Dying Well and the Role of Palliative Care

Abstract

In this dissertation I explore the concept of dying well and examine how this fits within aphilosophy of palliative care. Palliative medicine is the medical specialty closest to the end of life, and in these chapters I provide detail on what it means to ‘die well’ from the standpoint of the practice of palliative care. First I identify certain general features of any adequate theory of dying well, namely (1) recognize the need for adequate medical care and, ideally, palliative care; (2) provide useful guidance in comparing different ways the dying process can go for an individual person; (3) specify who has relevant interests in the dying process; and (4) take into account the distinctiveness of dying as a process as separate from living and death. I then examine the function of palliative medicine, which I argue is to support patients in dying well, and argue that this function is consistent with hastening death for some patients. I then examine the role palliative medicine plays in supporting grieving family members, which follows from a broad conception of dying well which includes improving the dying process for loved ones. I develop a tool for palliative medicine which involves consoling individuals who fear death or are grieving for a lost loved one. Finally, I apply the concept of dying well to the issue of treatment for individuals who exhibit the ‘death rattle’ during the dying process. While loved ones are a part of the function of palliative medicine, there are limits to the amount of care they are owed. One such limit is that such care must be consistent with providing for a good dying process for the individual patient. I argue this undermines the justification for standard pharmacological treatments for the rattle.