In search of a good death: conversations and contemplations exploring end-of-life care in the elderly

Abstract

There is an emerging global crisis in the delivery of end-of-life care for the elderly. In part this is due to financial considerations and in part to technological advancement: the practice of medicine has evolved to the point where hyper-medicalisation of death is frequently the norm for the elderly, often in opposition to their wishes. The impact on individuals and their families is often catastrophic; the effect on healthcare practitioners is considered by many to be no less so. The primary purpose of this narrative is to explore the implications of this medicalisation of end-of-life in our aged. Five main themes are considered, namely: the historical trajectory of how we die; the financial, legal, ethical and societal constraints that impact the delivery of a good death; how an individual’s understanding of a good death influences the care they give and receive; and, finally, what influence, if any, narrative-based medicine may have on practitioners and individuals in obtaining or providing such a death. The narrative was informed by an extensive review of clinical and non-medical research material, relevant books and popular media, together with twenty interviews conducted with healthcare practitioners, patients, families and individuals with expertise related to the topic. It makes use of the framework of non-narrative fiction espoused in narrative medicine, in an attempt to engage the reader in a more profound way than may have been possible through a mere recounting of facts. The work is presented in two parts. The first, an overview of the methodology and theoretical framework used in its compilation, together with a review of the emerging academic field of narrative-based medicine; the second contains the narrative work