There are many reasons why people find this ‘taboo’ topic so difficult to discuss. There may be a fear that: you won’t know how to start the conversation; you or the person you’re caring for will cry; it will upset other family or friends; talking about it might somehow make it happen; it will raise uncomfortable issues about spirituality and religion; or your loved one will feel that you have given up all hope.

While concerns such as these can prevent or delay discussions about the last stages of life, keep in mind that talking to the person you’re caring for about what’s important to them now can help you fulfil their final hopes and wishes over the coming months and weeks. Understanding what happens as the end approaches can also lessen any fear and uncertainty you may be feeling. Ultimately, talking about and preparing for this inevitable outcome can make you better able to care for the person.

How can conversations about end-of-life change the experience?

Whether sudden or expected, death affects not just the person facing it but also their family, friends and the people who care for them. Reducing the silence and stigma around it can have profound benefits for all. It also has the power to change the experience in our society so that more people can choose where they want to die, supported by good care and surrounded by the people they love. Open, honest conversations in the last stages of life can:

• Encourage rich and valuable discussions about what really matters in life and deepen your relationships
• Help overcome the fear, reluctance or uncertainty you may be feeling about caring for someone who has a life-limiting illness
• Allow you and your family to focus on making the most of the time you have left together
• Keep you better informed, giving you and the person you are caring for greater choice and control in the last stages
• Enable you to plan and prepare, aided by information and support that can lead to decisions, outcomes and experiences that are consistent with the wishes of your loved one

How do you start talking about the last stage of life?

It begins with a simple conversation defined by openness and honesty, sensitivity and respect. And only when people are ready – if you watch and listen carefully, they may give you cues (a subtle hint, a look, an indirect question). They might surprise you and want desperately to talk about it. Or perhaps you, the person you’re caring for or some family members are still in shock about the prognosis and do not yet feel able to broach the subject – this is okay, too, and may happen in time. It’s also possible that they may never be ready to discuss it. If this is the case, there is always someone you can talk to; your GP, a close friend or a Violet guide, for instance.  

Hopefully, this will be the first of many conversations and each one will get easier as you become more comfortable with this inevitable part of living. Try not to be afraid or embarrassed by your emotions – rather, acknowledge that you are finding it hard to talk but really want to. This is a challenging situation for all of you, but it is important to make the time to discuss it before it’s too late. You may want to talk it over with someone you trust (a close friend or spiritual counsellor) before you raise it with the person you’re caring for and you may want to keep speaking with them as the person moves closer and closer to the end.

If you are talking with the person who is in the last stages of life, both of you may get emotional; although that can feel distressing, try to keep going even if you need to take a break or get some tissues and a glass of water. It may be best to have several short conversations, talking about one thing at a time. Pick a place where you are both comfortable and a time when you are both well rested. Consider asking a trusted family member or friend to be close by in case you need extra support.

Here are some conversation starters that might help:

These conversations don’t need to be deep or confronting – sometimes it’s easier to talk about more practical, less emotional, issues first. You may want to make sure that you know how your loved one wants to be cared for over the coming months and weeks, discuss legal documents (will, advanced care directive, power of attorney, etc.) or ask if they’ve thought about funeral arrangements and how they’d like to be remembered.

One way to start the conversation might be talking about your feelings for the person you are caring for, the things you are grateful for or the life experiences you have both shared.

You might also try something like:

• I think it would be good for us to talk about what is happening…
• Things don’t appear to be going very well at the moment…
• What do you think is happening now?
• No-one seems to want to talk about what is happening…
• I don’t want to make us cry, but I’m scared about what’s ahead…
• I know the prognosis is hard to accept, but I would like to try somehow…
• It feels like we’re running out of time and I’d like to talk about things before it’s too late…
• Is there anyone you would like to talk to about this or get in touch with?
• The doctor seemed to be saying that the treatment isn’t working. What do you think that means?
• I’m worried that you are very sick and we haven’t ever really talked about what you want to do with regards to…
• I would really like to make the most of the time we have left together. Is that how you feel?