Dr. Marlaine Figuero Gray is a Seattle-based medical anthropologist who recently posted an article on “The Good Death Society” blog
Dr. Figuero Gray’s article examines the way language is used around loss and death and how modern medicine tends to approach death and dying as a failure—either a failure of medicine to preserve life or a failure of the individual to “fight” against illness. Language such as “failing” treatment or “giving up the fight,” reflects and reinforces the view that death is something to be avoided at all costs.
But, writes Dr. Figuero Gray, “Nearly everyone will face a point in their lives where medicine cannot provide a solution or sustain life.” Our cultural and medical narratives of illness often do not have adequate language for these moments. In many hospitals, she says, intensive interventions that are no longer effective or negatively affect quality of life are more readily available than non-aggressive care that provides palliative services focused on relieving pain and symptoms.
This modern medical structure can create an environment where the focus is solely on prolonging life, rather than on helping patients achieve a peaceful and meaningful end-of-life experience. “Many modern doctors have limited experience with natural death, a sharp contrast to medical training and experience even 50 years ago when doctors attended to dying patients at the bedside,” she adds.
Instead, we should allow for the recognition of death as a part of life—a natural process with opportunities for meaning-making, legacy-building, and connection. In this context, dying can be viewed as an opportunity for individuals to reflect on their lives, define what matters most to them, and plan for how they want to be remembered. This process should be seen not as a time of defeat but as one of psychological, social, and even spiritual growth.
Dr. Figuero Gray argues that a modern “art of dying” is needed, one that focuses on the personhood of those with serious illness rather than their diagnosis. This guide would encourage people to reflect on their legacy—how they want to be remembered and the impact they wish to have on others—during their final days. Medical care should support these goals by helping patients preserve their dignity and identity, rather than focusing solely on aggressive treatments.
Instead, “the process before death can be an opportunity for actively thinking about, planning, and creating a legacy” and to live richly and deeply during the end of life. She writes, “Speaking about a who a person is during their lifetime, and now in their dying process, respects and celebrates them apart from their illness… My research on how people with a serious illness think about their legacy shows that after death, elements of the self remain — how one impacts the way others live, how one is remembered, and what physical objects are associated with those memories.”
The article suggests that both healthcare providers and families should engage in conversations about legacy and remembrance. Palliative care expert Dr. Ira Byock describes the four things people need to say to each other, particularly as a death approaches: “Please forgive me,” “I forgive you,” “Thank you,” and “I love you.” Knowing that people think about their legacy throughout their lives, and especially during serious illness, we might also add: “How will you remember me?” and “How should we remember you?”
The article offers tools to guide conversations about legacy:
⦁ Dignity therapy: questions to elicit thoughts about legacy such as, “What roles and accomplishments are you proud of?”
⦁ The “Hello Game” to discuss what matters most to you as you approach death and dying.
⦁ Creating remembrance items and writing letters to continue one’s role as a parent, friend, or spouse after death.
Ultimately, the article calls for a cultural script for grief — helping loved ones know what their person most valued and wanted to be remembered for.
Dr. Marlaine Figuero is a medical anthropologist at Kaiser Permanente Washington Health Research Institute. To read the full article, visit the following link: The Good Death: A New Way to Talk to Each Other During Our Dying Days
