Editor—Ellershaw and Ward describe how access to good palliative care should be available to all patients who are dying.1 We agree that equity of access is crucially important but disagree with the implied definition of what a good death is.
The authors imply that a good death is one that is pain free, dignified, and one in which active resuscitation never occurs. If this is what the patient has requested, either verbally or through an advance directive, then this would be appropriate. However, we think that death can at times be unfair and premature and that a calm good death may not be what such a patient wishes. Such patients may wish to “rage against the dying of the light,”2 may never accept their end calmly, and may not wish to be pain free. The concept of a patient not wishing to be pain free and peaceful is so far removed from our concept of good that professionals may consider such a patient to be non-rational.
We argue therefore that to force patients to have what we would call a good death is inherently medically paternalistic. A good death is one that is appropriate and requested for by that particular patient. Our duty as healthcare professionals is to ensure that resources and skills are available for their, not our, good death to occur.
Competing interests: None declared.
References
- 1.Ellershaw J, Ward C. Care of the dying patient: the last hours or days of life [with commentary by J Neuberger]. BMJ 2003;326: 30-4. [PMC free article] [PubMed] [Google Scholar]
- 2.Thomas D. Do not go gentle into that good night. www.geocities.com/classicpoetry/dtdonotgogentle.html (accessed 17 July 2003).