D1: What is a good death?

Saturday, 26th August

This panel session will take perspectives from three different countries and explore how to give the best care for patients approaching the end of life. End of life care is a neglected aspect of care across the world, including the Asian countries. There is a need to address how to provide good care to ensure a “Good Death and to ensure good discussion and communication between all parties (patients, family and healthcare professionals) to ensure a “Good death” for everyone.

Good care to ensure a “Good Death” 

Death is an inescapable fact of life that every living being has to experience and it affects all ages from conception to the elderly. In some instances this may happen suddenly and in other situations, it may be a more foreseeable end. Efforts have been made in medical literature to define what a good death is – although no single encompassing definition has been widely adopted. Overlapping themes are frequently identified such as symptom management, the relief of suffering, open communication, care planning, maintaining dignity, spiritual peace, relationship closure, and life completion/fulfilment. Not all deaths may be good however, and what is good for one may not be the same for another.

Different perspectives of good may be held by patients, their families, and the multidisciplinary team delivering care. Rather than attempting to deliver a standard universal approach to achieving a good death, seeking to individualise and tailor care to the needs of all parties is potentially of greater worth.Dying is a highly personal journey filled with meaning and opportunity for all affected, and enhancing our capacity to deliver the best care possible facilitates the greatest likelihood of addressing the needs of patient, their families as well as the caring team.

“End-of-Life Conversations”

We – healthcare professionals – are good at healing patients, but often we are not comfortable or well trained to handle end-of-life situations. While aware our patient is approaching the end of his/her life, beginning an appropriate conversation and care is a challenge. The end-of-life care conversation is everyone’s business – healthcare professionals, patient and family members. For healthcare professionals, it is not feasible nor entirely necessary to leave it just to the palliative care specialists, as death is common. There is a real need to learn and work with palliative care specialists to provide a good death for our patients. There are barriers and difficulties (perceived and real) to “end of life” care and conversations: what, when, who, how. There are many levels of end-of-life-care conversations, which are often inadequate:

1.    Between healthcare professionals (e.g. doctors, nurses etc.)

2.    With other professionals (social workers, religious leaders supporting the patient/family)

3.    Between healthcare professionals and the patient and family

4.    Between the patient and family

5.    Social culture of Death

Lui Siu Fai, Clinical Professional Consultant, Division of Health System, Policy and Management, The Jockey Club, School of Public Health and Primary Care, The Chinese University of Hong Kong, HKSAR, Hong Kong
Yingwei Wang, Director General in Health Promotion Administration, MOHW Taiwan
Chee Loong Lam, Senior Lecturer and Palliative Care Physician, University Malaya; Malaysia