There is no scientific evidence for life after death, but the belief in an afterlife is strong among religious and also some non-religious people. For most religious people, belief in life after death is based on teachings in their scriptures or traditions.
The sacred texts in Christianity, Judaism and Islam talk of an afterlife, so for followers of these faiths life after death has been promised by God. Into the light: people who have had a near death experience are the most fervent believers in an afterlife. One day he was driving to work, tired after a late night and hungry from skipping breakfast. He was also in a bad mood following a row with his wife, who he suspected of having an affair.
At a busy junction, he lost control, drove into a telegraph pole and was thrown through the windscreen. The paramedics said he was dead before he hit the pavement. For many, who had already professed a belief in the afterlife, this was no big surprise. In the past, the acceptance of the role of dying was probably easier [ 3 ]. The "good death" was a part of a religious ethos , and the dying person was placed into a socially shared scenario, where it was possible to find a meaning, and to acknowledge death as a necessary and welcomed transformation process re-birth to True Life , which was provided with a wide set of rites, shared behaviour, and socially significant acts [ 4 ].
The shifting to a progressive secularization of modern western society involves both non-believers and believers, and seems to create an irremediable split in the re-orientation process of death towards life [ 1 ]. The loss of value of intrinsically unpleasant events such as pain, suffering, regret, death itself, and the replacement of old metaphysical certainties with new relativity and doubt, of eternity with finiteness of time, are not counterbalanced with equivalent consolations.
It is likely that the extinction of the once most feared Judgment and of Eternal Punishment do not compensate for the loss of meaning of death — whatever meaning it has. Today the model of "good death" accepted in the past is probably no longer good, and has been fragmented on several counts, sometimes worrying and threatening, perhaps because lacking in the certainty of a superior design.
In the Western world the process of individualization i. This event is developing symmetrically with the ever more intrusive presence of medical technology, specially when life is seriously threatened, and the more and more turning of people to a medicine which has grown into a total institution [ 7 ].
Doctors can better foresee the imminence of one's death, which today is mostly a consequence of chronic degenerative diseases.
However, this fact does not help in understanding death. Medicine is defining for, and unwittingly imposing on the dying a new role, and understanding this is crucial to correctly and coherently provide that end-of-life assistance that medicine today is called to do [ 1 ].
The attempt to re-orient death toward life, in order to mitigate the dying anguish and the relatives' grief, is recognizable in the widespread disposition to encourage terminal patients to feed on their expectation of recovery, and to hide or even deny the irreversibility of their disease [ 8 , 9 ]. This attitude, however, is actually paternalistic and it is hardly acceptable since it conflicts with the duty to respect one's autonomy.
The social and individual affirmation of autonomy as a founding value, and of self-determination as a right [ 10 ] has created an ideal character of self-control [ 11 ], empathy and critical and serene evaluation, which likely, openly or unconsciously, people refer to. But being consistent with this character, i. An explicit good death model actually doesn't exist but the medical namely palliative care literature converges towards some specific aspects that contribute to define a death as a good one: symptoms control, careful consideration for the social and relational context, preparation to die, and existential well-being [ 12 , 13 ].
Such elements of good death do not overlap completely between operators and patients [ 14 , 15 ]. The health professionals, in fact, highlight the conception of dying as a process which implies a graduality in end of life.
This gradualness is not welcomed as much by patients who seem to prefer a sudden death [ 16 ]. This study, in order to bring elements together for a more general debate on this subject, aims to: 1.
The identification of possible different ideas of good death could be useful for providing the patient with correct end-of-life care. A qualitative study was carried out using the long interview method devised by Mc Cracken [ 17 ]. The characteristics of interviewees are shown in table 1 in brackets is the coding utilized for identifying citations reported in this paper. All the subjects were known by at least one of the researchers but not at all by the interviewer. As well as the categories derived from literature [ 11 , 13 , 14 , 19 — 37 ], other categories have been considered from conceptualizations of good death taken from the authors' reflections and experience Table 2.
A semi-structured interview of twenty main questions was carried out, and, in some cases, of some secondary questions in order to go into the matter in more depth Table 3. All interviewees gave written informed consent. Given the sensitivity of the issues involved, the interviews were conducted by two clinical psychologists.
The interviews lasted for about two hours, were tape-recorded, and transcript by the interviewers themselves. For a stronger validity of the analytic process, the analysis of the text was carried out autonomously by each author in five successive steps, each of which represents an increasing level of generalization [ 17 ].
By this way each author identified some main categories referring to key elements of good death. A further level of analysis, was then carried out, comparing among the researchers their analytic processes, and achieving a consensus on what ought to be held as representative of the interviewees' points of view and beliefs.
All B declared to be Roman Catholics. The interviewees showed a high compliance. Sometimes a strong emotive involvement emerged when the interviewee took on the point of view of the dying patient. In no case was an escape into rationalization perceived. Out of 11 thematic areas constitutive of a "good death" identified, 8 show important differences between B and NB table 4. For the B, the individual dimension is permanent, consistent, reflected in Eternity and subject to a final judgment.
Dante Alighieri was certainly one of the most concerned with this problem, creating all that opera, but the best thing he said is that all the dead would have wanted to meet, and realize what that new world was like, and, above all, would have wished to meet again with their moms" B1. If something of me survives after death, I could return and see the people who are dead before me: if all this were true, then may be that someone would like to come back I feel more comfortable thinking that there is nothing.
I feel this is a more coherent way NB1. Nothing exists in our life without a beginning and an end. Even the simplest and minimal things are part of a cycle. For B death is a passage, a crossing, a dimension-jump which definitively fixes the quality of that immaterial element that deeply defines each individual — the soul. Death is a fracture in personal evolution, but, at the same time, it is something which also brings the hope of both the continuation of existing individually and the personal meeting with not the "melting" into God.
I think it is a fracture in it. This is how I feel" B2. On the contrary the individual dimension for NB is defined by temporal limits, therefore transitory and precarious, precious and unrepeatable. Individuality becomes completely nullified in death, either as a return re-absorption into the biological cycle of life, or as a melting into a sort of 'universal soul': two very different interpretations, but reaching the same conclusion.
Being conscious and aware of the moment of death is not fully welcomed by believers. Death is a passage, a fact of which the individual does have an experience, a mysterious experience not subject to either direct or referred empirical knowledge, which could also be dreadful and scary, and which is foreseen to have a tremendous impact on whoever has experience of it. This I think is a very intense moment, but also a terrible awareness.
I think that she felt a chill going up her spine. It's better to be asleep. It would give more sense to my life in the same way as the choices I made in my life. Perhaps death is the most important moment of life and I would like to "be there" as much as possible" NB1.
One ought to be aware, and even The way of conceiving hope is, obviously, different between B and NB, but it is also somehow conflictual among B. I believe that everybody has the hope of recovery; believing in miracles lies in everybody. So, there is the hope of a miracle also in someone who knows that he will never recover On the other hand there is the absence of hope in NB, the tranquility of knowing that 'afterwards' there is nothing, which leads one to focus on the control of the situation preceding death itself.
I hope I'm well until that exact moment when I have to go. Not believing in anything else beyond life and not knowing anything, I don't have any hope either. I think that hope does help believers, but if someone isn't a believer, hope is not important. If someone has done many things in his life, and had many experiences, he feels his time has not been wasted" NB4. It shows a vision-of-life that gives more importance to the things one does in his life" NB1.
All the interviewees paid particular attention to the scene of death with an emphasis on visual perception, suggesting and highlighting an aesthetic dimension of dying. The scene of death determines the quality of the memory that the deceased leaves to the living. Slovenliness, squalor, exhibition of one's own degradation constitute elements of a bad death. Also emotions, including those of the dying, should be controlled, in a sort of discreet way in exposing one's intimacy.
I remember her being beautiful, dressed in black, that she came back with this image of pain. What I associate with death is the sense of shame which I also associate with illness. I think that when someone is ill, he has the tendency to be ashamed. Maybe "shame" is an exaggerated word, but in illness one is also very bashful, and so tends not to have contacts with others " B2.
Particularly for NB, death should not only be "proper", but also "beautiful". The solemnity and uniqueness of the event demands an adequate script and ritual, where aesthetic canons are elevated compared to everyday standards; an aesthetics that is supposed has been expressed in times and cultures of the past, but that today is lacking.
I think this has a certain significance, for I think the place can condition the way of dying" NB2. I was taken away from my village in Sardinia when I was a child but now I feel that is my true home. The first things I saw were there, the first scents, the first tastes, the earth, the wheat fields.. So, from nowhere I found myself there, and it's from there that I wish to return to nothingness. The B stand regarding cremation relates to their need to maintain individuality after death.
I feel that a person who dies loses something at the moment in which nothing individual remains; the person's identity even after death. It was important knowing that [the deceased] was there It serves the deceased because it leaves something of that person, and it serves the living in that they can remember that person forever. As Christian religion says: "Ashes you were, and ashes you will be" " NB1.
For B a meaning of death does exist, and is 'already given'. It was revealed ab origine , and successively handed down from generation to generation. It was not possible to identify in their interviews neither an effort to construct a socially shared meaning to attribute to death, nor the mere possibility of alternative conceptions.
I think, however, that if everything has a purpose, that there is an established plan, this helps to accept [death]. I also think that a person with faith is privileged compared to a person without. This certainty is comforting. The meaning of death, handed down by past generations through religion is not satisfactory for NB, but they also feel that a secular approach to dying and a matured tradition outside a religious conception of life, is lacking.
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