a “good death” for children. I distinguish, first, between metaphysical and practical disagreements about the notion of a good death, and, second, between accounts of a good death that minimally and maximally promote the dying child’s interests. I propose a narrowed account of the dying child’s interests, because they differ from the interests of non-dying children. Importantly, this (...) account illustrates how disagreements at the end of a child’s life are sometimes the result of a shift from a future to a present-oriented understanding of the child’s interests on the part of some stakeholders but not others, and sometimes the result of a values-based disagreement about how different interests should be weighted. This brings into sharper focus the questions of for whom, and in what way, a child’s death might be considered good. (shrink)

Buddhists, including the Bhutanese, value human life as rare and precious, and accept sickness, ageing and death as normal aspects of life. However, death and dying are subjects that evoke deep and disturbing emotions often characterised by denial related to high-tech medicalisation and its inspiring hope. Advanced medical interventions such as cardiopulmonary resuscitation are believed to interfere with the natural process of dying. However, some excessively pursue medical interventions in the hope of prolonging and preserving life, refusing its (...) finitude. Healthcare workers are faced with increasing instances of ethical and moral dilemmas exacerbated by inadequate training and lack of proper understanding of the socio-cultural context on end-of-life care and to facilitate good death in Bhutan. We discuss these ethical dilemmas in providing quality end-of-life care and good death against the backdrop of rapidly changing social values and expectations. (shrink)