Ethicist encourages a rethink about death and dying

The life-to-death transition is not a favorite conversation piece.  Lucia Wocial, PhD, is a clinical ethicist who supports patients, families, and staff who face ethically challenging life and death decisions. WFYI’s Terri Dee talks with her about why death elicits different reactions and embracing news of a terminal illness or sudden passing of a loved one.

WFYI Reporter Terri Dee : Death impacts people in so many different ways. Why do you think discussing death or preparing a will causes reactions ranging from fear to curiosity to indifference?

Lucia Wocial: One, in our culture, we don't particularly talk about death. If you think about 100 years or so ago, a lot of people died at home. That's just kind of where it happened. Now we're in a situation where when people get sick, we have all this medical technology that's available to help them return them many times to a function, where they're quite happy with their quality of life. So there's this sense that we celebrate a medical miracle, and everybody wants to be the miracle. They want to be the person who gets better. So, when you either get a serious diagnosis or a serious illness, and you're faced with thinking 'maybe I'm not going to be here.' It's a hard thing to think about intellectually, I think we all know that we're going to die. But emotionally, that's a different story.

Dee: Is it realistic to prepare for death in the case of a loved one, who will inevitably face the transition due to a terminal illness? If so, how would one do this?

Wocial: There are now so many resources to help people have conversations around death. What we try and help patients understand is, if you're sick enough to be in the hospital, you're at risk of dying and the greatest gift you can give your family is to tell them what's important to you, rather than having people think about what are my end of life preferences, because of course, that's grim. It sounds pretty sad. If I could not speak for myself, what would I want people to understand about what matters most to me? if we encourage people to talk to each other about what matters most, it lessens the burden on families, and many times it is actually family members who are making decisions. It's not the patient's themselves. Usually patients are so sick, they can't tell us what they would want. I think the range is "Oh, no big deal," "I'll go make my will" or "not going to talk about it." We're going to talk about anything, but I think some of it is based on personal experience. What I've noticed is people who have had a family member or close friend, go through a life threatening situation, depending on how that experience went, many times will motivate them to have conversations with their loved ones about it.

Dee: Does the manner of death influence how a person responds to the occurrence? For instance, someone who has a cancer diagnosis versus someone who dies in a car accident.

Wocial: I think that's actually a really important reason why people need to talk to their family members. I think many people in their own mind, maybe think they know how they don't want to die. Maybe they don't know how they want to die, but they know that there are things that they clearly would not want. If I get a diagnosis that tells me I'm going to have an illness that I may or may not survive, then it becomes real. It's not artificial; it's not just a casual conversation. It is 'so now I have cancer and I know it could spread any number of ways, what does that mean for me?'  I think those are situations where it's so so important for patients and families to have conversations about it. Because while everybody hopes for a really good outcome we don't always get what we hope for. I've said to many people, there are three landmark situations that have really transformed how we think about dying in the United States. They were all young women in their 20s, who had sudden, unexpected illnesses or events that made it impossible for them to speak on their own behalf. So I use those examples to reinforce you're never too young to talk about it. talking about it again is the best gift you can give to your family.

Dee: This is just intriguing. Thank you for your answers.

Wocial: You're welcome.