Learning that a death can be a good death

When dying does not go well: a qualitative study

BACKGROUND

Several studies deal with the question of what constitutes a "satisfactory death". A smaller number of studies deal with unsatisfactory dying processes. And only a few shed light on unsatisfactory deaths that take place in hospices and palliative care units, which see themselves as places conducive to a "good" death. What also remains largely undiscussed are the ethical aspects that accompany the observation of an unsatisfactory course of death.

METHOD

The research was carried out as an exploratory and qualitative study. The data collection and analysis were based on the methods of the "grounded theory".

RESULTS

Notions of a bad death are articulated here, though hardly by the affected persons and their relatives themselves, but rather by the professionals. Principally, descriptions of unsatisfactory dying processes refer to deficient success in symptom control, whereby the principle of autonomy is of particular importance. The focus here is not only on the needs of patients, but also on the needs of staff. The manifestation of such notions is related to the requirements arising from a practice that apparently evokes a need for accountability in the form of communicative reassurance.

CONCLUSION

An idealised definition of "dying well" is in danger of losing sight of the contextual specifics of the practice involved, which can lead to ethically problematic situations.

The impact of death and dying on the personhood of medical students: a systematic scoping review

BACKGROUND

The re-introduction of medical students into healthcare systems struggling with the COVID-19 pandemic raises concerns as to whether they will be supported when confronted with death and dying patients in resource-limited settings and with reduced support from senior clinicians. Better understanding of how medical students respond to death and dying will inform educationalists and clinicians on how to best support them.

METHODS

We adopt Krishna's Systematic Evidence Based Approach to carry out a Systematic Scoping Review (SSR in SEBA) on the impact of death and dying on medical students. This structured search process and concurrent use of thematic and directed content analysis of data from six databases (Split Approach) enhances the transparency and reproducibility of this review.

RESULTS

Seven thousand six hundred nineteen were identified, 149 articles reviewed and 52 articles included. The Split Approach revealed similar themes and categories that correspond to the Innate, Individual, Relational and Societal domains in the Ring Theory of Personhood.

CONCLUSION

Facing death and dying amongst their patients affect how medical students envisage their personhood. This underlines the need for timely, holistic and longitudinal support systems to ensure that problems faced are addressed early. To do so, there must be effective training and a structured support mechanism.

Die Semantik des „guten Sterbens“ aus ethischer Perspektive

Der Beitrag will der Frage nachgehen, ob innerhalb von Hospizen und Palliativstationen in Bezug auf typische Merkmale des „guten Sterbens“ jenseits von in der Literatur erhobenen Konsensen auch Dissense beobachtet werden können, wie Sterbeverläufe, die als nicht gut betrachtet werden, zu Wort kommen, und schließlich: welche ethisch beachtlichen normativen Konsequenzen sich daraus ergeben.

Die Studie wird auf der Grundlage einer qualitativen Interviewstudie in der Befragung unterschiedlicher Akteursgruppen sowie im Vergleich dieser Gruppen durchgeführt.

Artikuliert werden – auch dissentierende – Vorstellungen von einem guten und einem schlechten Sterben, und zwar kaum von den Betroffenen und ihren Angehörigen selbst als vielmehr von den professionellen Akteuren. Die Ausprägung einer solchen Semantik hängt mit den Erfordernissen einer Praxis zusammen, die offenbar ein Rechenschaftsbedürfnis in Form von kommunikativer Vergewisserung evoziert.

Eine abstrakte Bestimmung des „guten Sterbens“ (typischerweise: ruhig, selbstbestimmt, begleitet und gelassen) steht in Gefahr, die kontextuellen Besonderheiten der damit verbundenen Praxis nicht mehr in den Blick zu bekommen, was zu in ethischer Hinsicht problematischen Situationen führen kann.