Talking about death is difficult. You worry that you’ll take away hope or burden your loved one with fear. Speaking about death may seem like a form of abandonment because it suggests you’ve given up on the lingering promise of a cure. Your own anxiety, sadness, and discomfort may make the words choke in your throat.

But clinicians who work with people with a terminal illness point out the following:

  • Some crave reassurance. Some people at the end of life are comforted by the thought that they will be embraced, not abandoned, no matter what happens.
  • Some want to talk. They may tire of keeping up a good front or talking around a topic that looms so large that every other conversation strikes false notes.
  • Some are afraid-and want empathy. They may be stifling their own
    numerous fears: leaving loved ones, losing control, becoming a burden, and
    leaving tasks and plans unfinished. Many people dread a painful death or
    the reflected fears of others. Sharing such fears and expressing beliefs
    about death can help people feel less overwhelmed and alone. It can also
    diminish physical pain, which is aggravated by fear.

Approaching this difficult conversation

Clearly, not everyone who is terminally ill is ready to talk about death. So how will you know when to talk and what to say? Below are some words that may help you. Your task in this difficult time is merely to open the door to this conversation and promise to stay for it if the person you care for wishes to talk.

Look for openings. A song you heard, a book you read, or the way someone else’s illness and death unfolded can be an opportunity for remarks that open the door. By commenting, you signal that you’re ready to talk and needn’t be protected.

Broach the topic gently. Elisabeth Kübler-Ross, psychiatrist and author of the book On Death and Dying, describes conversations that start with the simplest question: “How sick are you?” or “How sick do you feel?”

While you may be too close to reasonably make that inquiry, there are other questions you can ask:

  • What do you worry about?
  • How can I help?
  • Is there anything you want to talk about?
  • How do you feel about what is going on with you?

Try not to rebuff tentatively expressed fears with hearty assurances, such as:

  • That’s a long way off.
  • Of course you’re not a burden.

It might help instead to ask specific questions. Depending on your loved one’s comfort level and receptiveness to the topics, questions you could ask include:

  • What are you thinking about?
  • What would be a good death?

Sharing your own thoughts on the nature of a good death may help.

Seek spiritual counsel. Talk with your religious leader or counselor. Priests, rabbis, and other religious leaders can offer real comfort to believers. Even people who do not regularly attend religious services may turn toward their faith as an illness progresses.

Ask advice about hospice. Hospice workers and hospital social workers can also help you and the person who is ill grapple with the issues surrounding death. Even if you have chosen not to use a full range of hospice services, some resources are often available.

Ask a doctor to help. A doctor’s reassurance about how physical symptoms might unfold and how pain will be handled can be invaluable. Some doctors can ask gently about fears, as well. Realize, though, that it’s not unusual for doctors (and nurses) to shy away from talking about death. Some feel determined to try everything and view death as a failure. Being human, they have their own fears and discomfort to deal with, too.

Let it go. Kübler-Ross noted that people slip into and out of denial during the course of illness and even during a single conversation. Sometimes it’s too hard to think or talk about death. Let your loved one end conversations that feel too difficult. Allow him or her to hold on to comforting thoughts and fantasies.

Adapted with permission from Coping with Grief and Loss, a special health
report published by Harvard Health Publications.