Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments

End-Of-Life Planning Makes It Easier To Say Goodbye

This is a guest post by Dr. Barbara Okun and Dr. Joseph Nowinski.


End-Of-Life Planning Makes It Easier To Say Goodbye

Saying goodbye as the end of life approaches can be difficult, even for those with a gift for words. In a moving account in a recent issue of The New Yorker, writer Joyce Carol Oates describes the last week of her 49-year marriage, as her husband was dying from complications of pneumonia. Like A Year of Magical Thinking, Joan Didion’s poignant memoir of her husband’s sudden death and its aftermath, Oates’ essay highlights the need for each of us to think about death and dying — and discuss them with loved ones — long before they become a likelihood.

In our work with individuals and families facing death, we have seen too many people miss the opportunity to say goodbye because they avoid what feels like a scary or taboo topic: What do I want to happen when I die? Beginning this discussion early, preferably while you are in good health, can help pave the way for a “good death.” In our new book, Saying Goodbye: How Families Can Find Renewal Through Loss, we offer a guide to help individuals facing a terminal illness and their families navigate the realities of death and dying. Planning ahead is essential. Here are some suggestions for doing that:

Choose your team. Identify support people and specialists (legal, medical, financial, religious) you can count on to advocate for you and help you make decisions. Designate these people to act for you by signing advance medical directives.

Make your wishes known. Think about, and then begin to share with your closest loved ones, your wishes about:

  • End-of-life treatments if you are incapable of making that decision for yourself
  • Ending treatment, for example chemotherapy, if your prognosis for improvement was nil.
  • Where you want to spend your final weeks if it becomes clear that you have only that long to live.
  • Who you want to be with you in your final weeks, and what you would like them to do for you.
  • What you would want in terms of a funeral ceremony and burial.

Make plans for the living. Provide clear instructions for the guardianship of your children, if needed, or financial support for your survivors.

It isn’t easy to initiate a discussion about what you want to happen, or hope will happen, when your life ends. The purpose of this discussion is to ensure that your wishes are carried out and to save your loved ones the panic of not knowing what you would want and having to make these decisions without previous discussion or planning. One way to open the conversation is by saying something like, “I’ve been thinking what I would want if I were to become ill or die suddenly, and I want to share my thinking with you.” A colleague of ours, Samuel Bojar, M.D., has another approach. He has written a “Just in Case” booklet that includes his ideal end-of-life plan. He updates it periodically and makes it available on his computer to all his family members.

Things left unsaid is one of the themes that run though Oates’ essay. Don’t wait for a crisis or the specter of death to say “I love you” or “This is what I want to happen when my time has come.”


Barbara Okun, Ph.D., is a professor of counseling psychology at Northeastern University, a clinical instructor at Harvard Medical School, and a clinical psychologist and family therapist. Joseph Nowinski, Ph.D., is a nationally known psychologist with more than 20 years experience working with individuals and families. Their new book, Saying Goodbye: How Families Can Find Renewal Through Loss, has just been published.

*This blog post was originally published at Harvard Health Blog*

You may also like these posts

Read comments »

Comments are closed.

Return to article »

Latest Interviews

Caring For Winter Olympians In Sochi: An Interview With Team USA’s Chief Medical Officer Dr. Gloria Beim

I am a huge fan of the winter Olympics partly because I grew up in Canada where most kids can ski and skate before they can run and partly because I used to participate in Downhill ski racing. Now that I m a rehab physician with a reconstructed knee I…

Read more »

How Do Hospital Executives Feel About Locum Tenens Agencies And Traveling Physicians?

I recently wrote about my experiences as a traveling physician and how to navigate locum tenens work. Today I want to talk about the client in this case hospital side of the equation. I ve had the chance to speak with several executives some were physicians themselves about the overall…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

Read more »

See all book reviews »