Talking About Death
Why is it so hard to talk about death? We are all going to die one day, some of us sooner than others. However, there is still a huge taboo about talking about death, especially in Western countries.
However, it is important to have these conversations. By the time you—or your friend, partner or relative—are terminally ill, it may be too late or too hard to think about what you or they really want. When someone is in a coma in intensive care is not the time to be wishing that you had spoken to them about when they wished treatment to stop, or where they wanted to die.
This is a taboo that we urgently need to break down, as a society. This page discusses how you might start to have those conversations.
In this world, nothing can be said to be certain but death and taxes.
Why Talk About Death and Dying?
There are a number of important reasons why you should have conversations about death and dying. They include:
1. Most of us have an idea about how we would like to go, and family and friends would like to respect this.
For example, many people have thought about whether they wish to receive all possible medical treatment, and at what point they want treatment to stop. They have also often considered if they want to die at home, in a hospice or in hospital. If you don’t talk about it, you won’t know how your parents, relatives or partner wanted to be treated.
2. There may not be time to have the conversation ‘then’.
We all want to think that we’re immortal—or at least that we are going to live a long time. The reality is, however, that we are all going to die, and it could be a lot sooner than you think. Life expectancy is much longer than it was in Victorian times, but you could have a car accident, be run over, or be diagnosed with a terminal illness tomorrow. If you are unconscious, your relatives will not know your wishes unless you have discussed them beforehand.
A Doctor’s Perspective
In an article published on the Royal College of Anaesthetists’ website in March 2020, consultant anaesthetist Dr. Helgi Johannsson explained why everyone should talk about death.
“There comes a point where we are certain that our efforts will not save our patient’s life, and to continue treatment is simply adding to their pain and distress...
“It is nobody’s wish to die on an intensive care unit... Most people will have shied away from having that conversation with their loved ones because they don’t want to be morbid, upset themselves, frighten their loved ones, or there’s never really been the right time. I want to ask you please, make now the right time…. It is the greatest gesture of love you can give them [your family] and will make their discussions with us so much gentler and easier.”
3. It is not good to be making difficult decisions under pressure
When someone is seriously ill or injured, especially if it happens suddenly, everyone around them is upset and stressed. That is not a good recipe for calm, rational decision-making. If you have discussed your wishes beforehand, and talked about them with your loved ones—or even made decisions together about what you would like to happen—it is much easier for all of you, and for the medical staff providing treatment.
A simple example of this is organ donation (see box).
Organ donation: the importance of talking
Do you know what the legal position is on organ donation in your country?
Are you in an ‘opt-in’ system, or do you have a presumption of consent to donate without opt out?
Do you know if your relatives have opted in or out?
You will only have a few hours at most to make a decision about organ donation—and you do not want to find yourself taken by surprise at that time.
Talk early and often about these choices. Make sure you know what your relatives want—and that they know about your wishes too.
What Should You Discuss?
Talking about death is hard. It may be easier to keep things practical and focused on particular issues, rather than try to have a general conversation. So, what exactly do you need to discuss?
It is important that you think and talk about two broad aspects: end-of-life care and treatment, and after death.
End-of-Life Care and Treatment
Ideally, many of us would probably say that we would like to die peacefully in our sleep, in our own homes. Unfortunately, very few of us are given this option.
The reality is that an awful lot of people die in hospitals or hospices every year, simply because their families are unable to provide the nursing care that they need. It may be helpful to consider where you want to die, and how important this is to you, because this will affect your family’s decision-making.
You may also find it helpful to discuss questions about how long you want doctors to prolong treatment, especially if you are unconscious. If you have particular religious beliefs that mean that you do not want certain treatments, it is wise to make those clear.
You may also wish to consider who you would like informed that you are ill and/or dying.
Similarly, if you have relatives or friends in hospital, it may be helpful to ask if there is anyone they would like to see and/or speak to.
It may seem odd to be worrying about your wishes after you have died, but many people feel very strongly about their funeral arrangements and the disposal of their estate.
The first and most important issue is to make a will that clearly sets out your wishes.
The second is to tell your family and the beneficiaries what is included in your will.
Ideally, tell them all the detail, including why you have made that decision. Tell them who you have appointed as executors—and make sure that you have asked the executors if they are prepared to act.
A professional executor?
Many, if not most, lawyers are prepared to act as executors of wills. If you appoint your solicitor as executor, he or she will almost certainly do a good job of delivering your wishes.
However, the fees for this service will be taken out of your estate, and the beneficiaries will end up with less money.
You may therefore prefer to appoint a friend or family member to carry out the job. Some people also ask a local religious leader to take on the task, especially if they have very few family members left.
It is also helpful to include any particular requests for your funeral arrangements in your will—and tell your family.
If you really don’t care what happens at your funeral, it can be helpful to say that too. This will avoid endless arguments in the family about “What Mum/Dad/Uncle Joe/Auntie Edna would have wanted”—because they all know that you wanted them to do as they wished.
If you don’t feel able to have a full family discussion—or even any discussion at all—about your will and your wishes, it may be helpful to send a letter to everyone explaining why you have made your decisions. You may also wish to say that you don’t want to discuss them any further.
This can also be useful for dealing with problems later, because everyone will know your thinking. If any questions arise, they can draw on that knowledge.
Case study: A letter from the past
Some five years before their aunt died, Sally and her brother John had both received a letter from her. In it, she said that she had written her will, and left the house to them both as she had no children of her own. The letter said:
“You know that I have resisted any suggestion that I should develop the bottom of the garden. However, when I’m gone, I won’t care. I think that the property will probably be more valuable if you sell it to a developer, and what I want is for you two to get the most money from it.”
After their aunt’s death, Sally and John instructed a local estate agent to put her house on the market. They also asked him about the possibility of selling to a developer. He looked a bit doubtful, then said,
“I had some contact with your aunt over the years. She specifically told me that she didn’t want to sell the garden to a developer. I don’t know if you knew about her wishes.”
Sally smiled at him. “Thank you,” she said. “She actually wrote to both of us a few years ago. She said that she wouldn’t sell to a developer herself, but when she’d gone, we were to get the best price for the house, whether that was from a developer or not.”
The agent smiled back.
“That sounds like your aunt, all right! OK, I will put out some feelers to developers and market it direct too. We’ll see where we get to.”
Problem solved—and all by a simple letter from the past.
Present Discomfort Can Help in the Future
It may feel uncomfortable talking about death. Few of us want to admit that we, or anyone we love, might actually be mortal. However, a little discomfort in the present can mean a much easier experience in future, and being able to meet someone’s wishes about their death.
It seems well worth overcoming the taboo, and simply having the necessary conversations.