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A good death, or a public one?

BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7495.0-g (Published 07 April 2005) Cite this as: BMJ 2005;330:0-g

Rapid Response:

What is a 'bad death'?

A major controversial issue relating to ‘dying with dignity’ is that
the health professionals’ community uses as its starting point the concept
of a ‘good death’.1 The ‘good death’ concept has its roots in the flawed
perspectives of St. Augustine’s “City of God” essay (~4CE).2 Building on
this Christian perspective to define what ‘dying with dignity’ is may
further complicate an already polarised issue. Perhaps an approach that
starts with what a ‘bad death’ is might prove more instructive.
Attributes of a ‘bad death’ might be defined to include issues such as
death following prolonged unnecessary pain and suffering, death following
persistent vegetative state, dying as a suicide bomber, keeping a
terminally ill individual alive against her/his written wish to be allowed
to die, death from torture, and death from prolonged hunger. Consensus on
what constitutes a ‘bad death’ is potentially more likely to be achieved
compared with that on what constitutes a ‘good death’. I realise that as
the list lengthens, it would stretch into controversial grey areas.

However, the current approach that ‘dying with dignity’ should implicitly
derive from St. Augustine’s ‘good death’ perspective has so far proved
unhelpful, being coloured more by religious considerations than concerns
for individual autonomy, views of a dying individuals’ loved ones, and/or
the evidence-based decisions of health professionals.

References

1) Smith J. A good death, or a public one? BMJ 2005; 330: 7495.0

2) Burry JN. Darwinian Original Sin. Adelaide, SA, 2004.

Competing interests:
None declared

Competing interests: No competing interests

15 April 2005
Associate Professor Niyi Awofeso
Public Health Surveillance Officer
New South Wales Justice Health, Sydney, Australia.