The Quality of Death as a Component of Quality of Life

Abstract

According to the most recent data available from Eurostat, in the Eu-15, there are 3.7 million deaths per year. Death is one of the very few experiences that we can be sure that will happen to us. But it is a rare circumstance: It only happens to 9.9 out of one thousand persons every year, and it happens mostly among very aged people, over 80 years old, who have little chances to fight for organizing themselves to improve their conditions. The main causes of death are circulatory diseases, cancer, respiratory diseases, and other causes, including accidents and suicides: but causes vary significantly by age, sex, and life style. Not surprisingly, in 1995 the standard death rates per 100.000 were, in the Eu-15, for men, 896.2, while women only reached 529.9, a third less than men.

During the twentieth century, some great technological and social improvements permitted the modification of natural borders of life: birth and death. Concerning birth, the major improvements resulted in new ways of defining “quality of birth” in all developed countries, which nowadays includes four aspects: free decision, low risk for child and mother, absence of pain, comfort, and economic and social coverage for both child and parents. About the second life border, death, fewer changes have taken place. The only really big one is its delay, the general increase of life expectancy. But public opinion is changing, and probably the twenty-first century will see similar changes in attitudes about death, as already happened in the past century towards birth.

This paper analyses the conditions of the “ideal model of death” as it has been studied in several samples of population in Spain by Jesús de Miguel and Marga Mari-Klose, as well as half a dozen surveys done in Spain about the frequency of thoughts about death, worries about it, and attitudes towards intervention in the case of terminal patients who ask to die. The results are analyzed in the context of a society that is getting more and more non-confessional, and that recognizes a rising respect for the personal autonomy of subjects during all their life. The associations of patients and their relatives can play an important role as modifiers of conditions of death; especially the people involved in sicknesses like cancer in which death can be anticipated long in advance, when the patients and their families are still in a socially active age. Quality of death (pre-death, death itself, and post-death periods) is increasingly becoming part of the aspirations and expectancies for a good quality of life.