Having difficult conversations about death

Andy Knee from our Palliative Care team writes about having difficult conversations about death and provides a few ways that may help having them a little easier.

Though death happens to everyone, many of us have not spoken to anyone about our concerns, fears or wishes when it comes to our end of life. This may be because we don’t want to. Or it may be that we haven’t thought about discussing it before. Or we don’t know who we could talk to. It may be that we prefer to just focus on the here and now, or have suffered so much that we cannot face talking about it.

The nature of homelessness itself presents many barriers: complex needs, trauma, substance misuse, living on the streets and multiple health conditions. As a result many individuals live for the moment, prioritising needs in the present rather than focussing on what care they might hope for in the future. It maybe the fear of facing our own mortality. Perhaps our fears could be turned around? Instead of fear, maybe we could focus on what we want. For example, what would living well look like?

Maybe we can turn fear into hope? Talking about hope when someone is approaching the end of their life may seem like a strange concept, but in having these conversations it enables us to have discussions that identify a person’s wishes and preferences. Those who are homeless are no different and we all deserve to die with dignity and respect.

Someone once told me that by accepting death they were able to embrace life. Some might say this is a strange thing to say. But death is a natural part of life.

What can we do?

This is a difficult question to ask. We may think to ourselves “I don’t have the skills. I’m not an expert” or “I don’t know what to say. I might make things worse!” and this is perfectly natural. So here are a few things that may help.

  • We shouldn’t be afraid to talk. We don’t need to wait until we are sick, before we talk about dying. We may all chose to speak to different people about our fears, concerns, wishes and what’s important to us, be it friends or health professionals. Talking about what would happen should our health get worse, will not make it happen – it may make us feel more in control.
  • Parallel Planning: Hoping for the best, but planning for the worst. By using parallel planning we are maintaining hope, but are ready for the worst case scenarios. We have those difficult conversations, but always maintain hope.
  • Our life, our choices: To try and ensure we are treated as we chose towards the end of our lives, we may choose to have our wishes written down (for example: What music we like? How we would like to be remembered?)
  • Making our voice heard: we can decide how we want to be cared for including refusing treatment if we wish.

Dying Matters Week 2020

‘Dying to be Heard’ is the theme for this year’s Dying Matters Week, and for the very first time there is day specially for homelessness. This is an opportunity for our clients’ voices to be heard.

St Mungo’s will be co-hosting a webinar for NHS England with Dr Caroline Shulman, GP in Homelessness and Inclusion Health, and Niamh Brophy, Homelessness and Palliative Care Coordinator St Anne’s Hospice in Manchester, on Wednesday 13 May 2020 from 3:30-4:30pm.

We must not forget, in a world of many voices, those experiencing homelessness are the ones dying to be heard.

The current circumstances of the coronavirus pandemic may mean that you can’t say goodbye to family and friends as you would wish to. MuchLoved is an online tribute charity where you can remember someone special and fundraise in their place.