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Good and Bad Dying From the Perspective of Terminally Ill Men
Elizabeth K. Vig, MD, MPH;
Robert A. Pearlman, MD, MPH
Arch Intern Med. 2004;164:977-981.
Background Understanding the range of patients' views about good and bad deaths may be useful to clinicians caring for terminally ill patients. Our current understanding of good and bad deaths, however, comes primarily from input from families and clinicians. This study aimed to learn how terminally ill men conceptualize good and bad deaths.
Methods We conducted semistructured interviews with 26 men identified as having terminal heart disease or cancer. Participants described good and bad deaths in a section of open-ended questions. Participants also answered closed-ended questions about specific end-of-life scenarios. The open-ended questions were tape recorded, transcribed, and analyzed using grounded theory methods. The closed-ended questions were analyzed using descriptive statistics.
Results We found heterogeneity in responses to questions about good deaths, bad deaths, and preferred dying experiences. Participants voiced multiple reasons for why dying in one's sleep led to a good death and why prolonged dying or suffering led to a bad death. Participants did not hold uniform views about the presence of others at the very end of life or preferred location of dying.
Conclusions In discussing the end of life with terminally ill patients, clinicians may want to identify not only their patients' views of good and bad deaths but also how the identified attributes contribute to a good or bad death. The discussion can then focus on what might interfere with patients' attainment of their preferred dying experience and what may be available to help them achieve a death that is most consistent with their wishes.
From the Department of Medicine and Division of Gerontology and Geriatric Medicine, University of Washington, Seattle (Drs Vig and Pearlman); and Geriatrics and Extended Care (Dr Vig) and Geriatric Research, Education, and Clinical Center (Dr Pearlman), Veterans Affairs Puget Sound Health Care System, Seattle. The authors have no relevant financial interest in this article.
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