The social construction of good and bad deaths in hospice settings: a multiple embedded case-study

The activities that health-care professionals perform for the dying on a daily basis contribute in important ways to the experience of death, both for the patient, and those who care for them. Little is known however about the criteria that health-care professionals use when delineating a death as ‘good’ or ‘bad’. The case-study described identifies some of the criteria that health-care professionals working in one South London hospice used when evaluating the quality of deaths occurring in that unit, and demonstrates that hospice workers use a complex system of values when delineating a death as good or bad. Consistent views about the presence or absence of physical symptoms were found, but there was less agreement about the importance of criteria such as spiritual preparedness or acceptance of death. Control and autonomy also featured highly in descriptions of a good death, but these were regarded as problematic when exercised ‘to excess’ by clients and their families, a position at variance with traditional hospice philosophy. Similarly, there was little construct permanence between hypothetical and literal cases of a ‘good’ and ‘bad’ death, which suggests that the criteria which some hospice workers’ use are more subjective than the literature suggests.