The Importance of Planning

We’re bad at talking about death. And yet, whether or not it’s conscious, most people have fairly specific wishes for how they want to die.

  • Some prefer to die at home surrounded by family members whereas others prefer to die in a hospital to reduce the burden family members might feel
  • Some prefer to know that their doctors will fight aggressively to the very end whereas others prefer more emphasis on the quality of their life once they have come to terms with what might be a low chance of recovery
  • Some prefer making specific plans around finances or what a memorial service might look like whereas others might be less concerned with specifics than having their values considered when decisions are made

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The most important step, though, is to have the conversation because the alternative can be disastrous. When people don’t talk about end of life wishes, patients often get what they don’t want and family members often end up burdened with the worst consequences. A well-intending family member might have no idea whether or not his or her loved one would have wanted to be put on a ventilator, or even worse, know when a ventilator should be turned off. They might feel guilty for the decision they do make; they might regret not having clarified things much earlier; And I’ve seen time and time again that not having these conversations can disrupt a family member’s grieving process, causing unnecessary harm for months or years following the death.

Many people prefer not to talk about death secretly hoping that if they ignore it, it will go away. Others imagine that these conversations can wait. But I’ve learned a simple mantra over and over again from my, sometimes intensely suffering, clients: Don’t wait. Find a way to at least begin talking about the most important conversation most of us never have.

Looking for places to start? I can be a resource, or you may want to start with these fantastic websites:

Complicated Grief: Definition, Impact, & Risk Factors

In the wake of a death, people experience grief. They may feel sad, lonely, or low on energy. They may feel disconnected from others and think frequently about the person who has died. This can go on for months or even years, but as long as the intensity of their symptoms decreases over time, their experience is most likely healthy and normal. The trouble occurs when time alone does not heal; in some cases these acute symptoms morph into a persistent condition called complicated grief. People experiencing complicated grief get "stuck." That is, they are unable to effectively move on with their lives.

In spite of affecting ten to twenty percent of people who experience a significant loss, complicated grief is a little known mental health condition. This is all the more surprising when its impact is understood: People who develop complicated grief tend to be debilitated by it. They may look severely depressed or traumatized. They may have difficulty connecting to others or keeping a job and are at greater risk for developing a substance use disorder.


Someone with complicated grief can benefit from psychotherapy. Also someone who appears high risk for developing complicated grief in the future can benefit from psychotherapy as a means of prevention, even before the death. Psychological risk factors for complicated grief include: already having a significant history of close people dying, a history of coping through suppression (i.e., trying to force stressful thoughts out of your mind rather than facing them), having a significant mental health history, or simply being very close to the person who died (e.g., the loving spouse). If you or someone you care about might be at risk for, or is already showing signs of complicated grief, speaking with a trained mental health provider could be of real help.

Learn more about preventing and treating complicated grief by contacting Dr. Altschuh at 720-515-9427 or visit