Good and Bad Deaths

References to “good” deaths appear less commonly in discussions of children who die than in recollections of the deaths of elderly family members or friends. This undoubtedly reflects, in part, the different cultural perception of death at a young age that has come with the last century’s sharp reductions in child mortality in this country. Nonetheless, the committee believes that, in general, an earlier IOM committee’s characterizations of “good” and “bad” deaths apply when death comes to a child (IOM, 1997, p. 24):

A decent or good death is one that is: free from avoidable distress and suffering for patients, families, and caregivers; in general accord with patients’ and families’ wishes; and reasonably consistent with clinical, cultural, and ethical standards. A bad death, in turn, is characterized by needless suffering, dishonoring of patient or family wishes or values, and a sense among participants or observers that norms of decency have been offended.

As noted by the earlier committee, notions of a good death may reflect values of a dominant culture that some may not share. Thus, it proposed that “a humane care system is one that people can trust to serve them well as they die, even if their needs and beliefs call for departures from routine practices or idealized expectations of caregivers” (IOM, 1997, p. 24). This kind of trustworthiness—and the competence, sensitivity, and flexibility it demands—is integral to good palliative, end-of-life, and bereavement care for both children and adults.

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