How do you talk about death with your loved ones?

Have you ever lost someone close to you?

Me too. 

My life has been touched by all types of dying — the collective tragedies, the peaceful acceptance, the long-awaited, the “never thought it would happen to them.” And, you know what? Nothing in life prepares you for death. Interesting since it’s the only certainty. Is this because we don’t talk about death while we still can? 

We sometimes forget at the end of someone’s life that they need more than fluids, medications, and treatments. Like my grandpa Ed who wanted family and friends around him, they need human touch and interaction that convey understanding. Like my grandpa who just wanted to be in the same room with the family to watch a little tv and be normal, they need to be heard and seen as a whole human, not just as a vessel harboring a terminal condition.

However, the medical environment isn’t set up for such connections — whether physical, spiritual, or emotional. Have you ever tried fitting two people in a hospital bed with wires and tubes? And, try having a meaningful conversation about intimacy or sex or pleasure with your partner in overhead fluorescent lighting — with curtains for walls. 

What we want in death 

Nearly 80% of the U.S. population desires to die at home. Yet, only 30% actually do. Why so few? Well, as my dad used to say, “the answer is complicated.” And it is. Social fears and expectations, medical oaths, family behaviors, and personal uncertainties all contradict our ideals. But, therein lies the issue. 

We don’t talk about death. Instead, we make assumptions that things will or won’t happen in certain ways. We put the conversation, the feelings, the fears off to tomorrow — or never.  Avoiding difficult conversations isn’t going to help anyone. 

Where do you start when you talk about death?

First, talk with yourself about what you want. What are your fears about death? What are your wishes? Do you have an advanced directive? If not, I highly recommend Five Wishes program of Aging with Dignity since the document is legally binding in many states. The website also provides resources to help families start having conversations. Ask yourself, what do you want your last days to look like? Do you want to be at home or in a medical facility? Do you have a will or a death box so your loved ones know how to handle your things after you’re gone?  

Second, what are your ideas of connection at the end of life? Will you want to have your family surrounding you at the end of life? Or have more private moments with your spouse or partner? Perhaps both? What experiences in your life have shaped those ideas? What about intimacy or sexuality at the end-of-life? These may feel like tough questions, and it might be advisable to talk with your therapist or find a sex therapist to talk it through. My co-authors and I also put together this helpful self-guided reflection exercise for practitioners, but I find it is also useful in non-medical settings. 

Third, start communicating these wishes to others, including those closest to you — something that can be tougher than talking to a professional. If you have strong feelings about what you want, now’s the time to write them down or print them out, and schedule a chat over coffee. Start with the resources we mentioned above. Make your choices legally binding, and appoint someone you trust. And if you are that trusted person, give the person you love the final gift of telling them it is going to be okay. It will change their life.

If this all seems too far off for you to worry about, think about having these conversations with your parents — or grandparents. 

And start going through your own papers. Are they up to date and comprehensive? Do others know about your wishes and the supporting documents you have? Can they find them easily? Are your passwords someplace safe for others to access?

None of this is easy — even for someone who’s studied and dealt with aging and death. I expect there will be a solitude in knowing I must one day walk that path alone, not knowing what lies ahead. It feels scary. But while walking as far as I could with those I have loved, I have been given the gift of knowing there is also light, and warmth, and compassion.