What would an ideal death be? That was the question posed to a group of doctors as part of a study published in the journal Palliative Care and Social Practice.

The initiative was the work of a research team from the End-of-Life Care Research Group at Ghent University in Belgium. Forty-five professionals were interviewed: fifteen in Italy, fifteen in Belgium, and fifteen in the United States.

The study’s findings show that the definition of a “good death” according to these doctors differs greatly from that often given by other people. Previous research had already indicated that members of the medical profession do not always choose the same type of care for their patients as for themselves. But the work conducted by the Belgian team goes further, particularly since prior studies focused on a limited set of end-of-life decisions.

Three types of doctors were consulted: general practitioners, palliative care specialists, and specialists likely to encounter patients at the end of life. In-depth interviews were then conducted with each of them. The first discovery: “Palliative care doctors reported that they had thought a great deal about their own end-of-life preferences, which was not always the case for general practitioners or other medical specialists.”

“We found that most doctors take their personal end-of-life preferences into account, and for many of them, their ideas become clearer over time,” the study further states. Many reported that they regularly or often reflect on their own mortality and have contemplated end-of-life issues.

For the interviewed doctors, a “good death” often included the following elements: dying at home or in a nursing home (rather than in a hospital), being able to anticipate death, having loved ones nearby, having enough time to say goodbye, not suffering, managing pain and symptoms, putting affairs in order so that the consequences are manageable for relatives, having a clear mind, and preserving autonomy and dignity.

The main divergence between doctors’ and non-doctors’ responses was related to whether or not to prolong life at the end. This difference stemmed from the experience doctors had acquired in their work, which gave them much to reflect upon. “The strongest influence seems to come from end-of-life experiences they found most difficult and wish to avoid,” the researchers concluded.

Non-medical participants were more likely to want treatment that would extend their lives, although they too expressed a desire for comfort-based care. This burning wish to postpone the inevitable at all costs can be explained by fear, uncertainty, or lack of medical knowledge.

But doctors’ views on certain end-of-life preferences were also shaped by cultural factors, legislative context, and their own specialty. “Doctors in jurisdictions where medical assistance in dying is legal or where the laws have been considered (Belgium and Wisconsin) more often regarded it as a positive and important end-of-life option,” the research team explained, “while others expressed discomfort, particularly when their cultural or religious beliefs or the legal framework of their country opposed it (Italy).” | BGNES