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'You Promised Me I Wouldn't Die Like This!' A Bad Death as a Medical Emergency

Timothy E. Quill, MD; Robert V. Brody, MD
Arch Intern Med. 1995;155(12):1250-1254. doi:10.1001/archinte.1995.00430120015002.
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DYING IS a time of vulnerability and potential. Ideally, it can be a time of spiritual healing and personal connection, but it can also be dominated by physical symptoms and fear of the future. Dying patients depend on their physicians, nurses, and social workers to approach them with skill, knowledge, caring, and compassion.1-5 The core commitment made by health care providers to their dying patients is nonabandonment—that no matter what happens, they will be there to work through problems together with the patient and family.6,7 There is a profound difference between facing an uncertain future with caring, skilled partners and facing it alone.

One of our goals in working with the dying is to help them try to achieve a "good death."8-10 The meaning of this idealized concept may be highly individual, but there are likely to be some common objectives. The first is to die in


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