Must We Talk about Death?
August 23, 2024
Some readers were concerned by my post about thinking about when and how I want to die. They worried that this meant that I was on Death’s door and that, as they say, the family should gather.
That’s not the case! I have been resting and convalescing since my “Months from Hell.” I feel stronger than I have in many weeks. I didn’t write that my death was imminent, but I should have reassured my readers that even if I could see Death on the horizon, he was not sitting in the chair beside me.
But why did some readers think that I was facing imminent death? I’ll be candid. Many Americans and Canadians practice denial about death. From their point of view, you don’t talk about death unless and until you only have days left.
Denial isn’t a crime. Discussing death makes some people anxious. That’s understandable, and these folks have my sympathy. But failing to plan is planning to fail; you need to deal with your mortality.
Others believe that resolutely asserting that you will “beat cancer” helps you beat cancer. Unfortunately, it doesn’t. Again, failing to plan your death leaves you unprepared when it comes.
But if I am not imminently dying, why darken today by thinking about death? The answer is that the best time to think about dying is when I have all my cognitive capacities.
I’m cognitively intact today and will most likely be intact tomorrow. But the lifetime incidence of stroke is 25%; if I am among the unfortunate one in four, my stroke could happen tomorrow. One in five of us will, at some point, suffer a traumatic brain injury sufficient to cause loss of consciousness. I could be in a moving vehicle accident tomorrow. And so on.
I won’t doom myself by putting off thinking about death for another day. However, I will never be better prepared to think about death than I am today.
Consider my case. I have failed all the evidence-based treatments for my cancer. The quality of my life fluctuates, but my long-term trajectory is down.
So, what are my options? My best option is palliative radiation. This will reduce the tumour mass and temporarily extend my life, but it will not kill the tumour. However, radiation also causes extensive adverse side effects.
So, there is a trade-off here: I can live longer at the cost of increased suffering. Is this trade-off worth it?
Again, I’m not facing this trade-off now; today, I feel better than in weeks. I can decide to put off thinking about death until tomorrow. And if I am feeling good tomorrow, I can put it off another day. And so on. I won’t think about this trade-off on this logic until I am seriously ill. I prefer to think about life and death choices when I can do it calmly, not when I’m in an ICU.
Don’t engage in denial. The time to think about death is now.
Well said! "Many Americans and Canadians practice denial about death. From their point of view, you don’t talk about death unless and until you only have days left." "But failing to plan is planning to fail; you need to deal with your mortality." The train wreck photo works so well with this. Hey, it is possible the brakes on the train will fail. Then what? Have we planned for that? I am glad you are out of the month of hell. Hurray for feeling better.
Thank you for this! I am 75 so even with my family history of long, long lives, I am at least 3/4 of the way through my life. Planning is essential. Sometimes my loved ones are not comfortable with that, but you gotta plan. I’m so glad you are feeling better right now.