What a 'good death' means and why end-of-life planning changes everything

A good death, according to doctors, is not about stopping treatment but about shifting focus to comfort, dignity and patient wishes before crisis forces rushed decisions

We prepare for most milestones in life, but we rarely prepare for the end. Yet when serious illness strikes, families are often forced to make urgent decisions about life support, intensive care and invasive treatment, sometimes without knowing what their loved one truly wanted.

 

“When we talk openly about what matters to us at the end of life and put those wishes on record, we spare ourselves and our families avoidable suffering, and make space for dignity, comfort and care that truly reflects who we are,” says Dr Jyoti Goyal, Director – Critical Care, Yatharth Super Speciality Hospital, Faridabad.

 

Why early end-of-life planning may be the most compassionate choice

Dr Goyal says people plan their careers, their children’s education and their retirement, but when it comes to death, the one certainty of life, we prefer silence.

 

She stresses that planning ahead could mean less suffering, fewer machines, fewer frantic decisions in an ICU corridor and more peace.

What does a ‘good death’ mean in medical practice?

According to Dr Goyal, from the ICU’s point of view, a good death is not about surrendering or stopping care; it is about making sure that the care being given matches what the patient actually wants and what will truly help them.

 

Dr Goyal explains, “It means aligning medical decisions with the person’s values, their idea of dignity and their understanding of quality of life, rather than simply continuing treatments because they are technically possible. It is about compassionately supporting the patient.”

 

Clinically and ethically, she emphasises that the focus shifts from simply prolonging biological life at any cost to ensuring comfort, dignity, symptom control, autonomy and respect for a person’s values.

 

A good death, she adds, should involve clear communication, minimal suffering for both patient and family, and emotional support throughout.

 

However, in India, families often equate stopping treatment with abandonment or moral failure, she highlights, sharing her experience from the ICU. Cultural norms, religious beliefs and the fear of being wrong frequently push decisions towards aggressive interventions, even when the benefit to the patient is minimal.

Why is achieving a good death often difficult in India?

Dr Goyal points to several barriers, including delay in recognising medical futility, fear of discussing death, unrealistic expectations of ICU medicine, fragmented medical opinions and poor implementation of end-of-life policies.

 

She notes that doctors often avoid early conversations due to time constraints, fear of legal consequences or discomfort with discussing dying. Families may hold on to hope despite overwhelming medical evidence. Hospitals, meanwhile, are structurally designed for curative care, not supportive care.

When should families begin end-of-life planning?

Dr Goyal says, “In an ideal world, the best time to begin forming end-of-life plans is when someone is healthy or at the diagnosis of a serious or chronic illness, not during a crisis.”

 

Research consistently shows that early conversations lead to care that better reflects a patient’s values, fewer unnecessary invasive procedures, improved symptom management and fewer ICU admissions close to death, she explains.

 

Families also report less conflict and emotional burden.

 

According to Dr Goyal, in some cases, particularly in advanced cancer, it may even improve survival by avoiding complications of overtreatment.

Living wills in India: What the law allows and limits

Dr Goyal says that advance directives and living wills allow individuals to document what life-sustaining treatments they would or would not want if they can no longer speak for themselves.

 

In India, these documents are legally recognised following Supreme Court judgements. However, procedural safeguards apply, including verification and institutional review, which, according to Dr Goyal, can complicate implementation.

 

She clarifies that these directives guide decisions around withholding or withdrawing life-sustaining treatments such as ventilation or resuscitation.

 

She stresses that a living will does not permit euthanasia. “One document does not automatically work everywhere without due process, and families cannot simply rewrite a patient’s documented wishes, though, in practice, conflict may arise.”

 

She says that even when a living will exists, doctors may need to verify its validity, consult ethics committees and perform due diligence, all under immense time pressure.

 

“Ethical dilemmas emerge when family members disagree with the patient’s documented wishes. Guilt, hope and fear of social judgement all surface at once. Physicians then face a painful tension as they try to respect patient autonomy or avoid confrontation and potential legal repercussions,” she says.

 

In such moments, Dr Goyal shares, decisions may not always perfectly align with what was written on paper, and that is precisely why earlier conversations matter.

Is palliative care the same as giving up hope?

Dr Goyal explains that palliative care is often misunderstood as being only for the dying or as signalling the end of treatment. In reality, it focuses on reducing suffering from symptoms, providing psychological and spiritual support, and maximising quality of life alongside active treatment.

 

“Evidence shows that early integration of palliative care reduces suffering, hospitalisations, caregiver burnout, and improves decision-making for everyone involved. It is not about stopping treatment,” she says.

 

She further says that a patient can receive chemotherapy, dialysis or cardiac procedures while also receiving excellent pain management, emotional support and clear discussions about goals of care.

 

The balance depends on what the patient values most — how much discomfort they are willing to endure for a potential benefit.

 

The role of palliative teams is to clarify these trade-offs and ensure treatments serve something meaningful to the patient, such as comfort, autonomy, dignity or time with loved ones.

 

Dr Goyal notes that in the final weeks of life, many patients receive aggressive treatments their own physicians would decline. When preferences are documented, care becomes more personal, more humane and less driven by default escalation. Instead of “do everything”, it becomes “do what matters”.

 

Dr Goyal highlights that advance care planning reduces guilt, internal conflict and disagreements between family members during crises. Evidence also shows lower rates of complicated grief, depression and post-traumatic stress after the patient’s death.

 

Dr Goyal calls for integration of palliative care at both primary and tertiary levels, expanded training for doctors and nurses, streamlined advance directive procedures, standardised hospital end-of-life policies, public awareness campaigns, legal protections for clinicians, and insurance coverage that includes palliative and home-based care, not just intensive care.