A GOOD DEATH, DEMYSTIFIED

Saving lives is the raison d'etre for our existence as doctors, but at what cost? In the irreversibly critically ill patient, how long does one continue treatment? Having personally overseen over 3,000 deaths, the author reflects on the necessity of a good death

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Benjamin Franklin, in 1879, observed that certainty is limited to two things - death and taxes. Time and technology have proven him only half wrong. Sigmund Freud on the other hand, had remarked that we are all convinced of our immortality. Discussing death is considered, varyingly, macabre, ghoulish, grim or in morbid taste. Serious discussions on definitions of death, of personal, moral, legal and economic issues involved in death-related-decisions, seldom occur in Indian families. Do clinicians constantly exposed to death, become insensitive, forgetting that for the bereaved family, it could be the first experience?

From time immemorial, a doctor’s primary avocation was “to cure sometimes, to relieve often, to comfort always”. Until recently, there was no conflict of interest with this approach, when a doctor did his best to preserve life. However, the increasing availability of sophisticated medical technology and life support systems has changed the picture. The process of dying is now more protracted, and can be influenced to be prolonged. The importance paid to ‘quality of life’ should now also be paid to ‘quality of death.”