A good death: key conceptual elements to end of life care

01 November 2013
Volume 5 · Issue 11

Abstract

Humanity is aware that death is an unavoidable inevitability of life; however, for most it is not a subject that overwhelms our everyday lives. For patients with life limiting, palliative, and end of life conditions, however, this is different, and with what little control they do retain over their health, experiencing a “good death” remains a priority. Paramedics in their capacity as community workers are frequently called to assist end of life care patients and their families, and whilst they may be au fait with practical and clinical elements of practice, such as pain relief, the conceptual and philosophical elements are perhaps less well known.

This article introduces the concept of a “good death” before expanding on epistemology, existentialism, death anxiety, spiritual pain, grief, as well as the role of person and family-centred care, and empowerment. In addition, this article draws upon the author's personal experience of end of life care, in the hope that paramedics might have a better holistic understanding of the concepts related to those dying patients and families with whom we come into contact, ensuring a high quality, family centred, peaceful death for all.

It is estimated that between 355 000 and 457 000 people require specialist end of life care (EOLC) within the United Kingdom (UK) each year (Marie Curie Cancer Care, 2012); care which according to the National Council for Palliative Care (2011) involves helping those with advanced, progressing and incurable illnesses to live as well as possible until they die. This is done through pain management, symptom control, and importantly, family-centred social, spiritual, and bereavement support.

Improving the quality of death has become a major need for patients, their families and loved ones, as well as healthcare professionals, researchers, and policy makers who organise and provide care (Iranmanesh et al, 2011). This was recognised in 2008 with the release of the Department of Health (DH) End of Life Care Strategy, a document that set out a vision for giving people approaching the end of life more choice about where and how they would like to live and die. EOLC involves many healthcare and community disciplines, ranging from oncologists, palliative nurses, psychiatrists, general practitioners, counsellors, pastors, district nurses, social workers, and increasingly, paramedics.

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