When We Talk About How We Want to Live, Why Don't We Talk About How We Want to Die? We Talk About How We Want to Live, Why Don't We Talk About How We Want to Die?
By Katrina Shaw, R. Psych — Founder, Carbon Psychology
Have you ever thought about how you'd want to die?
Not in a morbid way. Just honestly. Where would you want to be? Who would you want there? What would the room look like? Would there be music, or quiet? Would your family be holding your hand, or would you want some time alone? Would you have said the things you needed to say?
Most people haven't thought about it. And the people who have, often haven't said any of it out loud.
We spend a remarkable amount of time imagining how we want to live. We plan careers, weddings, vacations, retirements. We talk about our hopes for our children, our partners, ourselves. But the one experience every single one of us will go through — the one thing we know with absolute certainty is coming — we rarely speak about. We hand it to medicine and hope someone else figures it out when the time comes.
I'm not sure why we do this. I have my guesses. We're afraid. We're superstitious. We think talking about death will make it happen, or that bringing it up will upset the people we love. Most of us also haven't been around death much. A hundred years ago, people died at home, surrounded by family, with the dying process visible and familiar. Now, most of us have never seen someone die. Death has been moved into hospitals and behind closed doors, and we've lost the language for it.
But avoidance has a cost. And the cost shows up most clearly at the end of life, when it's too late to change much.
The gap between how we want to die and how we actually do
In Alberta, 86 percent of people say they would prefer to die at home or in their community rather than in a hospital. The actual number who do is closer to 15 percent. Across Canada, around 60 percent of people die in hospitals despite their wishes to be at home, and only 16 to 30 percent of Canadians receive any form of palliative or end-of-life care services when they are dying.
That gap is one of the largest disconnects between preference and reality in our entire healthcare system. And it's not because the people working inside that system don't care. The doctors, nurses, and palliative teams I've worked alongside are some of the most compassionate people I've encountered. The gap exists because dying isn't really a medical problem. It's a human one. And our system, by design, is built to fix medical problems.
What gets missed is everything that isn't medical. The conversations that need to happen. The fears that need to be spoken. The forgiveness that needs to be offered or asked for. The love that needs to be said clearly, before there's no more time to say it.
What end-of-life care can actually look like
When dying is treated as a stage of life rather than a medical failure, something different becomes possible. People can be at home, or in hospice, surrounded by what's familiar. They can have conversations they've been avoiding for years. They can plan how they want their final weeks to feel, who they want around, what they want to leave behind. Families can be present without panicking, because they've had time to prepare emotionally for what's coming.
I've seen what this looks like up close. I've also seen what it looks like when none of it happens. When families call 911 in a moment of fear because no one has talked through what to expect, and a person who wanted to die at home ends up dying under fluorescent lights in an emergency department. Both of those experiences shape the people left behind in ways that last for decades.
The grief that follows a death where things were said is different from the grief that follows a death where things weren't. Not easier, exactly. Grief is grief. But cleaner. There's less to carry into the years afterward, less to wonder about, fewer conversations replayed in the middle of the night.
What we can do, long before we need to
You don't need to be dying to think about dying. In fact, the best time to think about it is when you're nowhere near it.
Some of the most meaningful work happens in ordinary moments, years ahead of time. Talking with the people you love about what you'd want, and asking them what they'd want. Putting it in writing, not because anyone is going to die soon, but because it's a gift to the people who would otherwise have to guess. Having the harder conversations — the ones about forgiveness, about old hurts, about the things that have gone unsaid — while everyone is still well enough to have them.
There's a framework I've come back to many times, drawn from the work of palliative care physician Ira Byock. He suggests that four phrases, said clearly to the people who matter to us, often carry the most weight at the end of a life: Please forgive me. I forgive you. Thank you. I love you.
I'd offer that these four phrases don't have to wait until someone is dying. They can be said now. And the relationships that include them tend to be more honest, more connected, and easier to be in, at every stage of life, not just the final one.
Why this matters for how we live
There's something the existentialists understood that we've largely forgotten. Awareness of death isn't morbid. It's clarifying. When you let yourself sit with the fact that this life ends — that the time with the people you love is finite, that nothing is owed to you, that the small irritations are usually not worth the energy you give them — something shifts. You stop postponing. You let go of grudges sooner. You say what you mean. You stop waiting for some future moment to start living the way you actually want to live.
The people who tend to die well are often the people who lived well. And living well, in my experience, has a lot to do with being honest about the fact that we won't live forever.
So I'll leave you with the question I started with. Have you thought about how you'd want to die? And if you haven't, what might it open up if you did?
Sources
Statistics on Albertan and Canadian preferences for place of death are drawn from public reporting by Alberta Health Services and the Government of Alberta's Advancing Palliative and End-of-Life Care in Alberta report, both citing data from the Canadian Hospice Palliative Care Association.
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