How to live your best death

In the course of living my best life after 50, I try to avoid thinking about when it will end. But after spending some time talking with Dr. Shoshana Ungerleider, I’ve decided to give some more thought to my own mortality. Shoshana is the founder of the End Well Project, and she just might be the biggest advocate on the planet for improving how people live out their dying days.

“As a young physician,” Shoshana said, “I saw so many people suffering in their last moments of life. I witnessed many people in their 80s and 90s being admitted to the intensive care unit in the very late stages of their incurable illnesses. They were spending the final days of their lives hooked up to tubes and machines, hidden away from their loved ones and often in physical, emotional and spiritual distress.”

Shoshana said that she realized quickly that those patients were, by default, being treated with aggressive and invasive means despite having no chance of recovery. The tragic fact, she explained, was that they had no say in the final trajectory of their lives.

“It set me on a path to think about how we can live as well as possible for as long as possible,” she said. “It’s about giving people an open invitation to talk about death throughout their lives and not just in an acute crisis moment in a hospital.”

Get off the conveyor belt

Listening to Shoshana made me think about how, too often, what people experience in their final days is not in harmony with how they lived their lives. Because we avoid talking about how we’d like to die, she explained, we end up on an impersonal “end-of-life conveyor belt” in a hospital setting where doctors are trained to use whatever means necessary to keep us alive. As Shoshana put it, in medicine, death equals failure even when it’s unavoidable.

“We don’t necessarily see a role for ourselves as physicians in healing when a cure is no longer possible,” she said. “It’s not infused in how we learn medicine.”

Shoshana’s point really struck a chord with me: the one absolute certainty in life – death – is considered a failure in healthcare. For many of us, death is the most sacred part of life, yet we approach it with no intentionality. That’s why I decided to write about this subject. The whole purpose of this series is to be more intentional about living, and that should include having a plan for how we die.

Because of her chosen profession, Shoshana said that she regularly thinks about her own mortality. She said it makes every aspect of her life – from watching sunsets with her husband to eating amazing food to working out – much more fulfilling.

“I’m 39 years old, I’m healthy and I plan to live a long, healthy life,” she said. “But the reality is, we just don’t know what tomorrow will bring or if there will be a tomorrow. Living each moment with that recognition isn’t weird or morbid, it just allows me to appreciate the sweet richness of life.”

Let’s talk about it

While most of us will probably never experience the ever-present awareness of our own mortality in the same way Shoshana does, we’d be well-advised to let our minds go there more often. According to Shoshana, discussing death and how we’d like to die can help us develop deeper connections with our friends and family.

She said it’s really about looking forward and ensuring those closest to you understand what a good day looks like for you. It could be listening to your favorite music, eating chocolate chip cookies or simply being surrounded by family. Universally, she said, people want to be comfortable and free of pain in their final days. But no one can ever know what you really want unless you have those tough conversations.

“We do so many things in life that are scary and hard, and having these conversations can be that way, too,” she said. “Sometimes, it’s really awkward. Other times, it’s joyous and fun. You might learn something about your loved ones that you didn’t know.”

To help start these conversations, Shoshana provided a couple creative suggestions. One is a card game called “Go Wish” that prompts people to talk about the things that are most important to them and another is the “Five Wishes” legal document that puts some formality behind your plan. You can also visit the End Well website for additional resources.

We can never predict how we’ll leave this world, but I intend to have as much control as possible over how I live my remaining years, months, days and hours. I plan to take Shoshana’s advice and discuss my wishes with my friends and family, and I hope they do the same with me. Have you had these conversations? If so, what have they meant for you and your loved ones? I’d love to hear from you in the comments.