When most Americans think of Thanksgiving, they think of turkey and football; they tend not to think about gathering with family to discuss end-of-life issues.
There are good reasons for this. After all, the holiday is supposed to be a celebration of abundance and happiness, not about decay and death. And yet, in many ways, Thanksgiving is an ideal time for families to engage with one another about the end of life. In fact, many families already choose Thanksgiving to discuss matters that are important to the family as a whole, particularly matters relating to the future well-being of the older members of the family.
What we want vs. what actually happens
It’s important for family to know what your wishes are regarding the end of life, because too often the circumstances of our deaths are not what we want for ourselves. This is because we tend not tell our loved ones what we want.
Surveys suggest that between 80%–90% of people prefer to die at home; nevertheless, only about 25%–30% actually do die at home.
What explains the discrepancy between what we say we want and what actually happens when we die? Among other things, we rarely talk about death with our families and loved ones. Californians were asked about their preferences should they ever be found in a persistent vegetative state. Over 80% said that loved ones knew their preferences, but only half admitted having actually had the discussion with them.
What it means to die at home
Modern Americans have very little close personal experience with death. This is the nature of our culture. In “Coming of Age in Samoa,” Margaret Mead noted the contrast between our tradition of shielding ourselves from death and the Samoan tradition of witnessing death beginning in early childhood. Most Americans have no idea what caring for a dying person entails. For this reason, many well-intentioned caregivers experience panic when a family member draws close to death, and they call 911. The result is that their loved one ends up dying in a hospital after all.
The role of hospice at home
Precisely because the process of death is foreign to most Americans, we have developed systems to help provide end-of-life care to our loved ones at home. Home hospice care is holistic in the sense that it is designed with the patient and the family in mind. Home hospice care providers both educate and prepare family members for death at home. They also provide welcome relief from the overwhelming stresses surrounding the end of life. It is important for individuals and families to understand that hospice care does not mean refusing treatment or giving up on a loved one. To the contrary, the benefits that accrue to a dying person at home are sometimes such that the individual’s condition improves, and some even discontinue hospice services for a time.
Something to be thankful for
End-of-life discussions at Thanksgiving need not spoil the other traditions that Americans care deeply about. To the contrary, talking about preferences surrounding the end of life can become a meaningful demonstration that family members truly care for one another. The fact that we can call upon the help of home hospice is one more thing to be thankful for.