‘A Good Death’: A Step-By-Step Guide for Dying

New book encourages readers to set up advance directives, engage in difficult conversations and confront denial of death

Sharon Jayson,

AARP

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Published March 18, 2025

Molly Snee

Death is a subject that makes many uneasy. But not so for someone who has cared for more than 1,000 individuals at life’s end and who personally has witnessed the deaths of almost 350 people. A palliative care professional who has more than 20 years of experience (including as an oncology nurse and a hospice nurse), Suzanne O’Brien, R.N., has made peace with death.

Because she’s lived among the dying for decades, O’Brien says a “good death” is not only possible — it’s what people should plan for and embrace.

“We don’t know what we’re going to be like as we age. We don’t know cognitively. We don’t know physically. We don’t know financially. We all hope that we have a plan for that, but we really don’t know the reality,” she says. “And so having your best-case scenario, the middle and then the last choice, at least we have blueprints of what can be done. When we are in that, we say, ‘Okay, this is the time. We’ve got that plan. Let’s put it into place.’”

O’Brien shares what she’s learned from her experience and research in her new book, The Good Death. The book is divided into two parts: a comprehensive resource that helps to facilitate a “good death” — including discussions around the fear of death and care for a loved one — and a workbook-style “peace of mind planner.”

“You can think of The Good Death book as the What to Expect When You’re Expecting for bringing a baby in, but for the other end of life. And so, it’s your complete step-by-step guide,” she says.

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The author reminds us that both young and old and all ages in between can suddenly be thrust into end of life. Patients in her care have ranged from five years old up to 106. Whether you’re 18 or 81, O’Brien, of New York City, urges people to develop a plan for dying that provides them comfort in whatever ways they want.

First off, she advises “everyone 18 and over to have an advance directive (legal document about end-of-life care preferences) or think about it because we know that traumatic accidents do happen, and, we know that things happen for younger people,” she says.

For those aged or infirm, O’Brien says the reality of death isn’t something many think much about until it begins closing in on them. The planner section includes five key areas to find peace of mind: physical, mental, emotional, financial and spiritual. The top priority is the emotional aspect of staring at death when people must face up to their past, she says.

“They start thinking about all the living they didn’t do. They start thinking about [their] regrets because now they have a time stamp on how much time they have left,” O’Brien says. “Usually, forgiveness is a huge part of that peace for their life’s journey. What they did. What they didn’t do. Things that they’ve been carrying around with them that they haven’t processed.”

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“At the end of life, they’re really talking about the things that they know they were supposed to do. They probably said, ‘I’ll get to it someday.’ If I can just emphasize with people, your ‘someday’ is today,” O’Brien says.

Here are some highlights from the interview, which has been edited for space and clarity:

How did you pick the book title? And what defines a “good death”?

Putting “good” on it was obviously very intentional to let people understand that it is possible for this very challenging part of the journey to go well. So, what is a good death? A good death is really dependent on what the person wants. Am I focused on symptom management? Where do I want to be? Who do I want to be there? What do I want the surroundings to look like? What’s important to me? How comfortable do I want to be? How do I want people to treat me there? What do I want to eat? If you want ice cream sundaes three times a day for all your meals, you get it. I think the first thing is allowing people to know that a good end of life is exactly what you want it to be. And you have lots of decisions that you can make.

suzanne o'brien sits in a chair and smiles at the camera

Author Suzanne O'Brien

Tasha Minn

When we talk about the good death, are we talking about it more for the person dying, or for the family members, or for both?

It’s really for both. I really hope that I can open up the conversation for all of us. One of the greatest gifts I can give my family is saying where I want to be, what that looks like, taking care of my financial things and how I want to be celebrated. I want to have a good death. And what does that mean to me?

Caregivers are the ones that are being thrust into this. People are coming on hospice very late in the process. Families don’t know the first thing about how to do the care, yet they’re expected to do it. And the fear of death is preventing people from learning — from absorbing anything.

How does age enter into preparing for a good death?

What struck me is the amount of elders that we have in this world at this moment. And then 20 percent of them do not have their own children. It’s usually the adult child that will step forward to care for a parent. I think we have to look at where we are in our world right now — not just addressing the very end-of-life moment but also this aging demographic.

What’s different about this book?

It’s the real boots-on-the-ground being an oncology nurse, being a hospice nurse, and then working with over 1,000 people and being able to pull from all of that. It’s not only in a structured way of having a good end-of-life from a practical standpoint but what I have learned about life from people at the end of life.

In your epilogue, you discuss three different end-of-life phenomena that you’ve personally experienced with patients nearing their life’s end. They include:

Getting a surge of energy — which you say is often called the “end-of-life rally” — that occurs in the final days or hours of a person’s life when they suddenly have more energy or mental clarity or physical function. You say you’ve seen it over a 12-hour period, which gives loved ones a chance for final goodbyes.
Controlling the time of death — waiting for a special date, an important life event or the bedside arrival or departure of a loved one
Talking about a visit from loved ones who have already died

What of the three is the most common you’ve experienced with individuals you’ve cared for who are dying?

The most common experience that they have is talking about loved ones that are back to help cross them over. And it happens again in all different cultures and religions.

(The book notes that up to 72 percent of dying individuals report these experiences during waking hours and not during dreams.)

Caregivers Need Care, Too

For those caring for a loved one with an illness or nearing the end of life, The Good Death focuses on caregivers. A chapter is devoted to avoiding caregiver burnout, with suggestions for creating a support system of family, friends and even hired help. Although it may be easier to say than do, O’Brien says it takes strength for caregivers to ask.

“I think that when we’re thrust into that role, sometimes we don’t even know how to stop and ask for help. End of life can’t be and shouldn’t be done by one person,” she says. “That conversation needs to be had beforehand.”

O’Brien also urges caregivers to realize that self-care isn’t selfish. She believes many caregivers think they’re supposed to sacrifice their own well-being for their care recipients, but that attitude isn’t healthy for anyone.

“Death is a natural experience,” O’Brien says. “It can go really well with the right education, kindness and support.”

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Sharon Jayson is a contributing writer who covers aging, family, health care and retirement. She previously worked for USA Today and the Austin American-Statesman, and she also has written for Kaiser Health News, Time magazine and The Washington Post.

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