I have been drawn to the subject of mortality for many years, not from a place of gloom but from a desire to prepare and understand. My engagement began three decades ago when a close friend, living with AIDS, and I collaborated on a book built around conversations with others facing similar circumstances. That early work was followed by four years of volunteering in a hospice, which later inspired a second book based on interviews with hospice staff. These experiences shaped my views about what matters at the end of life and taught me that end-of-life planning and conversations are both practical and deeply human.
Now, at the age of 84, mortality feels less abstract than it once did. Awareness of one’s own finiteness is a steady companion, and it prompts questions about quality of dying as much as about longevity. I have seen different endings among friends and relatives, and I have listened to hospice professionals explain what they believe constitutes a good death. Throughout this piece I use good death to mean a death that minimizes suffering, preserves dignity and aligns as much as possible with the desires of the dying person and their loved ones.
Personal stories: slow, sudden and something in between
Stories from my circle illustrate that there is no single ideal. One friend, Grace, reached 101 and, to my mind, had a good death. A lifelong music lover who had lived above a prominent London arts centre, she remained active in a choir and continued to attend concerts until shortly before she died. As she slowed, care shifted to family members and paid carers, and when the end arrived she passed away at home, surrounded by relatives. The transition was gradual: mobility declined, social life narrowed, but her wishes—to stay at home and to be with family—were respected, and this gave her passing a sense of completion and peace.
Contrast that with the ending of her husband a few years earlier at age 97. He had a pleasant afternoon attending a church concert followed by a meal with his wife; later that day he felt unwell and was taken to hospital, visited by family and then died soon after. There was no protracted decline or extended distress—just a relatively sudden close after a good day. I also recall another abrupt passing: a man known to my son’s friend collapsed and died while walking on a beautiful beach while away on holiday. He suffered a heart attack and was gone within moments. These different patterns—gradual versus sudden—both avoided long agony, and each felt, in its own way, acceptable to those who loved them.
What hospice workers say about a good death
When I asked hospice staff about their view of a good death, their answers often pointed to two essentials: freedom from pain and a sense of emotional calm. Professionals emphasized that physical comfort and emotional reconciliation are intertwined—relief from distress can allow people to make peace with what is ending. In their accounts, the ideal scenario is a person feeling safe, cared for and able to let go without unresolved turmoil. Such conditions enable families and patients to sort out last matters and for the dying person to relax into the final phase.
Trauma, dignity and the family’s memory
Hospice workers also described how traumatic, unexpected deaths can leave loved ones with a lasting sense of horror—circumstances where there was no time for farewells or the environment was chaotic. They recalled distressing events in emergency settings and tragic accidents where the scene left families shocked and unresolved. These memories can shape what relatives think of as a person’s final moments. For many relatives, even a minor symptom—such as a noisy breathing pattern—can feel catastrophic if it is their first encounter with death, turning what might have been clinically manageable into an emotional trauma that colors the memory of the whole dying process.
Planning, uncertainty and reality
Staff also noted that while planning helps, it cannot guarantee a particular outcome. They likened end-of-life wishes to birth plans: valuable for guiding care but vulnerable to unpredictable events. Some people make detailed plans and still face emergencies that alter the course. This tension between preparation and uncertainty leads many to focus on core aims—minimizing suffering, preserving dignity, and communicating wishes—rather than trying to control every detail of the final moments.
Opening the conversation
Practical preferences vary. My husband jokingly suggested he would prefer to be struck by a bus and gone instantly—one moment alive, the next not—so long as he did not leave a mess for someone else to manage. I, on the other hand, imagine a quieter, family-centered ending, what I half-jokingly call a Victorian death, with loved ones gathered and the chance to share a little last wisdom. Neither vision is superior: both highlight core values—minimal suffering, consideration for relatives and the preservation of dignity. The most important step is to talk about these wishes openly, document them when possible, and accept that while choices matter, so does flexibility.
What kind of ending would you choose if you could? Is it uncomfortable to think about at all? Starting that conversation with a partner, friend or clinician can be an act of compassion and clarity. Considering both personal preferences and what matters to family can help shape an ending that feels, as much as circumstances allow, peaceful and meaningful.