Courtesy of Canadian Virtual Hospice By Glen R. Horst MDiv, DMin, BA | Content Reviewed 11.2017 | Posted 11.30.2017

Knowing what to say to someone who is dying and when to say it can be difficult. The following tips may be useful at any point during a serious illness, but especially when the person is not expected to live more than a few weeks or days.

Tip # 1: Follow the dying person’s lead

It is normal to feel anxious when talking about dying with someone who is nearing end of life, especially if the person is someone you love. Some people handle this anxiety by being clear and blunt. Others say little or nothing about the situation for fear they may appear to be giving up hope. One way or another, we tend to try to protect each other at this difficult time.

If you feel it is urgent to talk about end of life with the person who is dying, you may be impatient with conversation about ordinary things. Humour and laughter may be distracting. On the other hand, if you find talking about dying embarrassing or awkward, you may be relieved that the topic doesn’t come up. In either case, what is most important is what the dying person needs. Ultimately, he or she will choose if, when and with whom to discuss dying. Listen for cues that the person is ready to talk about dying – for example, a passing comment about new symptoms, not being around for an upcoming event, being tired of being sick, or wanting to go home. When you think you hear such a cue, you might ask, “Do you want to say more about that?” or, “I’m not sure I know what you mean.” Then listen and ask more questions to make sure you understand. 

Tip #2: If possible, be clear that you know the end is nearing

Some people who know they are dying avoid talking about it right up until the moment of death. It’s important to recognize that this is a valid choice and to respect it. More often, however, people who are dying feel respected and supported by openness and honesty in conversations. They may talk about symptoms such as pain, shortness of breath, or nausea. They may wonder what to expect when death is near. Rather than avoiding these concerns, acknowledge that they must be worrisome. You might say, “Tell me more about what you are experiencing,” or ask, “What do you think is happening?” You could add, “This would be important to discuss with your doctor. Can I help you make a list of questions for the doctor?”

Inviting the person to share information from the health care team can lead to open conversations about the progress of the illness and an opportunity to ask, “What do you now need most from me (from other friends and family members, from the health care team)?”  If the person has difficulty answering this question, offer examples of the support you could provide –  perhaps being present and listening, running errands for the family, or helping with housework.

When death is near, close friends and family members may want to be present. This is a tender time requiring balance between the needs of the family and the wishes of the person. Ask who the person would like to have visit and how many guests would be appropriate at one time. Keeping his or her wishes front and centre can provide a dying person with a sense of control at a very vulnerable time.

The gathering of family and close friends becomes a quiet signal to all that death may be near. If the person wonders why you or others are present, explain that you want to be with him or her during this time.  Follow the person’s lead in talking about what is happening as death approaches. Direct questions deserve simple, direct responses. Use your own words to say something like, “It seems that your journey on this earth is coming to an end.”

Ask the person if there is anyone he or she would like to talk to by phone, internet, or in person. This may include a visit from a religious leader in the person’s faith community, or the spiritual care provider in the hospital or hospice.

If you feel that you still have important things to say, consider the advice of Dr. Ira Byock, a palliative care physician and author of “Four Things That Matter Most.”According to Dr. Byock, the next four tips are things that dying people want to hear from their loved ones.

Tip #3: Deal with regrets by saying, “Please forgive me.”

There is no need to fuss over small injuries or insults. However, when you are preparing to say a final goodbye, you may be bothered by regrets about hurtful words or actions, or ways you may have disappointed the dying person.  Deal with your regrets by saying something like, “I’ve been feeling sorry about something that happened between us. I know I had a part in it and I’d like to apologize for it.” After describing the issue or incident in simple terms, say, “Please forgive me.”

Whatever the response, you will know that you have done what you could to address a painful part of your relationship.

Tip #4: Free yourself of hard feelings by saying, “I forgive you.”

If you ask the person for forgiveness, you may be surprised that she or he wants your forgiveness too. Saying, “I forgive you” can clear the way for a deeper sharing of the remaining time. It can also give you a sense of peace following the person’s death.

Due to defensiveness, a lack of understanding, or some other reason, the person may not be ready to acknowledge the deep hurt in your relationship. You can still, however, forgive the person in your mind and heart. This involves letting go of your anger and any wish to punish the person for the hurt you experienced. One woman did this with an older male family member who had abused her as a child by whispering “I forgive you” in his ear shortly before his death. Since he was no longer able to respond, it was not possible to know the effect it had on him. However, for the woman it was an important step in freeing herself from her burden of pain and anger.

Tip #5: Appreciate the person’s legacy by saying, “Thank you.”

Expressing thanks for the positive ways the person has touched your life is a way of letting someone know of his or her lasting significance for you. It contributes to the person’s sense of dignity at the end of life.

Rabbi Harold Kushner writes: “I am convinced that it is not the fear of death, of our lives ending that haunts our sleep so much as the fear… that as far as the world is concerned, we might as well never have lived.” Dr. Harvey Chochinov’s research into dignity in the people who are dying supports this. You can support your loved one’s dignity with a sincere and specific “thank you.” It will let your loved one know that her or his living mattered.

Tip #6: “I love you” – Say it freely; say it often.

It is never too late to say, “I love you” in a relationship. If you are not in the habit of declaring your love for a person you call a “loved one,” take a risk and surprise her or him. It could take your relationship to another level.

Tip #7: Don’t wait until the last minute to say, “Goodbye”

When your loved one is nearing death, it is important to end each conversation in a way that will be okay if it is the last time you speak. Casual goodbyes like “See you around,” or “I’ve got to run, so bye for now,” may leave you wishing you had said something different. Your goodbyes don’t need to be mushy. Just say goodbye in a way that lets the person know that he or she will always be important to you.

If you are leaving for a longer time and unlikely to see the person again, your goodbye may be more emotional. You might acknowledge openly that you don’t know whether you’ll be with each other again. Say what needs to be said. Remind the person again of what he or she means to you. Saying goodbye in a satisfying way can prevent regrets after the person is gone.

Tip #8: Touch talks too.

When you talk with a person who is dying, you touch each other with your words. When words are no longer necessary or possible, you can still connect through touch. Placing your hand gently on the person’s hand, shoulder or head can be a tender way of saying, “I am here. You are not alone.”
Continue to talk to the person even when she or he is no longer able to respond to you. The dying person will sense your presence and hear your voice.

Content reviewed November 2017