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Ethicist Says Talking About Death Isn't Morbid, But More Like The 'Birds And The Bees'

Headstones in Calvary Cemetery in the Borough of Queens in New York (Bryan R. Smith/AFP via Getty Images)
Headstones in Calvary Cemetery in the Borough of Queens in New York (Bryan R. Smith/AFP via Getty Images)

During a global pandemic, it may be surprising that more people aren’t talking about death and specifically, their final wishes.

Dr. Lydia Dugdale has been seeing this scenario play out over the past year with some of her patients in New York. Dugdale is a medical ethicist and explores the concept that part of living well is “dying well” in her book, “The Lost Art of Dying: Reviving Forgotten Wisdom.”

People spend their entire lives fighting back against death as part of the human condition. Some doctors may fear death, too, but physicians need to talk with patients about their end of life wishes especially during the pandemic, she says.

When patients come in for annual physicals, Dugdale asks if they want to talk about their end of life wishes — and most people say no.

“However, when we get talking, people realize that this is something important, that dying well is very much wrapped up in living well,” she says. “And in order to die well, we have to make some active decisions now while we’re healthy.”

Many people want someone to open the door to this conversation but don’t know how to start it themselves, she says.

The pandemic has raised concerns about ventilators and dying alone in the hospital. One of the biggest obstacles of this challenging time is providing dying people with community and family despite COVID-19 precautions, she says.

In her book, Dugdale shares some forgotten wisdom from the 14th century bubonic plague outbreak. Historians estimate that the “enormously devastating” outbreak killed as many as two-thirds of Western Europeans, she says.

In the 1300s, people approached the possibility of death in some eerily similar ways compared to today.

Some people decided to live large and indulge in hedonism without fretting over the looming possibility of disease and death. This group is comparable to travelers who faced criticism for going on spring break trips early on in the coronavirus pandemic, she says.

Others didn’t leave their house or engage with their community at all during the plague in hopes of earning “divine retribution,” she says. People didn’t know that bacteria caused the plague, but they understood venturing outside could result in getting sick. During the coronavirus pandemic, some people similarly haven’t left their houses at all or only a few times.

The final group of people tries to strike a balance between living life and recognizing the inevitability of death. These individuals continue to engage with society in a wise, prudent way to protect themselves and others, Dugdale says.

“Whether it is plague or pandemic or famine or war, we all are facing our mortality,” she says. “Death has been and always will be 100%.”

Here & Now host Tonya Mosley’s grandmother always taught her that death is a part of life. Dugdale writes that conversations around death should mirror the birds and the bees chat, but she sees generational differences around talking about death in her patients and family members.

Dugdale’s grandfather returned from fighting in World War II and immediately secured cemetery plots. He made ongoing jokes for years about his relationship with the undertaker and threatened to write people out of his will depending on matters such as getting a tattoo he didn’t like, she says.

“But this idea that we need to, just as a matter of practical import, get ready for death is something that really feels like we’ve lost in the younger generations,” she says.

Everyone has a role to play in talking about living and dying well, she says. One common misconception around talking about death is that the conversation should occur close to the end of someone’s life.

People need to prepare to die well when they’re still healthy, she says. For some people that means fulfilling medical wishes such as do-not-resuscitate orders or planning to die at home. If someone wants to die at home surrounded by loved ones, Dugdale says to question if they’re investing in those relationships now.

Death also brings questions about the meaning of life and what happens afterward. Trying to seek answers on your deathbed is difficult, so Dugdale advocates for taking some cues from the Middle Ages.

“We should do this work now,” she says. “And so even engaging these questions of living and dying well — about what life means in the context of our communities over the course of a lifetime — is the best way to work toward a good death.”

Ashley Locke produced and edited this interview for broadcast with Todd MundtAllison Hagan adapted it for the web.

This article was originally published on WBUR.org.

Copyright 2021 NPR. To see more, visit https://www.npr.org.