We put enormous faith in medicine at the end of life. That’s understandable. When someone we love is dying, we want the best care available, so we reach for hospitals and specialists, and whatever machines and medications might help. But most of what actually makes a death a good one has very little to do with any of that. And I’m not just offering an opinion here. There’s research behind it.
Turning to the evidence
So what actually makes a death good? In 2021, a team led by Mehreen Zaman set out to answer that in The Lancet Healthy Longevity. They reviewed 13 systematic reviews on the good death, which between them drew together 407 separate studies. That scope makes it one of the most thorough examinations of the question we have.
Out of all of it, they distilled eleven conditions that make a death a good one. Listed here in order of how often they surfaced across the research:
- relief from physical pain and other symptoms
- good communication and a real relationship with health professionals
- cultural, religious or spiritual rituals
- relief from emotional and psychological distress
- having a say in treatment decisions
- dying in the place you prefer
- not having life prolonged unnecessarily
- awareness of the significance of what is happening
- emotional support from family and friends
- not being a burden on others
- the right to end one’s life
Most of that list is about people, not procedures.
The part that stopped me
Here’s what caught me, though. The researchers pointed out that of those eleven conditions, only three really call for medical expertise or infrastructure. Just three. Relief from physical pain (and even that can often be handled simply enough, outside a hospital), not dragging life out longer than it needs to go, and the right to bring it to an end. That’s the lot.
The remaining eight are a different order of things altogether. They come down to presence. Connection. Being heard, being at home, being surrounded by the people who love you. The study puts it about as plainly as you could ask for. Most of these conditions can be offered to most dying people without expensive infrastructure or specialist training. Which means the things that count for the most at the end are, by and large, within reach of ordinary people. They don’t hinge on your postcode or a private room or the size of your budget.
Why this matters
If most of what makes a death good is human rather than clinical, then how we prepare for dying has to shift. At the moment, we tend to hand the whole business over to the medical system. And the system does exactly what it was built to do. It treats, measures and intervenes. What it was never designed to do is hold those other eight things.
Someone still has to sit with the person lying awake at 3am, too frightened or anxious to sleep. Room has to be made for the words a family has been circling for weeks and never quite says out loud. The rituals that matter can slip through the cracks when everything feels rushed, and the wish to die at home can quietly fade once the pressure builds to move somewhere else. This is real work. It just doesn’t come with a Medicare item number.
Where an End-of-Life Doula fits
This is the space End-of-Life Doulas work in. We aren’t doctors or nurses, and we’re not here to replace them. Medical care stays exactly where it belongs. Our job is to tend to everything else.
We stay present, so nobody has to go through it on their own. We help start the conversations a family keeps meaning to have and can’t quite face. We honour whatever rituals matter to you, whatever shape they take. We back the wish to die in the place you’ve chosen and work out how to actually make it happen. And we ease that quiet fear of being a burden, so the person dying can keep giving something to the people they love rather than feeling they’re only taking. Add it up, and that’s eight of the 11 conditions, right there. None of it is exotic. All of it is deeply human.
There’s one more thing worth naming, and honestly it might matter most of all. The medical system passes you along. A GP, then a specialist, then a ward, then a different nurse on every shift, with each one holding only their own small piece of the story. An End-of-Life Doula holds all of it. We’re there in the lead-up. We stay through the dying itself. And we’re still there afterwards, for the people left behind. That kind of continuity, one steady presence for the whole of it, is something no other part of the system is really built to offer. It’s the heart of what we do.
A word of caution
The researchers also offer a note of caution, and it’s one worth passing along. A list like this can harden easily into a checklist without anyone meaning it to. And a checklist starts to feel like pressure. Pressure on the person dying to “die well”. Pressure on a family who might look back afterwards, convinced they got it wrong. That was never the intention. These 11 conditions aren’t a scorecard to tick off. Think of them more as a map of what good support can look like. Nobody dies perfectly, and nobody needs to.
What this means for you
If you’re facing the end of life yourself, or walking beside someone who is, then I invite you to think about this. The parts that matter most aren’t shut away inside a hospital. They take shape between people. For example, a family that has prepared, a community that shows up, or the right support alongside you. And that’s a hopeful thought. A good death isn’t reserved for the lucky few – it sits far closer to home than we’re usually led to believe.
If you’d like to talk through what that support might look like for your family, I’m here for that conversation.
About the Author
Shannon Beresford is the Director of Your Path Guide Pty Ltd, an Adelaide-based practice dedicated to helping people live and die with comfort, meaning and connection. His work brings together End-of-Life Doula care and sound therapy to honour each person’s story and choices.
As Chair of HELD Australia Ltd, the national peak body for holistic end-of-life and death-care practitioners, Shannon advocates for stronger recognition of the End-of-Life Doula role across Australia’s health and aged care systems. He also holds a Certificate IV in End-of-Life Doula Services, the only nationally accredited qualification in this field, and volunteers with the Central Adelaide Palliative Care Service (CAPCS), providing practical and emotional support to individuals and families in their final weeks of life.
Reference
Zaman M, Espinal-Arango S, Mohapatra A, Jadad AR. What would it take to die well? A systematic review of systematic reviews on the conditions for a good death. The Lancet Healthy Longevity 2021; 2(9): e593–e600. doi: 10.1016/S2666-7568(21)00097-0
Available at: https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(21)00097-0/fulltext
Published open access under a Creative Commons Attribution (CC BY 4.0) licence.
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