If nothing is certain except death and taxes, then why are we so afraid of talking about end-of-life planning? Like taxes, conversations about death and advance planning are important. But neither of those things should be difficult, says end-of-life educator and doula, Dr Annetta Mallon. “I don’t know about you, but I’m not interested in doing the stuff that’s really hard. I will put that in the ‘too-hard basket’ and I will just leave it there – forever! “Stop saying it’s ‘tough’, it’s ‘hard’, it’s ‘difficult’. Say ‘it’s important’ she said, at the recent Dying to Talk webinar, hosted by Bare . “Think of it like taxes. We have to pay our taxes, that’s very important. And we get in big trouble when we don’t pay our taxes… So your advance planning, in a way, is not too far away from being like paying taxes.” Society has made a taboo of saying the word ‘death’, in the way we’re not supposed to say the word ‘sex’, Dr Mallon said. “We have an interesting cultural more about not speaking the word in case the sky falls on us.” And because death happens to us all, our resistance to talking about it as a normal, everyday part of all our lives seems strange, when we think about it. “So, when we say to ourselves and to those around us that we care about, ‘we need to have the important conversations’, that opens the door that’s much less scary. Something ‘important’ is probably not going to fall on our heads. And we can talk about death as being a normal everyday part of our lives.” Advance planning should be something that is a normal, natural, integrated part of how we navigate our everyday life, she said.

WHY ADVANCE PLANNING IS ‘IMPORTANT’

“Advance planning is a gift of love for the people that are the closest to you” Dr Mallon said. Comprehensive planning can save a lot of time and money. It also means families and friends don’t have to put their grieving on hold to make financial decisions, or decisions about intervention, treatment, care, and what kind of quality of life their loved one might have liked. Despite this up to 80% of older people who are admitted to the hospital emergency department don’t have an advance care plan in place, Dr Mallon said. Without an advance care plan, important medical decisions are often left to medical staff alone. And doctors generally make conservative decisions to prolong death, which could also prolong the person’s suffering. “When you don’t plan and make family members guess, they may not get it right… Thorough advance planning conversations and arrangements mean our friends and family do not have to guess when making critical decisions.”  “So when we have advance planning as a normal natural part of life, all of us are prepared and ready … Don’t make people guess for you.” It’s also important to talk about death with younger people and children, because not talking about it only fosters the myth that only older people die, Dr Mallon added. “Not all of us live a long life. Children die, babies die. Young adults die. Life happens.”

FUNERALS AND ADVANCE PLANNING

When we put off talking about what we want for our quality of life, we put off talking about our funerals as well. It also makes it harder for those we love to make sensible decisions about what the person they loved would have wanted. It can also end up costing a lot more money, too. Having to make those decisions, after a loved one has died, can make the grieving process that more difficult, too. “We also end up with this strange metric where the amount of money we spend on someone after they’ve died – we have a big lavish funeral, and a very expensive casket or coffin, we have enormous amounts of flowers, we have all these extras at the funeral – we have all this extra stuff after someone’s dead and that’s supposed to show them how much they were loved. Which is interesting because they are dead. They are not aware of it. They’re not there.” “It’s important to understand that a funeral doesn’t need to be a formal gathering, or in a church… You can have a funeral at home, you can have a funeral at the beach. It can be improvised… you can have a dance floor. Your funeral can look and feel the way you want.” You might want to have a celebration-of-life party, or ‘living wake’, while you’re still here. “I call them fabulous going-away parties,” Dr Mallon said. “With fabulous going away parties, there’s a lot of joy and happiness. It’s about communications and a healthy cultural change.” She encouraged people to flip the metric of spending on life and death. “Let’s think about spending our money more on having a really good quality of life. And then we can budget a more modest amount for after our death.”

HOW TO MAKE AN ADVANCE CARE PLAN

Dr Mallon invited participants to take a moment to consider what they value in life, and in death, to form their advance care plan. “Sit down with your partner, spouse or parent and make some notes. Ask: ‘Have you ever thought about this?’ ” Things to consider in an advance care plan might include:

  • Do you have a strong position on resuscitation and/or heroic medical interventions for yourself? What would you like, if a decision had to be made for you?
  • What are your personal values, priorities and pleasures? What about pets, hobbies and passions like food, sex, art, music, writing and reading. Your planning should reflect your values first and foremost. For example, you might like a story or audiobook read to you, or to hear a favourite piece of music. Or perhaps, like Dr Mallon, your wish is to see your beloved pet every day.
  • Pre-plan your funeral or memorial. That way you get control over the farewell that best fits your life. And you can select your own music!

HOW TO TALK ABOUT DEATH

The topic of death can be hard to swallow. So Dr Mallon suggested sweetening the conversation with cake. “If they don’t like cake, take biscuits!” she said. You might start the conversation by saying: “So I’ve been thinking about my advance planning and I would like to have a chat with you about my choices. Cake or biscuits?” Or perhaps: “Hey Mum, do you want to be cremated or buried? Cake or biscuits?” That way, if a person is asked a question they don’t know quite how to answer, they might take a bite and mull it over while they are chewing and swallowing. Working with an end-of-life consultant or doula, like Dr Mallon can help to act as a mediator and guide the important conversations. Particularly if a person has been diagnosed with a terminal illness or they are experiencing rapid decline.  You might gain some extra tips by attending an in-person, or online event, like Bare Cremation’s Dying to Talk webinar. There’s even advance planning courses you can do, too. “Unfortunately, if someone is going to be resistant … it’s going to be a mess. It’s going to take a while, the state is going to step in and it’s going to take [at least] six months to sort it out.” But be mindful that not everyone is willing to talk so openly about death, particularly if it’s their own, Dr Mallon said. And there is nothing to be gained by forcing conversations and stressing people out. In some circumstances, the best option might be to do nothing now, and let the state take care of things later.   It’s crucial to normalise death as a natural part of life, especially around children, so that it becomes ‘important’, not ‘difficult’. Avoiding euphemisms like someone has ‘passed away’ or that you’ve ‘lost’ someone is a big step towards changing the way we talk about death and dying.   ‍

About Dr Annetta Mallon Dr Annetta Mallon is one of Australia’s leading end of life consultants and end-of-life educators. Her education and training covers grief support and counselling, advance planning and End of Life Doula (Death Doula) services. Learn more by visiting the Gentle Death Education and Planning website here. An expert in grief and loss, education, sociology and advocacy, Annetta is also a grief psychotherapist who has worked for more than three decades specialising in grief and loss, injury and trauma recovery and personal development.