Evaluating the “Good Death” Concept from Iranian Bereaved Family

Evaluating the “Good Death” Concept
bereaved family members were similar to those in Japan. This
finding thus indicates that these perceptions are foundational
elements of a good death, regardless of ethnicity or cultural
differences.
The results indicated that most family members are
likely to view a good death as “being respected as an
individual” and having “control over the future.” According
to Murata, 19 approaching death can cause a sense that
life is meaningless and a loss of the patient’s well-being
founded on temporality, relationships, and autonomy. Providing
a good death means that dying patients are able and
allowed to participate in the same human interactions that
are important throughout life and appreciating patients as
unique and “whole persons,” not only as “diseases” or
cases. 20 It means supporting patients’ well-being through
positive stimulation, for example, offering beautiful views
and tasty meals. 21 A good death is also perceived by family
members as “religious and spiritual comfort.” Ghavamzadeh
and Bahar 14 claimed that among Iranians religious
beliefs strongly and explicitly deal with the fact of death.
This finding reflects the result of Tayeb et al, 11 who found
that Muslims believe that death is closely linked to faith.
They appreciated the importance of access to any needed
spiritual or emotional support. Steinhauser et al. 20 also
found that 89% of American patients and 85% of their
families emphasize that a good death is “being at peace
with God” and “prayer.”
Participants perceived a good death as a “natural death.”
Johnson et al 22 claimed that death without “machines,”
“tubes,” and “lines” is considered more dignified and aesthetically
pleasing. Withdrawal or withholding of treatment
of the highly invasive and technological sort is conceptualized
as restoring patient dignity and, to a small
degree, personhood. 22 Many deaths were not considered
“good” because of inherent problems within a culture of
care that usually strives to prolong life and prevent death. 23
Similarly, Miyashita et al 18 reported that most Japanese
view unnecessary life-prolonging treatments such as vasopressors,
antibiotics, and artificial hydration as barriers to
achieving a good death. The domain perceived by family
members as less important was “unawareness of death.”
This is consistent with Steinhauser et al’s 20 finding that
96% of American patients emphasized “knowing what to
expect about one’s physical condition” achieves a good
death. This is inconsistent with Tang et al’s 24 claims that
in many traditional cultures (eg, most Asian countries and
a few European cultures), in an effort to protect the patient
from despair and a feeling of hopelessness, family caregivers
often exclude patients from the process of information
exchange. This is also in contrast to Miyashita et al’s 18,25
findings, where many Japanese do not want to know the
seriousness of their condition. Our findings could be explained
by the other results of this study. The results
indicated that the majority of participants had a high level
of education. The other findings showed there is a negative
correlation between level of education and “unawareness of
death.” Since the majority of participants were well-educated,
it can be concluded that they were less likely to view
a good death as “unawareness of death.” This has also been
found by Montazeri et al. 26
The results showed that the family members’ age was
correlated with some aspects of a good death. Miyashita et
al 18 also found that the older the family member, the more
positively he or she would look on the patient’s death.
They claimed that death at younger ages tended to be
evaluated as a bad death. This could be explained by their
earlier study, where they found that age and psychosocial
maturity inversely related to death anxiety. 27 Based on the
results, level of education positively influenced some domains
of a good death. There was a negative correlation
between level of education and “unawareness of death,”
with Montazeri et al 26 finding that Iranian patients with a
low level of education were more likely to not know the
diagnosis.
Conclusion
According to the results of this study, providing a good
death requires professional caregivers to be sensitive and
pay attention to the preferences of each unique person’s
perceptions through her or his senses. This includes views,
tastes, sounds, smells, and bodily contact. The ability of a
dying person to see a sunset may seem petty but is important
in providing high-quality care for people at the end of
their lives. The same goes for the other senses. These
circumstances deserve attention in all educational programs
and especially in programs dealing with end-of-life
care. In order to implement holistic care, caregivers must
pay attention to patients’ spiritual needs. Establishing a
specific palliative care unit in a hospital and meeting each
patient as a unique being and part of a family could be the
best way to improve the quality of end-of-life care that is
missing in Iran. It requires cultural preparation and public
education through the media and by well-educated staff.
Since demographic variables influenced the evaluation of a
good death from the bereaved family members’ perspective,
public education needs different strategies.
LIMITATION
All data in this study were collected by use of self-report
questionnaires. The dependence on self-report aspects in
this study may have caused an overestimation of some of
the findings due to variance, which is common in different
methods. The respondents were predominantly female,
which limits the generalization of the results for male
respondents. Moreover, the convenience sample of Iranian
bereaved family members, which is not representative of
the entire Iranian population, could weaken the generalization
of the findings. Further research is necessary to
illuminate the concept of a good death as perceived by the
general Iranian population.
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