Conceptualizations of “good death” and their relationship to technology: A scoping review and discourse analysis

Abstract

AbstractBackground and AimsBy the 1960s, medicine experienced technological revolutions that enabled it to control and medicalize death in many circumstances. The modern conceptualization of “good death” emerged in the late 1960s with the beginning of the hospice movement, and palliative care became an official medical specialty in 1987. This project aims to elucidate how the idea of “good death” has been discussed and perceived since then, as well as the impact of medical technologies on death.MethodsThe terms “good death,” “technology,” and “palliative care” were searched. One hundred ninety English sources that discussed “good death” explicitly or implicitly, published between 1987 and 2020, were included in the final analysis. Texts were analyzed for discursive themes related to “good death” and technology and demographic data related to authors, geographies, types of text, and date of publication.ResultsThe discourse of a “good death” with the patient being in control dominated the archive. Other discourses include a good death being peaceful and comfortable, one where the patient is not alone, and one that is not prolonged. Medical technology discourses are largely negative in the setting of death.ConclusionFindings indicate a strong critique of the medicalization of death in the literature. This also complements the dominance of discourses on patient autonomy. Medical discourses of “good death” and technology permeate discussion outside of the healthcare context, and there is an absence of spirituality and neutrality in “good death” discourses. The results of this study are relevant for ethics and communication in geriatric and palliative care.