Planning for death in pursuit of a good Life

"The pandemic has forced us to face the fear of death head-on. This article addresses topics we can no longer avoid, such as our mortality and the fear of losing those around us. Avoidance will only create emotional distress, therefore, it is essential to get comfortable with death and the unknown. Acceptance is key to having a good death. At the end of this article are some helpful resources — I encourage you to use these as conversation starters around end-of-life planning and legacy concerns."

- Dr. Maurya Cockrell DHPE, Death Doula

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Death is something we all will experience and yet it is a concept shrouded in mystery and, for many of us, dread. For those in the healthcare industry, particularly ICU units, the loss of life caused by the recent pandemic has hit especially hard. “They’re always second-guessing themselves, wondering if they could do more. Nurses and doctors are seeing multiple deaths in a day and they’re sitting with the anguish of the families. No one has been trained for this much death,” says David Kessler, as quoted in USA Today. Again and again, patients slip away — sometimes over a painful and prolonged period but often in a sudden and sharp decline. In spite of the frequency, or maybe because of it, healthcare staff are deeply affected by these losses. Often compounding their own sadness and frustration are the reactions of their patients’ families, grief-stricken and spinning wildly through the overwhelming bewilderment that comes with an unexpected end. This frequent confrontation with death will naturally turn many to consider their own preparations, but conversations on the topic of death are largely taboo in our culture, making it difficult to process the emotions let alone the practicalities of one’s own passing.

It is understandable to fear death and dying, but shoving this fear into a box and rejecting its presence, as is common in our society, is a futile exercise; it cannot be dismissed. Instead, fear thrives in obfuscation, and goes as far as to manifest in some as death anxiety, formally known as thanataphobia. Such a committed avoidance of the topic of death leaves many of us ill-prepared to navigate the emotional upheaval and practical arrangements required when it finally does make its obligatory appearance in our lives. However, many groups around the world have developed a more pragmatic attitude towards death and integrate various preparations for its arrival into the everyday, for some, as early as childhood. The concept of exposure therapy supports this approach — acknowledging the existence of death frequently and in varying degrees can help to normalize the idea and minimize its interference in daily life. In Japan, “Shukatsu” festivals — essentially fairs for end-of-life services — are gaining popularity and entire families attend, including children. The Igorot of the Philippines practice a 2,000 year old tradition of carving their own coffins, and a similar approach has been embraced by the elderly in New Zealand in the relatively new Coffin Club. Swedish Death Cleaning is also fast-growing trend — a process of thoroughly decluttering in order to enjoy a more present life and ease the post-death burden on family and friends.

Getting comfortable with death is perhaps the first step in preparing to have a “good death,” a notion heavily influenced by culture and religion, that varies from one person to the next, and is constantly evolving. In defiance of the universality of the death experience, there is a surprising lack of literature on the definition of a “good death” and an on-going discussion of how that definition differs by perspective (dying person/patient, family, provider). Given the generally accepted position that the dying person’s perspective is of principal concern, the term “respectful death” has emerged in an effort to emphasize the importance of their priorities and adherence to their wishes. A review of several qualitative and quantitative studies that provide a definition of a “good death” reveals these priorities to commonly be focused on three things: the particulars of the death process (where, when, funeral arrangements, etc), a pain-free experience, and emotional well-being. Regardless of how an individual defines their own “good death,” it is often difficult to broach the subject and communicate these wishes to someone who will ensure they are fulfilled. As tough as these conversations can be, though, they often bring peace to an otherwise agonizing process.

As death’s presence in daily conversation has grown, so too has interest in preparing for it. Tragically, how and when we die is a mystery. As medicine advances, some of us will be given some insight into what our ends may look like and perhaps even some time to prepare for them, but many of us will not. Fortunately, we can begin at least some preparations whenever we’d like.

- This checklist from legacy planner The Postage covers some essential documents, property considerations (physical and digital), and some basic funeral considerations.

- On a more personal level, Dr. VJ Periyakoil developed a template for a Friends and Family letter — a series of seven prompts based on discussions between caregivers and seriously ill patients of diverse backgrounds. Referred to as The Seven Vital Tasks of Life, completing this letter may help provide some measure of peace that even in the event of an untimely and unexpected death, important messages will make their way to your loved ones. Each of the prompts is entirely optional — some may not apply or may conflict with personal convictions and beliefs. As a deeply emotional exercise, Dr. Periyakoil acknowledges that she herself attempted several versions before she was satisfied with the final message.

- For a digital approach, Cake offers online tools for end-of-life planning that cover legal, health, and legacy concerns. Important documents may be stored here as well, and profiles can be shared.

In the face of all the upheaval and volatility that comes with life, the one thing we all share in common regardless of culture, location, or time, is death. Somehow, despite its prevalence, it has become a stranger to many of us. This is not to say that death is good or bad or cause for celebration or mourning, but simply that at the very least, it demands to be acknowledged. And also, that perhaps, in our committed pursuit of a good life, we include preparations for a good death.

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