Dear Barbara, I have worked as a hospice RN for the past 7 years. I have experienced some family members not wanting to discuss the dying process. They have become angry when it is brought up. How should the nurse proceed in that environment?

Great question about families not wanting to talk about dying. I’ve always considered it my job to educate and prepare the family for the approaching death of their loved one (or not loved one). That is why I am there, so here is how I have dealt with them——

“I know you are uncomfortable talking about Mom’s approaching death. The reason I am here is to guide and support you and your family during this time of your mom’s dying. Let’s have a conversation. You tell me why you don’t want me to talk about this and then I’ll tell you why I think you need to hear what I have to tell you."

When it is my turn I talk about opportunities to care, to show love, to be prepared by acknowledging that Mom's death will happen. I give them Gone From My Sight and The Eleventh Hour as reading assignments. "Do you see Mom anywhere in Gone From My Sight? Every time I visit I am not going to talk about dying but I am going to be looking to support you, guide you, and provide care for your mom. I don’t lie. You can trust me to have your and your mom’s best interest always in the forefront.”

An important note: We live inside our bodies, when our body is preparing to die on some level we know it. In the months before death we play a game with ourselves that it isn’t true, that the doctors are wrong. In the weeks before death the knowledge that we are dying goes to a deep level and we know in our very being that we are indeed dying. WE KNOW. Families need to know this information since some think by not addressing the seriousness of Mom’s illness she will be spared knowing that she will die sooner rather than later in her life.

Our job as an end of life specialist is to address the elephant in the room, to be direct and honest in the gentlest way possible. We are not doing our job, and doing a great disservice to the family, if we don’t talk about Mom’s approaching death, educate, and at least try to prepare the family.

What’s the worst thing that can happen if you insist on talking about end of life? The family can discontinue hospice services, maybe try to find another hospice that will let them play their denial game, BUT you, as a hospice professional, will have your integrity, you will know that you tried to do your job.

Something More... about How To Talk About Approaching Death

As families are alone with their loved one during the dying process and don't have regular in person visits by hospice, giving them The Eleventh Hour is crucial. It will help the family know what they can DO during the last days to hours to minutes before and just after their loved one dies. The death then has a good chance of being sacred.