Talking about dying

Talking about death and dying can be difficult, and people often avoid the subject. However, sharing your feelings can bring you closer together, and help everyone involved to cope better with the situation.

Why it’s helpful to talk about dying

Often people think that by not talking about death, they are protecting the other person from hurt or sadness. It can be hard to know what to say, and the longer it goes on without anyone talking about it, the more difficult it can become.

If your loved one has not brought up the subject of death, you may wonder if they really understand the situation. In reality, most people who are dying are aware that they are dying, but may avoid the topic because they think you won’t be able to cope and you will leave. For many dying people, their greatest worry is being abandoned, and this can lead them to avoid talking about difficult issues.

In reality, though, dying is often foremost in the minds of the patient, carer, family and friends, and not talking about it is like trying to ignore the elephant in the room. It can be hard to hold back feelings and to think of anything to say that doesn’t verge into the "no go" area of death and dying.

Not talking about death can create tension, isolation, sadness and anxiety. Carers and patients often feel a sense of relief after they have talked about their feelings and taboo subjects like funeral arrangements.

When to talk about dying

The first conversation about dying takes courage. There are no fixed rules about when the conversation should happen – some people will want to talk about it immediately after they are (or their loved one is) given a terminal diagnosis; others will prefer to wait until closer to the time of death.

If your loved one does not seem ready to talk about dying, it can be difficult for you as a carer. On one hand, you need to have an outlet for your emotions, and avoiding the topic can create an invisible wall between you and your loved one. On the other hand, people need to be able to come to terms with dying in their own time.

Sometimes it can help to broach the subject gently by saying something like "I know it is tough for us to discuss what is happening, but I would feel better if we can talk openly about it," or "I know the cancer can't be cured and I would feel better if we could talk about this." Reassuring your loved one that you will always be there for them before you do this will help.

Sometimes, the dying person will take steps to initiate the conversation, but may not come straight out and say that they would like to talk. They may say something like "Well, I guess this is the end" or "Looks like I’m not going to escape this time", or they may hint at being frightened of dying. If your loved one says something like this, it can be an indication that they are ready to talk.

It can be tempting to answer them in a way that avoids the conversation – for example, saying "Don’t worry, things will be fine" or "Let’s not talk about that". But often, the dying person is trying to tell you that they want to talk, and they are hoping that you will listen. It can be more helpful to acknowledge their feelings by saying something like "You must find this very difficult". People who are dying are often scared that they will be abandoned, and showing that you are not afraid to talk about death and that you will be there for them can be very comforting.

What to say when talking about dying

Many people are worried that they won’t know what to say when they are talking to someone who is dying. You might want to start by encouraging them to talk about their feelings, by saying things like:

• You must be finding things difficult right now
• Is there anything you want to talk about?
• What is worrying you the most?
• Do you feel frightened?
• Is there anything that helps you feel calm?

It is important to allow them time to talk, even if they seem to be saying the same thing over and over again. This is common amongst people who have learned that they are going to die, because their mind is in great upheaval. Some of their feelings may seem absurd to you, such as feeling guilty about their disease or being in denial that anything is wrong. Your listening will help them work through those feelings.

It’s OK to cry – don’t feel like you need to stop the conversation or change the subject if one of you starts crying. Crying is a very normal and often helpful reaction that can release a lot of emotions.

Try not to offer advice, as the person will likely not take it in, and you may add extra stress. Try to avoid saying things like "I know exactly what you mean" or "I have felt like that before". It is better just to let your loved one talk about what they are going through, and for you to do the same.

You might also want to consider talking about funeral and other practical arrangements. The time immediately after their death will be very stressful, and knowing their preference about whether they want to be buried or cremated, what sort of ceremony they want and what type of memorial they would like can help remove some of this stress.

What to say when you’re not talking about dying

Many people also feel uncomfortable around a dying person, because they are afraid of saying the wrong thing. Most dying people want to be treated as normally as possible, to chat about what’s happening in your lives and what you’ve each been doing. The dying person will usually want you to recognise that they are still there and still a part of your life.

Although a lack of mobility may have caused their horizons to have narrowed, they may still be reading, listening to the radio or following the football. Your mutual interests and the things you disagree about won’t have changed.

Cultural considerations

Some cultures believe that talking about death is disrespectful to the person who is ill, or shows a lack of hope, or that talking about death may make the person die sooner than expected. However, most people will want to talk about what is happening at some point. It is very natural to want to share your feelings and fears with someone you trust.

When it’s too hard to talk

Some people may find it too difficult emotionally to have this type of conversation. Sometimes it can help to talk to people outside your close family and friends, or to ask doctors and nurses for help to talk about your situation, and you may also want to consider professional counselling. The Cancer Council NSW also runs support groups for patients with advanced cancer and their carers, and these might give you some insights into how to begin the conversation about dying.