Death as a Conversation Starter

Death and dying are a natural part of life's continuum. The more we as a society discuss this ubiquitous stage of life, the more educated and empowered we will be to navigate our own final days and those of our loved ones.
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On a recent sunny Saturday afternoon in Baltimore, nearly 30 people ages 18 to 85 got together for iced coffee, chocolate cake and conversation about death and life. "Does consciousness survive death?" they wondered. "What constitutes a good death?" And, "What would the world be like if there was no death?"

This was not a university class, nor a bereavement support group. It was the latest convening in a U.S. city of a "death café" and part of a growing global movement that convenes groups of interested parties to explore feelings and beliefs about mortality, death and dying. Participants gather in non-religious, open-minded community settings. Lately, death cafes have been convening from New York City and Baltimore to Petaluma, Calif. and Brattleboro, Vt. There are nearly 30 more events scheduled throughout the summer, including in London, Atlanta and Toronto.

What an important and timely movement. Death and dying are a natural part of life's continuum. The more we as a society discuss this ubiquitous stage of life, the more educated and empowered we will be to navigate our own final days and those of our loved ones. And the more we have these conversations outside the context of an imminent death in the family, the more thoroughly we will understand our options and communicate our wishes and those of our loved ones when the time comes.

"I think the death café movement is having success in raising awareness and consciousness and in prompting direct conversations," says Valerie Sarani, a palliative care nurse coordinator who co-organized the Baltimore event. "I think it's a great thing."

Attendees at the Baltimore café divided into small groups of four to eight people. Each table had "icebreaker" questions, but beyond that, conversations were agenda-free and ranged from abstract, philosophical discussions to more concrete conversations about how people navigated deaths in their own life. Spirituality and religion were touched on from group to group, but were far from the organizing framework. I was delighted to hear about the diversity of the gathering, with Jews, Catholics (lapsed and practicing), Buddhists, atheists. There were people who had never experienced the death of a loved one, those who worked professionally with death and dying, and a man whose own mother had died that very morning.

Youth and Death
Most surprising to Valerie, the organizer, was that the largest single age group were 18- to 24-year-olds. Many of the young people had no experience with death but attended because they wanted to learn more. One recent college graduate had done his senior film project on the subject of death -- but he hadn't made the connection until the café tableside discussion. While many of the young attendees had never heard of hospice care -- end-of-life services that focus on enhancing the quality of remaining life for those in their final months -- several were so intrigued by their conversations, Valerie said, that they left the meeting planning to investigate hospice volunteer opportunities.

My colleague at the Visiting Nurse Service of New York Kathleen Olsen was not surprised by the eagerness of 20-somethings, who are so deeply engaged in the world, to discuss death in an unflinching and open-minded context. "The younger generation doesn't really have information about death and dying because this generation of parents -- and I'm one of them -- never had that conversation with our children," she muses. "I'm glad they want to hear." She introduced the topic of her own end-of-life wishes with her 22-year-old son the other day, in some ways to test out his feelings. "He was more than ready," she says. "He said, 'Absolutely, Ma. What do you want to do?' I was blown away."

Death cafes, Kathleen feels, offer the perfect break from the day-to-day hubbub, which keeps us away from reflection and serious consideration of such heady subject matter. "We're so busy working and doing that we don't think about or talk about death until we have to, until we or a loved one need to make decisions," she says. "I'm glad to hear people want to have this conversation earlier."

Upstreaming "The Conversation"
The answers to one of the Baltimore event's prompting questions -- "What constitutes a good death?" -- were not altogether surprising to someone who has spent 25 years in end-of-life care. The attendees enumerated their wishes: to die at home, not to die alone, to be free of pain, to find closure in their lives. "One person said she wanted to die in her garden," said Valerie.

The vast majority of Americans say they want to die at home -- and yet 75 percent do not, spending their final days in a hospital or nursing home. The more people talk about death, as they would any other stage of life, the more likely they are to experience the kind of death they want. When our children head to college, we invest a lot of time and research and conversation to plan out just where they will go, the place that is right for them and what it will take for them to get there. I'd like to see more families hold similar conversations on how they would like to navigate their final days.

This includes having conversations about end-of-life wishes with aging parents and other family members, as I blogged about recently. I always encourage people to begin these conversations with loved ones as soon as possible. One colleague of mine suggests having the conversation as part of the getting-to-know-your-partner discussions before marriage. Another suggests families have such discussions yearly, say, around the Thanksgiving or Passover table.

Add to these suggestions: over coffee and cake on a summer weekend. It is a great way to get the conversation started.

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