We need to talk about death

According to a survey conducted last year, only 17 per cent of doctors are aware of their patients’ death-related preferences. In order to die a “good” death, we must talk about it.

According to a survey conducted last year, only 17 per cent of doctors are aware of their patients’ death-related preferences. In order to die a “good” death, we must talk about it. (Pic: Thinkstock)

As the adage goes, nothing is certain (in life) but death and taxes. While we’ll complain, stress and talk endlessly about tax, death is a subject we’re inclined to avoid.

Whether it’s because, in a superstitious leap, we believe raising the topic will hasten a visit from the grim reaper, dismiss the subject as too morbid, find it so uncomfortable we resort to platitudes and metaphors, or wait until we have no choice — often in a harrowing situation in a hospital — discussions about death and how we want to die well before the event are essential.

People talk about how someone died peacefully or terribly, as if death was a happy or tragic accident (which of course, it often is); but it’s also inevitable. Yet, in most cases, we can intervene and ensure those we love have the kind of dying and death they really want.

In 2014, I wrote about the importance of establishing an Advanced Health Directive (outside QLD it’s called an Advanced Care Directive) where in the event of trauma, terminal illness, coma and a range of other serious health issues, including dementia, the requirements of a patient over 18 years of age, are denoted and followed.

Designed to give the dying dignity, autonomy and control over the manner of their death — and reduce stress and anxiety for both the living and dying — the rate of completion is very low. In 2014, only 7 per cent had utilised the service.

You’d think if we were going to discuss death with anyone, it would be our doctors. According to a survey conducted by the Australasian College of Physicians last year, only 17 per cent of doctors were aware of their patients’ death-related preferences.

Discussions around death shouldn’t only be about medical interventions/support either. They should also include who we want present at our deathbed (friends, loved ones, biological family, no-one), where we die (if we can choose), how our final hours will be filled and what happens in the aftermath — how and where we’re interred, the music played, how we wish to be mourned and celebrated — the kind of memories we engender even after we’re gone.

The all-important topic of death can be thrashed out over dinner with family and ensure your wishes are met. (Pic: iStock)

Travelling on a train one day, American Michael Hebb started talking to two doctors about death and dying, learning, much to his dismay, how much denial of death plays a detrimental role in families and (western) culture.

Hebb decided to create a forum in which this all-important topic could be thrashed out — the dinner table. And so, deathoverdinner.org and “dinner table activism” was born. There have now been more than 100,000 dinners hosted in over 30 countries. Hebb states it’s not only about dying, “It’s using death as a mirror to see how we want to live”.

There was a time when death and its many rites and rituals were very much a part of culture, but progress in medical science has replaced many of these with those involving instruments and medications designed to prolong both life and death — and not always in positive ways.

In a special edition of ABC’s Compass, A Good Exit: Who Decides, Palliative Care Physician Dr Linda Sheahan spoke about Australian culture’s “poor death literacy”. In other words, we don’t understand or talk about death — something all panellists agreed with while also acknowledging everyone seeks a “good” death.

In 2011, I lost a beloved friend to cancer. In her final months, we had a frank discussion about her treatment, where she wanted to die and what she wished to happen afterwards. As her Next of Kin, Advocate, and decision maker, it was left to me to ensure this happened.

Though some of her desires were difficult and conflicted with what others wished to happen, I did everything she asked. This was about my friend. She trusted me with the privilege of making her death exactly the way she wanted. I was so grateful for her utter clarity — it ensured my role was easier than it might have been.

As a consequence of this and my own brush with death a few years ago, I’ve had frank and specific talks with my husband and children.

Above all, when I die, I would like all my loved ones — family and friends — to celebrate my life, not mourn my death.

It’s probably the last part that’s the hardest for everyone. Amidst tears, loss, grief, disbelief, anger and so much heartache when someone we love dies, celebration of who they were to us and in the world seems impossible.

By openly discussing with friends and/or family what we’ll all face — dying and death — over dinner, coffee, wine, whisky, whatever, and sharing what we do and don’t want, we can celebrate having last wishes fulfilled and, in doing so, ensure we give each other and receive our version of a “good” death.