All Deaths Can’t be ‘Good’: Death Positivity Depends on Quality of Life

Open communication alone can’t prevent a ‘bad death’. Privilege plays a significant role in achieving a better ending.

The ideal of a ‘good death’ is central to the death positive movement. But inequalities in our world make the possibility of dying well unlikely for hundreds of millions. (Renato Danyi/Pexels)

For some, it means quick and painless. For others, final moments with loved ones are most important. Maintaining autonomy and feeling heard by caregivers is often a key factor.

Most people don’t like to think about their own death. However, identifying critical end-of-life values can help people achieve a death that inflicts the least amount of emotional and physical harm. While a good death is more possible through open communication and willingness to delve into existential discomfort, it is not always possible, or even likely, for those who experience a reduced quality of life due to social inequality.

Privilege may not guarantee a good death, but factors like wealth, status, and social conditions do affect the likelihood of having access to one. For some, it’s not the culture of silence that leads to a bad death, but the inequities they face in life.

The death positivity movement was built on the idea that there is such a thing as a ‘good death’. While there is no single and absolute definition of what constitutes a good death, it is generally considered to be the most comfortable and ethical death possible for the dying individual. The circumstances of the death and the patient’s values influence both the definition and possibility of attaining a good death.

Modern revulsion of death may originate from a lack of direct engagement in death rituals, like the washing and preparation of loved ones’ bodies. Up until the late 19th century, all funerals were home funerals in which the family of the deceased (usually women) would prepare the body for burial. Today, tasks associated with dead bodies are mostly reserved for morticians. Families are spared the emotional pain of seeing and touching their loved ones after death, however some say they are denied the opportunity to engage with death meaningfully.

Lack of experience dealing with death may contribute to increased death anxiety. Anxiety about death creates a culture of silence around this topic, meaning many people die without having expressed their end-of-life wishes to those who can ensure they are carried out. For example, a family that is afraid to confront the reality of an impending death may wait too long to notify other loved ones until it is too late, depriving the deceased and their loved ones of the chance to say goodbye.

According to researchers at the University of California, San Diego School of Medicine, there are 11 core elements that signify a good death: “preferences for a specific dying process, pain-free status, religiosity/spirituality, emotional well-being, life completion, treatment preferences, dignity, family, quality of life, relationship with the health care provider and “other.’”

Some of these core elements can be attained by everyone. However, the idea that all people are equally able and likely to achieve a good death is fundamentally flawed. Many core elements of a good death depend on privilege and wealth.

For example, a pain-free death often depends on medical care, and a system that reliably values end-of-life care — something many countries do not guarantee for their citizens. Religiosity and spirituality depend on a political system that allows and values freedom of thought and religion. Even emotional well-being depends on a person’s ability to lead a fulfilling life, which is directly correlated to the quality of life the person was able to achieve.

Inequities prevent hundreds of millions of people from living their best lives. To ignore this fact in philosophical discussion of achieving a good death, is to ignore the experience and reality of life and death for much of the population. When discussing death positivity and the ideal of a good death, there is no separating a person’s ability to achieve quality of life from their ability to achieve quality of death.

Poverty is one of the most significant social determinants of health and mental health, intersecting with all other determinants, including education, local social and community conditions, race/ethnicity, gender, immigration status, health and access to health care, neighborhood factors, and the built environment (eg, homes, buildings, streets, parks infrastructure). The mental health effects of poverty are wide ranging and reach across the lifespan.

Psychiatric Times

Poor mental health, lack of stable connections with others, and poverty issues greatly affect a person’s likelihood of greeting death with a sense of acceptance. These issues can’t be solved by death acceptance without willingness to work on quality of life for all.

A good death is often a privileged one. The bad deaths — violent, patterned deaths — are disproportionately experienced by the marginalized.

— Tessa Love, The Establishment

Death positivity, in essence, is harm reduction. It is a way of thinking that prioritizes ethics and comfort in death by advocating for open communication, pre-planning, and the breaking of taboos. No amount of death education or acceptance can remove the ache of grief, but thinking about end-of-life issues openly and honestly can take some of the sting out of it.

Some in the movement have acknowledged the importance of including discussions of privilege, identity, and inequality in conversations about death positivity. Until more emphasis is placed on improved health care, reduced poverty, and equality, the concept of a good death is largely a fantasy for those in our society who are rarely afforded an opportunity to thrive.

As the wealth gap widens, and more people face food insecurity and other inequities, the ability to achieve a good quality of life — and death — is in jeopardy. Seeking to understand death is a worthy endeavor that can improve end-of-life outcomes. However, more emphasis on improving quality of life for all is needed before the ideal of a good death can truly gain traction.

Originally published on BeyondtheDash.com

Editor, blogger, orphan, grief analyst and plant parent.

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