Death and dying: what the patient wants.

A good death and a death with dignity may be achieved when death is congruent with the personal values of the patient. It behooves the practitioner to recognize these values and to cater to them. This paper describes effective communication with the dying person, and the partnership of treatment team, patient and family in face of the patient death. To identify and define the patient wishes it is necessary to learn how to interpret the patient's non verbal as often patients are unable to formulate the questions they wish to ask concerning their passing. These difficulties stem from several cultural factors including concern about disturbing the practitioner. It is the treatment team's responsibility to facilitate this discussion. A good death is achieved when symptoms are controlled and when patients and family recognize death as a unique living experience to be treasured as any other living experience. A death with dignity brings healing, that is always possible even when cure is out of reach. Patient's and practitioner's values may be at odd in face of controversial issues including euthanasia, assisted suicide and terminal sedation. Though he/she should not be compelled to execute these requests, the practitioner should be able to entertain an open discussion with the patient concerning these issues. Open communication and reflective listening even in presence of disagreements are the venue of healing. The study of death and dying requires novel approaches including personal narrative and qualitative research to complement traditional research instrument, such as questionnaire that cannot embrace the whole human dimension.