You are going to die one day — better start talking about it before it's too late
There's a movement to bring death out of hospitals. Professor Kathy Kortes-Miller explores what that means in her new book, Talking About Death Won't Kill You.
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When death comes up in conversation — specifically, dealing with the actual death of ourselves or someone we love — the reaction is often predictable: denial, discomfort, even downright dashing to the door. Death isn’t easy to talk about.
Enter Kathy Kortes-Miller, a social work professor at Lakehead University who is committed to making your dinner-table conversations awkward — because better that, than never have them happen at all. As the title of her book suggests, Talking About Death Won’t Kill You. Here’s her best advice for having that chat before it's too late to change someone's dying experience for the better.
What’s wrong with how we're doing death as a society?
We’ve made death and dying into a medical event. And it’s not really. It’s more of a social process. And most Canadians will tell you (dying in hospital) is not what they want. They want to be dying at home, as part of their community. To make that happen, we have to have the conversations ahead of time.
What if our loved ones are extremely resistant or in deep denial?
In my own family, it’s not easy either. When I tried to broach this with my mother-in-law, she literally left the room on us. But we persisted. When she would come to visit, we would make sure her pillows were plumped, and that there were also advanced care planning documents left on her pillow. Eventually she recognized that because we love her, she needed to have the conversation with us. It wasn’t a big massive conversation. It's bits and pieces.
Talk about your concept of “holding space” around a dying person.
It means recognizing that we can’t fix the situation. Instead, we’re literally accompanying them through it. We’re letting (the dying person) know that we’re there, that we love them. We’re creating an environment that allows them to have conversations if they’re able, to sleep if that’s what they need, to be angry and to have extreme emotion, to be as free and open as they possibly can.
What surprises people the most when they’re seeing someone through this process for the first time?
There’s a generation that didn’t receive any sort of death education. One (surprising) thing would be some of the sounds that occur when a person is dying, the changes in breathing. Also, when someone is no longer taking in fluid or food, that’s okay, because the body no longer has those requirements.
The second thing is how isolating dying can be. It’s not uncommon for people to lean into themselves and not be as social or want to talk. The act of dying can be a really hard piece of work for people to do. And sometimes they don’t have the energy to engage with those they love. Just as most of us need space during our day-to-day lives, we also need space during our dying process.
You were working on this book just as Canada decided to allow medical assistance in dying. Has your thinking on that changed at all?
It was so lovely to no longer have to discuss whether it was right or wrong to allow medical assistance in dying. What we can do now is focus on quality of living until we die, and make sure we have really good palliative and end-of-life care available for all Canadians, so this becomes an additional intervention, and not a focus of all our care at the end of life.
With demographic changes, more of us may be dying without traditional family support. How is that going to change things?
I think we’ll look to our communities. More people are volunteering their time to take care of people at the end of life. Often people will come to hospice volunteering having experienced a death either because it went really well or it didn’t go as well, and they want to improve that.
Are there death rituals from cultures around the world, or from our cultural past, that have gone away but are worth bringing back?
We are shifting a little bit to having deaths occur in our homes. For a time, it was all in hospitals, and people did not have the opportunity to spend time with the person after they had died. We're recognizing that people need to say goodbye, clean the body, clothe the body. While the funeral system can assist with that, it’s becoming something that people would like to participate in for themselves.
The key point is that while we may no longer do funerals in churches or religious places as often, we need to acknowledge that a person has died, think about what that meant, and develop rituals that will allow us to begin grieving.
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