Why Americans avoid talking about death — and the hard conversations we should all be having

Death, alas, comes for us all. So why do so many of us avoid discussing it? As USA Today reports, a survey released last year found that an overwhelming majority of Americans (91%) think it's healthy and normal to discuss death and dying — but nearly a third (27%) are uncomfortable actually doing that, and 31% struggle to contemplate their own mortality. (One's comfort level, not surprisingly, increases with age, with Boomers most open to discussing matters of death and Gen Z-ers the most wary.)

Additionally, separate research has found that only about a third of people actually make plans for end-of-life care. As one hospice social worker previously told Yahoo Life, that can cause "anxiety and chaos" for those left behind, not to mention a diminished quality of life for the person who is dying.

While there's no avoiding the pain of death, experts say that having — and communicating — a firm plan for the eventuality of your death is in everybody's best interests. Here's what they want people to consider.

Why we should be having these hard conversations

“American culture avoids talking about death, because it forces people to confront vulnerability and a lack of control,” says Daniel Rinaldi, a therapist with Fresh Starts Registry. “There’s a strong emphasis on youth, productivity and self-sufficiency, which makes discussions about mortality feel uncomfortable or even taboo.” While many people do feel comfortable discussing death, studies suggest that they avoid the topic because they don't want to make others uncomfortable.

But Dr. Kwadwo Kyeremanteng, head of ICU at the Ottawa Hospital, says that without these conversations, grieving families are at a loss as to what to do next. They may feel like they are “giving up” on a loved one when choosing to withdraw care, or they opt for aggressive treatments their loved one may have wanted to avoid, simply because they didn’t know their wishes.

“One of the most stressful situations I encounter as an ICU doctor is when families are unaware of their loved one’s end-of-life wishes,” he tells Yahoo Life. “It’s a moment filled with uncertainty, guilt and, sometimes, lasting trauma.”

Rinaldi adds that communicating our preferences ensures that our wishes are honored and that any burden on our loved ones is eased. “It may feel uncomfortable, but it’s an act of care that brings clarity and peace for everyone involved,” he tells Yahoo Life.

Decisions to make around end-of-life care

There's no predicting what the future holds, but if you had any say, what would your final days look like, and who do you trust most to see that through?

“Near the end of life, many medical decisions involve trade-offs between prioritizing quantity or quality of life,” says Dr. Lindsey Ulin, a palliative care physician at Massachusetts General Hospital. Ulin says there are a few key health decisions to consider and make known to your loved ones, including:

• Choosing a health care proxy: This is someone who makes medical decisions when you’re unable to speak for yourself.

• Code status: Do you want to receive CPR (with chest compressions and a breathing tube) or allow for a natural death (sometimes referred to as a DNR, which stands for “Do not resuscitate”)?

• Medical interventions: This may include deciding whether or not you’d want to be placed on a ventilator and/or to receive nutrition artificially through a tube, or if you’d prefer to avoid any uncomfortable intervention.

• Preferred place of death: If given the option, would you prefer to die at home, in a hospital or in a hospice?

• Organ donation: If you want to be an organ or tissue donor and aren't already registered, you can learn more here.

Decisions to make around death

There are two parts to making arrangements for your death. The first involves deciding what you want done with your body. “Talk to your loved ones about your preferences for funeral homes and whether you want a burial or cremation,” says Ulin. “These costs can catch families by surprise, but there are ways to arrange payments ahead of time.”

And then there's deciding what happens to your belongings. “Take time to consider what personal effects, possessions and keepsakes are important to you and how you would like those to be gifted or donated,” adds Dr. Kurt Merkelz, senior vice president and chief medical officer at Compassus. “In the absence of that type of guidance, and I see this often, it can create stress, conflict and even guilt among the remaining family, as they try to make those decisions at a very difficult time.”

Making it legal

You've made your decisions. Now it's best to get it in writing. This is where advanced care (for future health care needs) and estate planning (for assets after death or being incapacitated) with the help of a lawyer come in.

“It’s the only way we can ensure we receive the type of care we want and that our wishes will be honored,” Merkelz says of advance care planning. “Too often, these decisions are put off until we have a loved one who’s had an acute episode and we have to make decisions about their care in the hospital or after discharge. If you’re the patient, you may not be able to make your wishes known at that moment.”

These are the main documents to consider for advance care:

• Living will: Also known as an advance directive, this document details your choices for end-of-life care, including whether or not you want CPR, tube feeding, dialysis, use of a ventilator and other procedures and medications. It will also include your choices on organ donation and information about your health care proxy.

• Durable power of attorney for health care (aka medical power of attorney): This names your health care proxy. Ulin says this person should be someone who understands your end-of-life wishes and values in addition to being reliable and reachable by a medical team.

• POST (Physician Orders for Scope of Treatment Form): Also known as POLST (Physician Orders for Life-Sustaining Treatment), this document provides specific information about life-prolonging medical care. “It’s not uncommon for individuals to have both an advance directive and POST,” says Merkelz.

In terms of formalizing your wishes in the event of your death, you may choose to create a will, a living trust or both. There are pros and cons to each option; attorney Padideh Jafari, founder and CEO of Jafari Law & Mediation Office, notes that wills are more straightforward documents but involve a probate process that "usually takes a significant amount of time and money." Living trusts, on the other hand, enable direct asset distribution to beneficiaries without the need for probate proceedings, but they must be set up through a lawyer.

Ultimately, Jafari sees value in getting both. “The trust handles major assets, but a will is still needed to address any items outside the trust and appoint guardians for minor children [and pets],” Jafari explains. “Estate planning becomes more effective when people utilize both trusts and wills, because they fulfill different yet complementary roles.”

Jafari says there are a few other legal considerations everyone should think about:

• Designating a power of attorney: This is someone who will manage your financial affairs when you’re unable to do so.

• HIPAA authorization: This enables selected individuals to access your medical records.

• Final wishes statement: This can come in the form of a written document, video, etc., with personal messages to your loved ones. It may include instructions for your funeral arrangements and charitable contributions as well.

Talking it out

Merkelz recommends The Conversation Project as a handy resource, with guides on communicating your wishes to your loved ones and health care providers. These guides offer various talking points to address, along with the reassurance that this can be an ongoing discussion that treats a delicate topic with care.

What's most important is that your preferences are clearly communicated, says Ulin. These conversations may be tricky, she says, but "can help guide your loved ones so they aren’t stuck making difficult decisions on your behalf in the dark."