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Why Is Death Left Out Of Wellness? Here's How To Start The End-Of-Life Conversation

Author:

Shoshana Ungerleider, M.D.

April 05, 2019

Internal Medicine Physician

By Shoshana Ungerleider, M.D.

Internal Medicine Physician

Shoshana Ungerleider, M.D. is an internal medicine physician, founder and activist living in San Francisco, CA. She is the executive producer of two Oscar-nominated documentaries on palliative care and the founder of End Well, which advocates for end of life care.

Image by Sophia Hsin / Stocksy

April 05, 2019

As an internal medicine physician practicing in a busy urban hospital setting, I care for people of all ages who have never considered their own mortality. Far too often, this results in an experience at the end of life that doesn't embody the goals and values of the life they have lived. They suffer, and so do the people they love. It's led me to question, why is this?

For the vast majority of human history, we have been thoughtful and intentional about death. Without the benefits of modern medicine, we cared for our family members at home when they became ill. When people died, they were laid out in the parlor of the home, surrounded by family, and ancient death rituals were performed. Death was an expected occurrence that was accepted and planned for. Our cultural understanding, at least in the West, began to deteriorate about a century ago as death became increasingly medicalized.

Despite our culture's propensity to share just about everything, the idea of death remains a cultural taboo, keeping us from personal reflection, discussion with those we love, and planning ahead.

Why death is left out of the wellness conversation.

There are only two things we really know for sure: We are born, and we will die. As a culture, we invest in nutrition, exercise, and spiritual well-being as a means to live well—but a critical part of living well is dying well. A recognition of our own mortality can allow us to live an even more fulfilled life. We become better people who feel more grateful for our experiences every day.

While historically many people pondered death and the idea of an afterlife through the lens of religion, the growing number of Americans turning away from organized religion and seeking a hybrid spiritual identity invites us to actively explore other cultures' practices around death, both past and present. Almost every philosophical and spiritual tradition encourages thinking regularly about death to not only reduce our fears but ultimately, to live a more authentic, meaningful, and even joyful life.

How to bring end-of-life discussions into the wellness movement.

No matter your spiritual or religious beliefs, here are six steps to take action toward living more comfortably with death:

1. Take time for personal reflection about what matters most to you.

Make it count, and make it a regular practice. I like using my birthday as an annual reminder to step back and reflect.

2. Recognize which relationships matter most to you.

Think about the one or two people in your life who you would want to speak for you if you were unable to speak for yourself, AND ask them to serve as your health care proxy.

3. Have a conversation about your values and priorities.

I like the card game Go Wish to help with this conversation. Go Wish has 35 cards with simple prompts about what might matter most if you are seriously ill or at the end of your life. The goal: to facilitate a conversation and prioritize what's important so those who have to make decisions for you will know your wishes.

4. Document your wishes.

Do this in the form of an advanced health care directive or living will, and make sure your health care proxy has a copy.

5. Discuss your wishes with your health care provider.

You don't need to wait for them to bring it up. You can start the conversation about your end-of-life preferences with your health care provider at your next visit.

6. Revisit your wishes annually.

As new circumstances arise or your health condition changes, review your wishes annually with your loved ones.

End-of-life wellness looks different for everyone. The goal is to identify what is most important to you, regularly check back in with yourself, and create a network of people who support your values. Give one of these steps a try today, and see how it goes. You might be surprised that by making choices about how you want to live and die, you feel inspired to live life to the fullest.