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29th November 2018

Rainsford S, Phillips CB, Glasgow NJ, MacLeod RD, Wiles RB.

Palliative Medicine Sept 2018; 1-9. Epub ahead of print. DOI: 10.1177/0269216318800613

Achieving one’s preferred place of death is often considered, within palliative care, as a proxy for a ‘good death’. In rural settings, relationships between place and self are often stronger than for urban residents, so one may expect that rural people would view dying at home as a major feature of the ‘good death’. To date, most place of death studies are quantitative and reflect an urban view. This ethnographic study, conducted in the Snowy Monaro region of New South Wales, explored the concept of the ‘good death’ articulated in interviews with 12 rural patients with life-limiting illnesses, and 18 of their family caregivers.

A ‘safe death’ was central to a ‘good death’ and was described as a death in which one could maintain (1) a connection with one’s previous identity; (2) autonomy and control over decisions regarding management of end-of-life care and (3) not being overwhelmed by the physical management of the dying process. For all participants, the preferred place of death was the ‘safe place’, regardless of its physical location.

Safety, in this study, is related to a familiar place for death. A home death is not essential for and does not ensure a ‘good death’. We all have a responsibility to ensure all places for dying can deliver the ‘safe death’.

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