Palliative care specialist BJ Miller and Shoshana Berger explain how to bring more meaning and less suffering to the end of life.
Most of us don’t like to talk about our own death. And when we refer to other people’s deaths, we often say things like “Her health is failing” or “He failed treatment.” These common sentiments make it sound like death is an option or that we can prevent it somehow—if only we ate more kale or walked 10,000 steps a day.
But guess what? Death isn’t optional.
Death is as much a part of our life as birth. And, just like a birth, it goes better when we are prepared for it. Not that we can control all outcomes or make it pain-free—but there is a lot we can do to help make it easier and more meaningful.
In our new book, A Beginner’s Guide to the End, we talk about all of the ways people can prepare themselves and their family members for the inevitable. Some of our book focuses on basic practicalities—like how to talk to doctors if you have a chronic illness, how to make treatment decisions, what documents to have in place for your end-of-life care, and how to create wills and trusts. We try to provide a comprehensive list of resources and detailed advice about how to manage this part of dying.
But, while many people think to prepare for the practical aspects of dying, too often they give short shrift to the emotional side of dying—meaning, what to do so that your death has more meaning and is less emotionally trying for yourself and those left behind.
There are many ways that you can improve the experience of dying if you plan for it and communicate your wishes to your loved ones. Here are some of the ideas we recommend in our book.
Don’t leave a mess
Many people don’t realize that the stuff they’ve been saving may not be of much value to those they leave behind. Therefore, it’s important to take time while you are still alive to clean out those closets and attics. Doing a big purge serves a dual purpose: It will make you feel lighter and also lighten the load on loved ones when you’re not around to help sort through your belongings.
It’s important to ask yourself why you’re keeping so much stuff. It is because you still use it and it brings you pleasure? Or does keeping it push away thoughts of dying? Or are you overwhelmed by the task of going through it all?
It can be cathartic to set aside time to go through your possessions, reflecting on what they mean to you, then letting them go. In some cases, you may want to save family heirlooms that have special value and make a plan to talk to your heirs about keeping them after you die. But it will have more meaning for them if you explain why you’d like them to have the item and what it means to you.
Clean out your emotional attic
Cleaning out your emotional attic is important, too. This may include sharing old secrets that you have kept from loved ones that are likely to be discovered after your death. Especially in this age of popular DNA testing, it’s important not to leave important things unsaid, though it requires sensitivity in the delivery.
If your secrets are just too damaging to reveal, consider enlisting someone to “scrub down” your life after you die. This can be a close friend who goes through your medicine cabinet, electronic files, and nightstand to rid them of old medications, personal diaries, sex toys, and other unmentionables. If you are happier knowing that these parts of your personal life won’t be exposed after you’re gone, we are not here to shame you! Just take care to make it a choice.
Mend important relationships
When people die, they don’t regret not having worked harder; they regret not having worked on their relationships. It’s important to mend old wounds before it’s too late. Even if you meet resistance from loved ones, keep pushing for more conversations, making sure you say what you want to say to them now.
In Ira Byock’s book, The Four Things That Matter Most, the pioneering palliative care physician talks about what most people long to hear that can help mend even long-fractured relationships:
Please forgive me.
I forgive you.
Thank you.
I love you.
Why these four phrases? True apologies and forgiveness, while helpful to consider at any stage of life, can go a long way toward making someone’s death more peaceful. Gratitude and love are what most people tend to need at the end of life. Closure is a human construct, rather than an act of nature, and a very useful one at that. This framework offers a recipe.
When we asked Dr. Byock if he would add anything to this list, 14 years after publishing that book, he said, “It’s useful for a parent to say to their child, ‘I’m so proud to be your mother, I’m proud to be your father.’” He’s met many men in their 60s who still yearn to hear that from a father who’s long gone.
Leave a mark
Legacy can be a loaded word. But most dying people want to know they mattered in some way, and they want to leave a mark. While for some this will mean using assets to fund a scholarship or a trust for their kids, others will have fewer material—but no less valuable—things to leave behind.
In a survey of baby boomers, only 10 percent thought it “very important” to inherit financial assets from parents, while 77 percent said that receiving and providing “values and life lessons” is very important. This means that money is not the only thing of value you can leave behind, and you may want to start thinking about what you want to pass down.
Here are some ideas that we’ve found helpful to those who wonder what to leave.
1. Leave your story. Telling the story of your life and leaving a record of experiences, people, and ideas that mattered to you gives those who love you a feeling of continuity from one generation to the next.
While you may assume that no one will care, imagine this: What would it be like to have the story of your great-great-grandmother in your hands? Wouldn’t that be amazing?
If you’re still daunted by this idea, you may want to enlist the services of StoryCorps or StoryWorth—two organizations committed to helping people get their stories down. Or you could create a family tree, perhaps using Ancestry.com or the National Archives. Fun for you, important for those you leave behind, and research suggests doing so may help improve your and your caregiver’s well-being at the end of life.
2. Leave a letter. Writing a letter can be a good way to put into words things that may be difficult to say in person. You might want to express how much you love someone, how proud you are of them, what they mean to you, your hopes for their future. If you need help, you can look to services like Last[ing] Letters.
3. Leave an ethical will. An ethical will is a way of transferring immaterial things to your loved ones: your life lessons and values. It’s not a replacement for a regular will, but a complement to it, and research suggests it reduces your suffering by taking care of “unfinished business” and bringing a deeper sense of purpose to the life you still have.
An ethical will can explain why you made certain choices in your legal will—e.g., why you left your car to your youngest daughter instead of all of your children—or tell a story about where you came from and what you value. Barry Baines, a hospice medical director who wrote a book called Ethical Wills, found that 77 percent of his patients felt their emotional well-being improve and 85 percent felt their physical well-being improve after completing an ethical will.
Of course, there are many other ways people can make the experience of saying goodbye less fraught. Few folks will get to every last detail before the end comes; as ever, do the best with what you have, while you can, and forgive yourself and others the rest. By taking care of emotional needs and focusing on what you hope to leave behind, you can bring more meaning to the experience and ease the burden on loved ones in the process. In other words, bring the same dignity and care to death that you bring to life.
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