A few months ago, I asked my friend, Dr. Geoff Galbraith, to read a book that intrigued me.  Written by Dr. Samuel Harrington, “At Peace: Choosing a Good Death after a Long Life” became the subject of Geoff’s talk to the ACN Hawaii group a few weeks ago.  Geoff did an outstanding job in discussing the key features of this book.  I am told some members of the audience stayed long after the talk to discuss and share among themselves key points from the presentation. 

It’s so like Geoff to note key points from the book, which you will find here.  Among the take aways for me are these: 

At Peace: choosing a good death after a long life 

is simply a practical look at declining health, old age, progressive debility, and practical choices that people can make to minimize the likelihood of the unconsidered death and to maximize the likelihood of a “better” death.  Therefore, the restated goal of this book is to use the knowledge of disease trajectories to choose a point in the disease process at which one considers stopping aggressive treatment and recognizes that palliative treatment is likely to offer a better outcome. 

. . .  those of us who do not die suddenly or unexpectedly will die older, later in life, with progressive disability and diminished faculties. “Old age” will be our terminal diagnosis, and living longer than desired is likely to be our punishment for lack of planning 

Consider your concept of a good death.  

  • Think about the level of medical intervention you want. Outline your goals and expectations.  
  • Communicate your goals and wishes to your friends and family while you are still able.  
  • Remember, aggressive treatment to the very end results in futile and painful therapies.  
  • Look for opportunities to review less aggressive options. 

Things to Remember/Things to Consider  

  • Remember you are mortal, not immortal.  
  • Keep in mind that, on average, if you are lucky enough to live past the age of seventy-five, you are likely to have to cope with eight years of variable disability.  
  • Consider the occasional inventory of your age, diagnoses, disability milestones, and performance status.  
  • Understand that with age the risk of treatment increases and the benefit decreases.  
  • Consider a combination of disease, debility, and functional status beyond which you will not seek aggressive care.  
  • Do not look for potential problems with screening tests; address active illnesses purposefully. 

If you think that you have lived “past the expiration date,” then you are enjoying the first inkling of a reality check. Embrace it. Promoting aggressive medical treatment at that point increases the likelihood of prolonging a life of decreasing ability and diminishing returns. Transitioning to a more passive and accepting posture while actively refusing all but palliative care will give you as much control as possible. 

Recognizing the reality of a disease is empowering.  

  • Communicating your vision unburdens your family.  
  • The recognition of a terminal diagnosis does not immediately consign you to a terminal condition.  
  • Know the “why” of your disease so that you can visualize the “where” and consider the “when” of its terminal evolution.  
  • Remember your option to limit or decline treatment. 

.. the attributes of a good death are (in order of decreasing importance) being in control, being comfortable, having a sense of closure, being valued as a person, trusting one’s care providers, recognizing the impending death, honoring beliefs, minimizing the burden, optimizing relationships, utilizing the appropriate amount of technology, leaving a legacy, and being cared for by family. Of these twelve attributes, most require advance planning. 

Given that nine of the twelve attributes of a good death require enough advance planning to achieve control, comfort, closure, self-worth, trust, honored beliefs, the setting of choice, and family care, I maintain that understanding and acknowledging illness, in concert with a vision of the end, is central to achieving a better death.  

Let me add that the book contains a very good list of resources.  I would commend it to your reading. 

Best, 
Cora