Dr. Feargal Twomey:

I will answer the question in a slightly different way. Each person's experience is his or her own, and each family member's recall of a family member's experience is his or her own. The so-called bad deaths or the distressed deaths often occur when someone actually is not able to accept his or her diagnosis or is not able to accept that treatment is no longer available to him or her. When I meet somebody like that lady or, in fact, anybody I meet, I see my role genuinely as trying to help them. I sometimes ask, "Can I join your team to help you?" My role is to see if I can get them as physically comfortable as possible, whether it is pain or other symptoms. Oftentimes, in fact, suffering in advanced illness has nothing to do with pain or symptoms at all; it is to do with the loss you will have, the family events you will not attend, the questions, "Have I lived enough?", "Have I loved enough?", "Have I let enough go?" Palliative care is everybody's business; it is not just what I do. Everyone in healthcare work does palliative care work. We should truly and meaningfully listen to what causes people the most distress. I ask people, "What matters most to you today?" I ask them, "What are you most worried about?" Most people are able to voice that, but even in my practice again this week I have seen a man with terribly unrealistic expectations that have been created by another healthcare professional. That man is a member of society who is petrified of the idea of dying. We try to repair that.

I will repeat what I said earlier. In my experience, severe, unremitting distress, be it from a physical symptom, including pain, or from psychological or social distress, is extremely rare. If it is present and someone is very close to the end of his or her natural life, we are able to manage that.