By Sheryl Ubelacker, The Canadian Press on March 8, 2018.
TORONTO – It’s one of the last taboo topics: dying and death, the “elephant in the room” that nobody wants to discuss.
But in her new book “Talking About Death Won’t Kill You” (ECW Press) released this week, Kathy Kortes-Miller says it’s essential that families have conversations about end-of-life issues – and it’s never too early to start.
“It’s going to happen to 100 per cent of us and it’s very much a life experience,” said Kortes-Miller, palliative care division lead at the Centre for Education and Research on Aging and Health at Lakehead University. “It’s part of what happens to us as a result of living.
“And also because when we die, our death will impact a minimum of five other people,” she said from Thunder Bay, Ont. “And it will impact them in ways of learning about life, how they grieve, how they’re able to function and then also how they deal with it the next time they encounter dying and death.”
Kortes-Miller, who spent decades working in palliative care, said she wanted to bring “death out of the closet” after experiencing her own brush with mortality when the mother of two was diagnosed with colon cancer.
The book is in part an answer to the concerns that arose during treatment as she faced her own thoughts about potentially dying and the role of health-care providers in helping patients and their loved ones navigate a final journey.
“I really thought we were doing a good job until I recognized my own experiences as a patient and saw that we really weren’t,” the death educator said of medical professionals.
“I was a person who knew how to talk about these things and I had a tough time getting my health-care providers to talk about it.”
But it’s not only medical practitioners who need to learn how to discuss end-of-life issues with patients and their loved ones, said Kortes-Miller.
Discussions about death – including fears, regrets and one’s personal wishes when dying – should be part of every family’s conversational tableau, she suggested.
“It’s not something you need to dive deep into and do in one massive, huge conversation, but rather different pieces of it as you think about what’s important to you, whether your health-care providers need to know about you so they can provide the best care possible, and what you think is going to matter to you at the end of life.
“I think it’s best to have conversations throughout the course of our lives.”
That includes allowing children to ask questions and express their feelings about death, whether that’s over seeing a dead animal on the road, the loss of a pet or the death of a grandparent, she said.
When a child expresses curiosity about what it means to die, for instance, it can be an opportunity for adults to open a conversation and make it a teachable moment.
“Kids are not born fearful of death … They’re actually really curious about dying and death. And so if we support their curiosity by talking about it, by normalizing it and having conversations with them, they’ll begin to develop that education for themselves.”
One of Kortes-Miller’s pet peeves is when people use euphemisms for death, such as a person having “passed away” or “gone to a better place.”
“We’ve really moved away from using the ‘D’ words – dying, death and dead,” she said.
“And I think that has done us a disservice, especially in Western culture, because we have couched our language trying to make it gentler or cleaner or more sanitized for people. And it has turned out that it is confusing our children.”
Many people fear the idea of dying – and that includes talking about it, she said, noting that because Canadians are living longer, many people are middle-aged when they first experience the death of a loved one.
“And we’ve isolated ourselves from it because we don’t see it. We’ve turned over the care of our loved ones who are dying to the health-care profession … so we find ourselves at a loss of knowing what to do.”
Talking as a family about death can lay the groundwork for an advance care directive, which spells out a person’s wishes during the process of dying, such as the desired level of pain management.
The legalization of medically assisted death has also given people the option, under certain conditions, to seek to hasten end of life – and controversy over the law has caused Canadians to pay more attention to the issue of dying and death, said Kortes-Miller.
“This has been a really good catalyst for us having more conversations.”
Part of those conversations might revolve around how to say goodbye to a loved one who’s dying and whether they will have a “good” death, a popular buzzword in the world of palliative care.
“For me, it elicits the idea of family members holding hands around the bedside of a person who is dying and singing ‘Kumbaya,'” she said, almost as if there is a checklist of what it means to have a good death.
But that idea may not match the way the person lived and it can put pressure on families to have a “Kumbaya” moment despite it being inappropriate for their loved one and themselves, she said.
“We sometimes tend to Hollywoodize a death vigil scene or put high standards of what families need to make happen for their loved one in order for it to be a good death,” said Kortes-Miller.
“And that can sometimes make the grieving process really difficult for people.”
– Follow @SherylUbelacker on Twitter
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