NOBODY wants to talk about death.

It is one of the few experiences we all share, yet it is perhaps the biggest of all taboos in our contemporary Western societies.

We work out at the gym, eat our organic veggies, spend way too much on miracle wrinkle creams, all in a vain attempt to deny the inevitable.

Too often, when those closer to the threshold than we are try to talk to us about their needs or fears, we respond with an attempt to jolly them out of such negativity.

“I don’t think I can go on,” I remember my beloved grandmother saying in her last weeks of life.

My autopilot began rallying the forces of positivity, preparing to tell her not to give up, that of course she could find the strength to continue.

Fortunately, my younger and wiser cousin spoke first, saying quietly: “You don’t have to, Gran”.

Research shows that doctors, too, struggle to have honest conversations with patients about death.

One study of around 1000 recent medical graduates in the US found that more than 99% experienced barriers in having end-of-life conversations with patients and 86% described this as “extremely challenging”.

The challenge was greater when the patient was from a different cultural background to their own, the doctors reported.

Of course, it’s not just the doctors. Patients and families may collude in moving the conversation away from difficult topics or in latching on to words like “treatment” or “better” to bolster unrealistic expectations.

One review of 65 advanced cancer studies found serious discrepancies between doctors’ and patients’ understanding of the likely prognosis.

Across studies, the patients were more optimistic than their doctors, often believing their cancer could be conquered and that palliative treatment might achieve a cure.

In one study of terminally ill patients with lung or colon cancer, for example, the patients deemed by their doctors to have less than a 10% chance of survival to 6 months overwhelmingly believed their prospects were much brighter.

Of 158 patients in this category, 117 believed they had a 75% or better chance of survival to 6 months and just seven held the same view as their physician.

We tend to see hope as a good thing, but unrealistic optimism can lead us to opt for intrusive, futile treatments or deny us the opportunity to prepare for an imminent death.

Our collective reluctance to talk about dying can also mean we fail to give those who are closest to it the support they need.

While some of us might persist with denial to the last, others, like my grandmother, may want to talk frankly with clinicians or family about what they are experiencing and what lies ahead.

UK palliative care physician Kathryn Mannix has devoted much of her career to such conversations, but it didn’t necessarily come naturally.

In a recent book, she writes of her shock as a young doctor at hearing a superior offer to describe to an anxious patient what dying would be like.

“If he describes what? I heard myself shriek in my head,” she writes.

The senior doctor went on to give his terminally ill patient a detailed account of the process of dying as he had observed it over years of practice: increasing tiredness, more time spent sleeping, a drift into unconsciousness, followed by altered respiratory rhythms until the breath finally stopped.

“No sudden rush of pain at the end. No feeling of fading away. No panic. Just very peaceful …” he told the reassured patient.

Amazed that it was possible to be this honest with patients, the young Dr Mannix hastily abandoned her “ill-conceived beliefs about what people can bear”.

We would all benefit from reclaiming the language of dying, she argues, from abandoning euphemism in favour of greater openness about what death actually involves.

“In the generations of humanity before dying was hijacked into hospitals, the process was common knowledge and had been seen many times by anyone who lived into their 30s or 40s,” she writes.

“The art of dying has become a forgotten wisdom, but every deathbed is an opportunity to restore that wisdom to those who will live, to benefit from it as they face other deaths in the future, including their own.”

Jane McCredie is a health and science writer based in Sydney.


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I regularly talk with my older patients about advance care planning
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3 thoughts on “We must talk about death

  1. Paul Jenkinson says:

    The anxiety in all of us re how we die is the major cause of the “existential distress”that increasing numbers of ill people use as the reason to choose doctor assisted suicide in those jurisdictions like Oregon,The Netherlands, Belgium and soon to be Victoria.
    Doctors are atrocious at talking about death with their patients-literally lying to them and giving false hope.
    What an awful,tragic disservice to this most vulnerable group of patients.

  2. Dr Roger Wilson says:

    great to see an honest approach being taken to the subject of death. Oh when will people ,newspapers, magazines and news reports stop describing people who have died as having”passed away” !!!
    They don’t pass away they die and should be described as having died. What is it about our pathetic more recent culture of “diversity” ,”equality”, “gender fluidity” and political correctness which is frightened to call death what it is . No wonder the E.D. wards are filling up with young people with mental health issues . They no longer live in a world where the truth is spoken. sadly in Australia there is a downward spiral of moral decay manifest in politics ,sport and business to name a few areas.please may we have a movement to ban the expression “passed away”.
    This is an attempt to pretend in some way that death did not happen it just passed us by and so could not hurt our feelings or offend our precious little selves. I’m tempted to say “MAN UP” but better settle fo “person up” despite
    its more pathetic exhortation.

  3. Anonymous says:

    Death in physical sense is similar to a snake shedding away it’s cocoon and taking a new shape.
    The body dies naturally and the Energy leaving that body takes another form in evolution as it is indestructible .The energy(Soul) ,which is responsible for running the physical body is indestructible and become a part of the universal energy, once the physical body dies of it’s natural course. The Energy can neither be created, nor destroyed. The total energy is constant (as Per Newton, The Great “Rishi” science has ever known)

    The physical body has a finite tenure on this earth as prescribed by the almighty( One Single super power who is responsible for our existence on this planet and managing the laws of the entire universe; which you can call God if you like. There is only one, independent of all religions).

    The very attachment of us to the physical body makes us not to talk about the death. In fact, after living a fulfilling life and helping humanity, one should be given opportunity to leave the body peacefully, to be assimilated into the elements of the earth. Unfortunately the human beings are currently denied of their fundamental right in our hospitals by manipulation of this truth. Death is a good friend of us and it is always behind us and only some of us are lucky to embrace it peacefully.

    It should happen to everyone naturally when the time of extreme Frailty takes it’s natural course. Health system should only prevent premature demise of a person as he/she has lot to offer to the community and their family ,but not come in the way of natural death from Disease or Frailty.The ancient Rishi’s and Sages of India and other continents who understood millions of years ago, gave a meaningful definition to life on earth and our responsibility to mankind and the Mother Earth.

    This truth is conveniently covered up by human beings and Healthcare community with vested interests. Hence death and dying are made unnatural and unacceptable outcomes of human civilization .
    which lead to the current levels of suffering, we are enduring silently and looking for answers. Hence we can see lots of individuals going over to various parts of India and other spiritual destinations in the world and searching answers for their suffering. The age old traditional cultures with healthy lifestyle have been exposed to similar sufferings in various continents on this earth by our lifestyles and modern medicine

    From East to West and North to South ,human beings currently suffer in hospitals in their last days of their life as the doctors and patients all need to be blamed for this disaster. As an Intensive Care Physician, I see this day in and day out .We are forced into the role of providing Advance Care Directives to these sick patients with terminal illness , when we come across them for the first time at an emergency call, to resuscitate and admit these patients to ICU inappropriately.

    The whole civilization should redefine, address and understand the meaning for life. Then the doctors need not take the blame of not raising end of life issues with patients

    There is no need to discuss about death at dinner table if everyone understands that it happens to everyone and we should not get attached to these bodies

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