Creative Healing

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6 Keys to Cultivate Dignity at the End of Your Life

Posted by Karen M. Wyatt on March 3, 2015 at 11:50 AM

In recent months there has been a lot of discussion and debate about the idea of dying with dignity, spurred by the story of Brittany Maynard’s choice to end her life while she still had control, rather than continue the progressive suffering caused by her brain tumor. Proponents of Death with Dignity laws suggest that terminally ill patients should be able to “hasten an inevitable and unavoidable death,” and thereby preserve their dignity by being able to control the timing and manner of death.


While everyone seems to agree that the dying process should indeed maintain a patient’s dignity, there does not seem to be a clear definition of what dignity actually means at the end-of-life. Is taking control over the timing and manner of death all that is necessary to instill dignity in the dying process?


Dr. Harvey Max Chochinov, a Professor of Psychiatry at the University of Manitoba and Director of the Manitoba Palliative Care Research Unit, has identified in his research six primary factors that affect dignity for those who are dying: pain, informal support, formal support, hopelessness/depression, heightened dependency needs, and quality of life.


What will it take to ensure that you will die with dignity when you reach the end of your own life? Using Dr. Chochinov’s six factors as a framework let’s look at some choices and actions to take right now in order to foster dignity for yourself when your life is reaching the end:


1. Pain: Practice pain reduction techniques


While pain management is one of the most important functions of a hospice/palliative care team, the patient can augment the relief provided by their medications with certain techniques that lessen the intensity of pain, such as music therapy, guided imagery, prayer or meditation, and EFT (Emotional Freedom Techniques.) Use of these modalities can enhance resilience and coping skills, as well.


If you learn these techniques now they will help you manage the pain you encounter in your day-to-day life and they also might prove useful at the end-of-life. By practicing with the pain you experience now you will learn how your own body and mind respond to pain and may discover which techniques work best for you. In addition, regular practice of one of these alternatives will train your brain so that the technique will be easier to initiate and more effective when it is needed in a crisis situation.


Read more about alternatives for pain


2. Informal support: Foster your relationships with loved ones


If you end up needing home-based care at the end-of-life, your caregiver will most likely be a family member or close friend, unless you can afford to hire a private nursing staff. By focusing now on healing old resentments, practicing forgiveness and strengthening the bonds of unconditional love with those people closest to you, you will lessen the tension in those relationships long before you need to rely on them for supportive care.


Building bridges of love to the people closest to you now will help you avoid two of the biggest obstacles Dr. Chochinov found to attaining dignity at the end-of-life: “Not being treated with respect or understanding” and “feeling a burden to others.” In my own hospice experience, when relationships have been based on mutual respect and love over the years, the burden is lessened for everyone, caregiver and patient alike, during the dying process.


3. Formal support: Promote hospice and palliative care in your community


The best way to ensure that quality care will be available to you at the end-of-life is to become active in your community right now in promoting hospice and palliative care. Learn about the resources in your area, offer to serve on a board, help with fundraising, or become a volunteer for your local end-of-life care providers. If you are lacking certain services in your area form a task force to improve end-of-life care and encourage local medical providers to get involved.


Read about more action steps you can take in your community.


4. Hopelessness/depression: Find meaning in your life


Viktor Frankl wrote in Man’s Search for Meaning--his classic story of life and death in a Nazi concentration camp--“Those who have a ‘why’ to live can bear with almost any ‘how’.” To counteract the feelings of hopelessness and depression that can rob you of dignity at the end-of-life, it is imperative that you begin your own search for meaning in life right now. Perhaps you have never thought about the purpose of your existence before, but it is far better to begin looking at that question now than to wait until you are on your deathbed.


Spend some time in contemplation, identify what really matters to you in life and then create a daily practice that will support your search for meaning. You may want to try journaling, meditation, prayer, yoga, mindfulness, or a combination of some of those practices. It doesn’t really matter what you practice – only that you practice with consistency and diligence. Having a daily practice helps calm anxiety and creates opportunities for deeper contemplation and inner work, which will lead to a greater sense of meaning in all of life.


Read more about finding meaning in later life.


5. Heightened dependency needs: Learn to let go of expectations

One of the greatest challenges for any patient is to accept the reality of becoming increasingly dependent on others for the basic activities of daily living, including bathing, grooming, eating, and using the toilet. The fear of giving up autonomy and independence is so great for most of us that we resist even thinking about the possibility.


But the reality is that unless you die at a younger age of a non-illness-related cause, then you will end up being dependent on the intimate care of others at the end-of-life. To prepare for this challenge you must learn to let go of your expectations and accept whatever life brings to you. You will need to practice surrender by remembering each day that you are not really in control of life, you do not have all the answers for things that happen to you, and you waste your precious energy when you try to force life to be other than it is. Practice deep breathing to stay calm during this process of gradually letting go of your attachments and expectations.



6. Quality of Life: Develop a spiritual practice


Multiple studies have shown that quality of life at the end-of-life is enhanced for patients who have a strong sense of spiritual well-being, which may or may not be related to being part of a religion. Other studies have correlated prayer and meditation with improved quality of life during the dying process.


This data is compelling enough to lead to some conclusions: if you already have a spiritual practice you would be wise to continue it; if you don’t currently have a spiritual life but you are interested in moving in that direction, the time to start is now. As mentioned above, you can begin by exploring practices that resonate with you, such as prayer or meditation. Interestingly some studies have also shown that people with a regular spiritual practice are also likely to live longer, so there are multiple benefits to tending to your spiritual life now.


Read more about how to start a spiritual practice.


If dignity at the end-of-life is important to you, as it is for most of us, then pay attention to the factors discussed in this article. By working now to develop some coping skills for pain management, heal your close relationships, find meaning in your life, and learn to let go of your expectations, you can influence your own mental, emotional and spiritual well-being at the end-of-life. Strengthen your sense of self-worth and dignity now in order to preserve it when the time comes for you to die.


Consider joining the conversation about dignity at the end-of-life by tuning in to “Choices and Dignity in Dying Symposium” at End-of-Life University. This online event will be free of charge March 12-14, 2015. Your thoughts and opinions are welcome and needed. Visit this page to learn more:



About the Author:

(Dr. Karen Wyatt is a hospice and family physician and the author of the award-winning book “What Really Matters: 7 Lessons for Living from the Stories of the Dying.” She is a frequent keynote speaker and radio show guest whose profound teachings have helped many find their way through the difficult times of life. Learn more about her work at






10 Ways to Manage Pain Without Taking Drugs

Posted by Karen M. Wyatt on March 2, 2015 at 1:15 PM

When a high-profile celebrity like Whitney Houston or Heath Ledger dies from a drug overdose involving prescription medications everyone hears about it, but did you know that drug-related deaths in the US now outnumber traffic fatalities? Data from the Center for Disease Control and Prevention shows that the death toll due to drugs has doubled in the last decade and emergency room visits tied to the abuse of prescription painkillers have jumped 111 percent over a five-year period.


Some experts believe that the use and abuse of pain medications has now reached epidemic proportions, having been fueled by a change in physician prescribing practices over the past decade, resulting in more liberal use of highly addictive narcotics for moderate pain. The US consumes 83% of the world’s oxycodone and 99% of its hydrocodone, which are the number 1 and number 2 most frequently abused medications in this country. Pharmaceutical companies, always seeking profitable new markets to tap into, are in the process of developing even more new forms of the addictive opioids.


Clearly, many patients with legitimate pain are becoming unintentionally addicted to the medications they have been prescribed because the drugs are so potent and can cause tolerance and dependence in a relatively short time. But what if you are experiencing chronic or acute pain and don’t want to risk becoming a victim of the drugs that have been prescribed for you? One piece of advice is to use pain medications very sparingly rather than on a regular schedule. Whenever possible try other techniques for coping with pain rather than reaching for a pill:


1. Laugh. Laughter causes the release of natural endorphins in the brain, which help increase your ability to tolerate pain. So watch a funny movie, humorous videos on YouTube, or enjoy a laugh with friends.

2. Listen to music. Music has been shown to be effective at reducing the experience of pain for a variety of reasons including increasing relaxation, causing distraction from negative feelings, and also creating neurochemical changes in the brain. Try various types of music that you enjoy to see which is the most effective for you.

3. Exercise. Moving the body has been shown to reduce pain by releasing endorphins and improving function. Go for a walk, dance, do yoga or just move any part of your body that you can use without further injury. Check with your doctor or physical therapist first if you have a condition that makes exercise difficult.

4. Get a massage. Studies have shown that massage can be as effective as pain medications for alleviating discomfort and can also help with inflammation, swelling and stiffness. In addition, massage also causes the release of endorphins, which have already been discussed.

5. Use guided imagery. This form of relaxation/hypnosis has been shown in multiple studies to provide effective pain relief as well as improve sleep, elevate mood and increase motivation. You can listen to audio tapes or CD’s that talk you through the process of guided imagery to get the most benefit.

6. Apply hot or cold packs. These old-fashioned remedies are still effective at reducing the sensation of pain and can make a big difference in a short time. Use whichever temperature feels best to you and combine it with one of the other methods listed here.

7. Practice deep breathing. Deep breathing helps increase relaxation, reduce stress and improve energy levels. Try it multiple times throughout the day and combine it with other techniques for the most benefit.

8. Love. Experiencing loving feelings and sexual intimacy can help alleviate pain by releasing endorphins, generating positive emotions and decreasing anxiety. Ask your partner for a massage for added benefits.

9. Pray or meditate. Prayer and meditation have both been shown to be effective at reducing pain by increasing relaxation, providing distraction and alleviating anxiety.

10. Practice EFT. Emotional Freedom Techniques, also known as tapping, has been demonstrated to be effective in reducing pain symptoms and studies are now showing that the practice can help reduce cortisol levels and stress. It is a simple technique that can be learned quickly and requires no special tools.


If you have been given narcotic medications for chronic or acute pain, view your prescription as potentially dangerous and use it with caution. By utilizing some of these techniques you should be able to reduce your reliance on drugs and feel calmer, more alert and in better control of your symptoms. Be sure to keep your medication away from children, dispose of any unused medication safely (such as through a pharmacy take-back program) and never share any prescription with another person.





What Does Dignity Really Mean at the End-of-Life?

Posted by Karen M. Wyatt on March 1, 2015 at 6:40 PM

Our society is currently struggling with the concept of “death with dignity” as we try to understand what it really means to die a dignified death. In order to find common ground for this conversation it is helpful to consider the original meaning of the word “dignity” from its Latin derivation--the root word dignus, which means “worthy.” So from this perspective to die with dignity means to have a sense of self-worth and value up until the last breath of life.


This concept of dignity was first introduced to me when I was practicing as a hospice medical director. At that time one of the hospitals in our community had a huge mural on the wall that featured their mission statement:


“Care must be taken of the sick as if they are Christ himself.”


Each time I entered that hospital I would see that slogan and be reminded of the humility and compassion that are required of all who care for the sick and terminally ill. We must cherish and support each patient’s sense of worth, regardless of diagnosis or circumstances, in order to preserve dignity at the end-of-life. We must see the sacredness of each life we touch.


One of my hospice patients at that time, Andy, was dying from a malignancy that had developed on the side of his nose and spread to eat away half of his face. The invasive cancer had left a ghastly, gaping hole where his cheek and upper jaw had once existed. Andy covered that part of his face with a dressing of gauze and tape and would allow only a few people to see what was hidden underneath.


His suffering was intense because the gradual erosion of his facial tissue by the cancer caused tremendous pain. But he was not at all bitter or angry about his situation: he accepted it as part of life. His goal was to live as long as possible to watch his children grow up and his tremendous love for them was visible in the way he glowed when he spoke of them.


Andy was an inspiration to me and to everyone who spent time with him. He managed to live for one year after his admission to hospice, though he had been expected to die much sooner. Over the course of that year I visited him many times and found myself in awe of his equanimity and his capacity for love. Shortly before he died I helped him change the gauze on his face because he had become too weak to do it himself.


As I removed the dressing and saw for only the second time the necrotic wound left by his skin cancer, Andy said, “I’m sorry you have to see my ugliness.” With tears in my eyes I responded, “Andy, you are the most beautiful person I have ever met.”


Indeed, Andy lived each moment of his life with great dignity, despite the increasing disfigurement caused by his cancer. He valued life and love above all else and those who cared for him responded by valuing him and preserving his sense of worthiness throughout the entire end of his life.


A few months later I had a dream that I was visiting Andy in a nursing home and found him whole and healthy, standing next to the bed and looking down at his own cancer-stricken body. He smiled and said, “I came to tell you thank you. You cared for me like God.”


This then for me is the essence of dignity at the end-of-life: for each dying patient to be cared for like God, like Christ himself; to be so loved and cherished that he knows he is valuable, that she knows her unmistakable worth. To attain dignity at the end-of-life is to be seen and loved for exactly who you are, to be honored for your uniqueness.


When we begin our care of the dying with such a definition of dignity, then we will truly help each patient determine the best way to live out those final days. For some the burden of suffering at the end of their illness may be too great to bear—their sense of self-worth and value may require them to control the timing and means of their own death. For others, like my patient Andy, living and dying with dignity may involve holding on for as long as possible to be with those we love.


Our task as hospice workers is to support our patients on their unique end-of-life journeys and honor their choices and perspectives. We must learn to become perfect mirrors for them, reflecting back to them their worth and value so that they can always maintain dignity, regardless of the paths they choose. Our work then comes down to this: polishing our “mirrors” so that the reflections we offer our patients are clear, true and without bias.


Please add your voice to this conversation by joining the “Choices and Dignity in Dying Symposium” at End-of-Life University. This online event will be free of charge March 12-14, 2015. Your thoughts and opinions are welcome and needed. Visit this page to learn more:



About the Author:

(Dr. Karen Wyatt is a hospice and family physician and the author of the award-winning book “What Really Matters: 7 Lessons for Living from the Stories of the Dying.” She is a frequent keynote speaker and radio show guest whose profound teachings have helped many find their way through the difficult times of life. Learn more about her work at





Change Your Life With the 30-Day Thank-You Challenge

Posted by Karen M. Wyatt on February 24, 2015 at 8:35 PM

If you are looking for a way to boost your happiness, health and relationships with one simple practice, the answer to your search is this: Gratitude. Studies have shown that cultivating an attitude of thankfulness in your life correlates with well-being, strengthened relationships with romantic partners and other individuals, and health benefits like a stronger immune system, lower blood pressure and improved sleep.


Scientists have yet to explain exactly how gratitude produces these impressive benefits, but there are some theories that perhaps gratitude increases brain-levels of dopamine, the “feel-good” neurotransmitter. In addition the Institute of Heartmath suggests that the positive effects begin in the heart, because their studies have shown that the rhythm of the heart becomes smooth and harmonious when we experience appreciation and other positive emotions.


No matter how gratitude works to improve mental and physical health, there is plenty of evidence available to suggest that gratitude is a worthwhile practice to add to your daily routine. But how do you actually incorporate an attitude of thankfulness into your busy life—especially when you are coping with a multitude of stresses and struggles? Can you still feel grateful when things are not going as well as you would like?


One interesting study reported in the Journal of Positive Psychology showed that people who are aware of their mortality, such as those who have faced a life-threatening illness or near-death experience, are more likely to express gratitude than those who have not reflected on death.


While you might think that you have to wait until your life is moving in a positive direction before you can be grateful, this study suggests that difficult times might actually help you find the way to greater gratitude. So it is possible for us to become even more grateful when we are suffering because our losses remind us that life itself is precious and fleeting.


There are many excellent ideas for cultivating thankfulness in your daily life, like keeping a gratitude journal or reciting a gratitude prayer each evening before you go to sleep. But here’s an idea for expressing your gratitude that will have additional positive benefits for you:


Write a thank-you note to someone in your life each day for 30 days.


The note you compose can be short and simple and may or may not actually be sent to the other person. The goal behind this practice is to focus each day on a person in your life, past or present, for whom you feel grateful and to express in writing why you are thankful for their presence on your life’s path.


You should be able to think of 30 different people throughout your lifetime who have changed your life in some way. And not all of those interactions may have been positive when they occurred—sometimes people who have caused you pain in the past have actually helped you grow the most.


So the idea is to thank a variety of people for the help they have sent your way, even if some of it felt hurtful at the time. By doing this you will be sorting through your old memories of both joy and pain and healing many of the wounds you may have been carrying with you over the years.


Here is an excerpt from a thank-you note I wrote to my 4th-grade teacher:


“Dear Mrs. Ingersoll,

Thank you for challenging me to be the best person I could be when I was 10-years old. You inspired me to dig deep and see what I was capable of, even though I felt afraid and unsure of myself at times. Thank you for not settling for anything less than my best work—you helped me set my standards high and reach beyond my limitations.”


This practice helps you build a convincing body of evidence that life is good and that you have been blessed, even during difficult times. By intentionally expressing your appreciation for 30 days you will be creating a “habit of gratitude” that will help you stay in a state of thankfulness for your life in every situation.


In addition, if you actually do mail some of the thank-you notes you will increase the happiness of the people you thank and strengthen your relationships with them, as well. Join me in this 30-day challenge to put your gratitude in writing and change your life, one thank-you note at a time!


About the Author:

(Dr. Karen Wyatt is a hospice and family physician and the author of the award-winning book “What Really Matters: 7 Lessons for Living from the Stories of the Dying.” She is a frequent keynote speaker and radio show guest whose profound teachings have helped many find their way through the difficult times of life. Learn more about her work at





What the World Needs From You in 2015

Posted by Karen M. Wyatt on January 14, 2015 at 9:50 PM

This New Year has already started off with a rush of energy—can you feel it? The economy is recovering, unemployment is on the decline and marriage equality is spreading rapidly throughout the U.S. Yet there’s no time to celebrate these advances because the planet is still in a dire state of emergency with global climate change, political unrest, horrific acts of terrorism, worldwide poverty, and threats of a pandemic.


Your personal New Year’s resolutions to lose weight or get your house organized may seem trivial when they are matched up with the problems of a world-gone-slightly-mad and on the verge of disaster. As a person of higher consciousness, how do you align your own life goals with the needs of the planet and feel you are making a worthwhile contribution?


From my meditations on the state of our world at this time in history I have an idea of the mindset and attitude shifts that are being called for—what we are now being asked to bring to humanity, the planet and the Universe. Here are my thoughts on what the world needs right now and how you can step up to make things better in 2015:


1. Creativity


More than ever the world needs you to become a creator in 2015. Each one of us contains the seeds of a “good idea” that can contribute to healing and transformation on this planet. Not that you must find the solution to global warming or single-handedly end starvation, but you must activate within yourself the unique creative spark you carry and give the world your contribution.


All of creation is waiting for the gifts you can bring to life by expanding your vision and freeing up your inspiration. Begin by examining all of your habits and routines: What can you do better? Where is there room for change? Feel the life energy that arises within you and allow yourself to change and grow—that is what is being asked of you in 2015.

2. Balance


If your life is at all out of balance you probably already know that and may be making excuses for yourself. This is the year that your denial must end. Perhaps you know that you don’t get enough exercise or you watch too much television or you drink too much alcohol. Acknowledge this imbalance in your life and focus on finding equilibrium.

You don’t have to make big changes all at once. In the beginning simply increase your exercise by 30 minutes each week, watch 1 hour less television each week, or give up alcohol one day per week. Keep your focus on being in balance and take small steps toward that goal. You will be contributing to the stability of life on this planet by maintaining your own healthy equilibrium—and that is desperately needed in this topsy-turvy world.


3. Collaboration


This is the year you must put aside your jealousy, competitiveness and rivalries to find common ground with others in your field. Solutions to our world problems will arise through synergy, cooperation and unity. We must relax our boundaries and open up our territory to others who can create with us.


Begin to see your rivals not as threats to your success but as the keys to fulfilling your highest potential. What is now true in this world is that only by working together with your peers can you achieve your ultimate purpose in life and bring about the “new earth” that is waiting to be born. Make a list of the competitors you fear the most and think creatively about ways you might work together on a project.

4. Integrity


Integrity can no longer be just a clichéd bullet point on your mission statement, but must be brought to life in a new way in everything you do. The word “integrity” comes from the Latin word integer, which means “whole and complete.” Your goal for 2015 must be to become whole within yourself, to integrate your Shadow, your weaknesses and your failures to become as complete as you can be.

To promote integrity in the world you must be impeccably honest in your choices and act for the highest good of the whole planet as often as possible. Stop telling lies to others and especially to yourself. Each day in your journal write down the lies you have told (we all tell them much of the time), uncover the reasons why you lie, and understand what you will have to change within yourself to become more honest. Our world can no longer afford the burden of our lies and incompleteness. Moving toward integrity in our own individual lives will contribute to the wholeness of our entire planet.

5. Presence


This shift is really the key to all of the other changes you are being asked to bring to the planet in 2015. Presence means being fully aware and awake in each moment, right here, right now. It means bringing your whole self—body, mind and soul—to each and every activity your do, to every situation that arises for you. Presence is necessary for your creativity, because you can only create in this present moment; being present to what is happening now will help you to stay in balance and operate from integrity; and focusing on the present moment will alleviate your fear of competition and allow you to freely collaborate with others.


To cultivate your ability to remain in the present moment you must first heal the wounds of the past that keep dragging you back to old memories and resentments. You must begin a practice like mindfulness, yoga, meditation, contemplation, or prayer that trains your mind to focus on the here and now rather than jumping to the future or retreating to the past.

Increasing your ability to be in the present moment is really the only change you must make in 2015 to contribute to the welfare of the planet. All other growth and transformation will flow naturally once you bring your full attention to this moment.


As we face the uncertainty of this global emergency together, remember that it is really a time of emergence, when what is old and worn falls away to allow something new to come into being. There is nothing to fear and everything to rejoice in as we allow change to unfold before us.


Bring your gifts, open your heart and mind, embrace your own limitations and breathe deeply in this present moment—that is really all that is required of you for this remarkable year.


About the Author:

(Dr. Karen Wyatt is a hospice and family physician and the author of the award-winning book “What Really Matters: 7 Lessons for Living from the Stories of the Dying.” She is a frequent keynote speaker and radio show guest whose profound teachings have helped many find their way through the difficult times of life. Learn more about her work at






Stuart Scott Didn't Lose to Cancer - He Transcended It

Posted by Karen M. Wyatt on January 6, 2015 at 12:35 PM

The sports world has been overcome with grief since the passing of popular ESPN anchor Stuart Scott on January 4, 2015. He died at the age of 49 after a 7-year battle with cancer, beloved by fans, athletes and colleagues at ESPN. Tributes to Scott have been pouring in through social media since the moment the news was released.


The death of such a high-profile media hero is one of those life-events that doesn’t make sense to us on a rational level: why does such a good man, who gave so much and was admired by so many, have to die at such a young age? Death seems capricious and unfair when it snatches away someone with so much potential left to fulfill.


Many of Scott’s supporters and fans had been hoping and praying that he would overcome the cancer that ravaged his body. Michael Jordan summed up this sentiment in his statement: “He fought so hard against cancer and I hoped he'd win the battle.”


While this battlefield metaphor is one that may work well in sports, where there is almost always a winner and a loser at the end of the contest, it falls short when applied to an illness like cancer. Cancer has no rules, no time outs, no substitutions, no game clock—it operates by its own mysterious playbook that we have yet to master.


Our best defense against such an opponent is to look beyond the narrow view of “winning or losing” as an outcome, and to recognize that there is a higher path through illness: a sacred path that allows us to transform from being a victim of the disease to becoming a craftsman of our own life, using cancer as a tool for transcendence.


On this sacred path of illness there is no losing of the battle, only a refining and shaping of what really matters in life—of the ability to love and to live each moment with meaning. Stuart Scott made this point beautifully in his stirring speech at the ESPY’s in July 2014: “When you die, it does not mean that you lose to cancer. You beat cancer by how you live, why you live, and in the manner in which you live.”


The very fact that Scott came to this realization is evidence that he had transcended the illness that was slowly overtaking his body. He had found the sacred path that rises above the plane of physical suffering and had created a life of beauty, purpose, passion and love despite everything that cancer had thrown at him.


Stuart Scott managed to live life on his own terms in the face of devastating illness. In doing so he brought the rest of us the greatest gift he could ever give: proof that you can shape your own life with love, no matter what challenges come your way. Thank you Stuart for having the courage to walk that sacred path and show the rest of us the way—your light will shine on.


About the Author:

(Dr. Karen Wyatt is a hospice and family physician and the author of the award-winning book “What Really Matters: 7 Lessons for Living from the Stories of the Dying.” She is a frequent keynote speaker and radio show guest whose profound teachings have helped many find their way through the difficult times of life. Learn more about her work at




5 Movies to Jumpstart Your End-of-Life Conversations

Posted by Karen M. Wyatt on January 1, 2015 at 6:30 PM

Recently more people than ever before have begun to take a look at their hopes and desires for the end-of-life and are even putting those wishes into writing. Through movements such as Aging With Dignity and The Conversation Project, individuals of all ages are being encouraged to talk about that day when their own life will come to an end and to express their thoughts and feelings about it with their loved ones.

As a society we are waking up to the fact that we need to tell others what we want for our final days of life in order to make it happen. However, once we figure out how we feel about our own death and dying, the next step we must take—initiating the conversation with our loved ones—is often the most difficult step to complete.

(Read “Tips for Talking With Your Loved Ones About the End-of-Life”;)

But here’s an idea for you if you are struggling to find a creative way around the barriers to an end-of-life conversation: host a “movie night” and feature a film that will introduce the subject for you and get your loved ones in the “mood” to talk about death and dying. A movie can inspire your imagination, stir up your emotion and provoke your deepest thoughts, so it’s an excellent way to introduce a difficult topic and start a conversation.

There are many excellent movies that address the end-of-life, including some recent independent films and documentaries, but these are my top 5 recommendations for commercial films that can be used to lead into an end-of-life discussion. Choose one that best fits your situation:  

1. The Bucket List

This movie focuses on the joys of living life fully, even up to your final days, rather than on dying itself. The two main characters Carter Chambers (Morgan Freeman) and Edward Cole (Jack Nicholson) both learn that they have only one year left to live and decide to help one another fulfill their “bucket lists” before they die, leading them to many adventures and learning experiences.

Think of The Bucket List as “End-of-Life Lite” since it doesn’t directly deal with dying as much as it emphasizes living. But it can be a gentle introduction to the subject, providing just enough humor and conflict to be entertaining without causing much discomfort for the viewers. You could show this movie to loved ones of all ages and then embark on a discussion by asking: “What’s on your bucket list?” When you share your own list, be sure to include your wishes for your final days, e.g. “I want to be at home for my last days of life and have my family nearby.” You’ll be planting a seed with each person in the room and opening the possibility for deeper discussions in the future.

(Read the full review of The Bucket List)

This popular film from 1988 focuses on the unlikely friendship between two women, C.C. Bloom (Bette Midler) and Hillary Whitney (Barbara Hershey), as it evolves over many years. The movie provides some humor, plenty of relationship issues and conflicts, and cathartic emotional appeal—especially for women viewers. But the story ends with Hillary’s death and that’s what makes it a good candidate for an end-of-life movie night.

Like The Bucket List, Beaches gently introduces the subject of death and dying and helps open the viewers emotionally and prepare them for the conversation that will follow. This movie would work best with adult audiences and seems most suitable for women, but men would be touched by the story as well.

(Read the full review of Beaches)

3. Marvin’s Room

This powerful film from 1996 centers on the relationship between two sisters with very different lives, Bessie (Diane Keaton) and Lee (Meryl Streep), who must deal with the challenge of providing suitable care for their elderly father and aunt. Bessie has cared for them by herself for the previous 17 years but now faces a terminal diagnosis of her own. The movie beautifully portrays the suffering within a dysfunctional family, but shows the healing and redemption that are possible as well.

Marvin’s Room provides a compelling look at the challenges faced by family caregivers and would be an excellent stimulus for a conversation about where and how to care for our elderly when they become ill. This is a serious movie that requires an audience comfortable with looking at deeper emotions, family conflict and the challenges of caregiving, but the ending provides catharsis and inspiration for all viewers.

(Read the full review of Marvin’s Room)

4. Life As a House

This 2001 film is one of my all-time favorites and I have watched it many times. The story centers around George (Kevin Kline), an architect who decides to build a house on his family’s property after he receives a terminal diagnosis. The primary conflict in this story is between George and his teenage son Sam (Hayden Christensen), who eventually heal their estranged relationship by working together on the house. The building of the house throughout the movie serves as a metaphor for finding meaning and purpose at the end of life.

Since the father-son relationship is central to this film, Life As a House can appeal to both men and women and is suitable for a younger audience, as well (teenage and up). The movie teaches us about the opportunities for transformation that dying can offer and opens up possibilities for a discussion of how to live your life with meaning.

(Read the full review of Life As a House)

5. The Barbarian Invasions

This French-Canadian film is an intelligent and cynical look at various aspects of the end-of-life, which focuses on Remy, a radical socialist professor during his final days battling cancer. The story is provocative and controversial and ends with Remy choosing to die by a lethal dose of heroin while surrounded by his family and friends.

The Barbarian Invasions is a challenging film and would be best for an audience already open to the subject of death and dying and willing to engage in discussion about some of the controversies facing the end-of-life movement, such as physician-assisted death. This thoughtful and disturbing movie raises many questions for the viewer and should lead to animated discussions amongst audience members.

(Read the full review of The Barbarian Invasions)

Of course there are many other movies that deal with death and dying so don’t limit yourself to this small list (also check out Stepmom, Dying Young, My LIfe, and Terms of Endearment). Think about who you want to invite and what issues you would like to discuss and choose a film that best suits your needs. Have some snacks and beverages on hand, comfortable seating and plenty of tissues, since tears may flow freely. No matter how you begin, this conversation about the end-of-life is one worth having—you will feel relieved and supported once you get started and make your wishes known!

For more ideas on planning for the end-of-life you might enjoy listening to interviews at End-of-Life University – a free online educational series. Just go to to learn more and register. About the Author: (Dr. Karen Wyatt is a hospice and family physician and the author of the award-winning book “What Really Matters: 7 Lessons for Living from the Stories of the Dying.” She is a frequent keynote speaker and radio show guest whose profound teachings have helped many find their way through the difficult times of life. Learn more about her work at

5 Gifts to Give Yourself This Holiday Season

Posted by Karen M. Wyatt on December 16, 2014 at 8:35 PM

Another December has arrived and once again we are busily preparing for the holiday rituals that will take place as the year winds to an end. This is a perfect time to stop for a moment and really think about the meaning of your own celebrations, so that you don’t end up spending a fortune in time and money with nothing real to show when it is over.


This is the year that you should dedicate yourself to staying in the present moment as much as possible, no matter how crazy and hectic your schedule becomes. If you race through each day of the season, mindlessly completing the items on your to-do list, you can become exhausted, depleted and resentful and totally miss the joys of this special time of year.


The solution is to give yourself some special gifts this year. I’m not talking about gifts that cost money or are indulgent, like a spa day, a fancy night on the town, or an exotic vacation – though those things may be just what you need right now. But these are some “splurges” for the Soul – activities that will help you find meaning in these holy days:


1. The Gift of Solitude


No matter how busy you are, take some time out to be totally alone during part of one day or evening. Try to find a place to go where you will not be around other people and turn your phone off or leave it behind for at least one hour. I live in the mountains and it’s easy for me to snowshoe on a trail above my house and walk in solitude for an entire day. But if you live in a city you may have to be creative: find a park where you can sit in an out-of-the-way grove, visit a little-used section of your local library, or find a time when you have your home to yourself, with no internet, television or radio to distract you.


The idea is to be totally alone with your thoughts for an hour. During that time, take some deep breaths, think about the holiday that is approaching, reminisce about good times in the past, and contemplate what is most important to you about this season. Think of at least one thing you love about the holidays and plan how you can emphasize that activity or feeling in your life this year.


2. The Gift of Spontaneity


Be watchful for opportunities to do something special that is not on your to-do list: wander through a local neighborhood to look at the lights, stop to listen to carolers on the street corner, take in the special window displays downtown, make a snow-angel or build a snowman if you live in a cold climate.


3. The Gift of Wisdom


Spend some time reading from one of the great Wisdom texts available to us: the Bible, The Bhagavad Gita, The Kabbalah, I Ching, The Gospel of Thomas, Tao te Ching, the poetry of Rumi, or countless other sources. Immerse yourself in the beautiful language and thoughtful sentiments in these ancient writings. As Rumi wrote: “Let yourself be silently drawn by the stronger pull of what you really love.”


4. The Gift of Hunger


This may not sound like a gift at all, but I encourage you—just once during these holy days—to skip a meal. In this season of baking, feasting, partying and frequent overindulgence, it is an interesting experiment to go without eating for part of a day. When you have felt hunger for a few hours you will actually appreciate the abundant food that surrounds you and remember those who are not so fortunate at this or any other time of the year. You might even want to donate the money you save from that meal to a local soup kitchen or charity.


5. The Gift of Stars


Though it may be difficult for some, depending on where you live, I recommend going to a place one evening where you can look up and see the stars. Lie back for a brief time and study the vastness of the universe, reminding yourself how small we really are here on our beautiful planet. All of the rushing, shopping, buying, wrapping, baking, and entertaining that fill up your schedule are not really important when you consider the entire expanse of creation. But the Love that you feel and share with others rises above everything as what really matters during this holiday season.


And finally, no matter which of the above gifts you choose to give yourself this year, I suggest that you spend some time writing about the experience in your journal. Remember to express your gratitude every day for this amazing life and all the blessings that have been showered upon you, during these holy days and all year long. May you have a December to remember as you bring this year to a close and share your gifts with the world!


And please accept a small gift from me this year: if you are interested in starting a journal or enhancing your journaling practice, you can download the “Journaling Starter Kit” on my website at (no obligation – you don’t even have to sign up!) Enjoy this gift of reflection from me to you and may your days be blessed with what really matters!


About the Author:

(Dr. Karen Wyatt is a hospice and family physician and the author of the award-winning book “What Really Matters: 7 Lessons for Living from the Stories of the Dying.” She is a frequent keynote speaker and radio show guest whose profound teachings have helped many find their way through the difficult times of life. Learn more about her work at





6 Steps to Rise Above Your Fear of Death

Posted by Karen M. Wyatt on November 8, 2014 at 3:30 AM

Let’s face it: if you’re human you have most likely experienced a fear of death at one time or another in your life – or else you may have been in complete denial of your fear and repressing it. That’s because the fear of death is normal for us Earthlings – we have a survival instinct that motivates us to avoid death-inducing situations.


Death represents the ultimate unknown, a territory in which we have no experience and no control. So it is natural to feel fear when we think about death and also natural to avoid those thoughts whenever possible. But it turns out that this avoidance of death doesn’t serve us well in the end.


When we haven’t thought about death’s meaning or impact for ourselves or our loved ones, we can be caught unprepared and unable to cope when sudden tragedy strikes. Then we are more likely to make hasty decisions out of desperation that we may later regret.


I have witnessed many families who agreed to life-prolonging measures for a loved one in an emergency situation because they hadn’t previously thought about or discussed what to do in such a crisis. Then, after taking time to think through the wishes of their loved one, they had to reverse their decision and stop the heroic measures that were taking place – all at a great emotional and financial cost.


The solution to this heartbreaking situation is to spend time contemplating and preparing for death before it becomes a critical issue. But to follow through on the necessary preparations, you must first overcome your own natural fears about death and dying. Here are six approaches to working through the fear:


1. Think about it. Spend some time each week allowing yourself to think about death in a personal way. Imagine that you are on your death bed taking your last breaths: who would you want to have with you, where would you like to be, what would you want to say to your loved ones?


2. Write about it. Use your journal to record your experiences from the first exercise above. Then explore you fears of death – what exactly are you afraid of? Where have those fears come from? Do you actually believe they are true? Writing about these thoughts in your journal will help you track how your feelings about death begin to change over time.


3. Read about it. There are many excellent books available right now that discuss death and dying from various perspectives: medical, spiritual, historical, sociological, psychological, metaphysical, and more. Choose the approach that best fits your interests and spend some time with a good book. You’ll find that reading stories about death and dying can help ease your fears and answer some of your questions, as well. There’s a list of books that are Recommended Reading at End-of-Life University, which is a good place to start your search.


4. Learn about it. There’s nothing better than education to counteract fear, so take time to learn some factual information about death and dying. Try listening to the interviews with expert speakers posted each month at and expand your knowledge base.


5. Talk about it. Sign up for a Death Cafe event where you can join in conversations about death and dying with other people who have an interest in the subject. Or download the Conversation Starter Kit from to help you talk with your friends and family about the end-of-life.


6. Work with it. One of the best ways to rise above the fear of death is to become a volunteer for a hospice or palliative care organization in your community. You will receive training to work with patients and their families as a volunteer and you will discover the beauty that arises at the end-of-life. In my experience as a hospice medical director, most volunteers find that their fear of death is greatly diminished through this work.


No matter which approach you choose to help you rise above your fear of death, you will benefit a great deal from working through that fear. You will be able to contemplate all of the aspects of life, from birth through death, with less anxiety and you will experience increased peace of mind about all of life’s uncertainties.


In addition you will be able to prepare yourself for the later years of your own life, when unexpected situations can arise and quick decisions may be required. If you have discussed and planned ahead for that time of life, then you and your loved ones will be better off because of your actions.


There’s no better time to start facing your fears than right now because, as Sogyal Rinpoche reminds us in The Tibetan Book of Living and Dying, “death is real and comes without warning.” Take comfort in knowing that you are not alone on this journey since each of us must do this same work of rising above the fear of death.


About the Author:

(Dr. Karen Wyatt is a hospice and family physician and the author of the award-winning book “What Really Matters: 7 Lessons for Living from the Stories of the Dying.” She is a frequent keynote speaker and radio show guest whose profound teachings have helped many find their way through the difficult times of life. Learn more about her work at




Tips for Talking with Your Loved Ones About the End-of-Life

Posted by Karen M. Wyatt on October 14, 2014 at 4:00 PM

Recently there has been a big push to get people to start talking with their family members and other loved ones about their wishes for the last days of their lives. Baby boomers seem to be embracing this suggestion and are beginning to make plans for later life and formulate their own ideas about what constitutes a “good” ending to this life.


But some of us are running into obstacles when it's time to communicate our thoughts and wishes with our loved ones. One woman told me she has been struggling to talk with her children about her end-of-life plans – they are disinterested and have refused to listen to her. Another woman has tried unsuccessfully to talk with her mother, who doesn’t have an advance directive, about making her own wishes known so that her children can arrange care for her in the future.


These two stories illustrate just how difficult inter-generational conversations can be about the end-of-life. Younger people are not concerned with the subject because it seems so far away from them – it’s not yet part of their consciousness. And older folks, from the Traditional Generation, are not used to talking about feelings or expressing their personal desires, in addition to being uncomfortable with the idea of death as it rapidly approaches.


So how do we go about engaging in these very important conversations when we meet resistance from those we most need to listen and talk with us? Here are some suggestions for “talking the talk” and breaking through that resistance:


  • Complete your own Advance Directive first. Paul Malley, President of Aging With Dignity and speaker for this year’s Death Expo, suggests that you fill out your own living will document (such as Five Wishes) before you try to talk with others about the end-of-life. Going through the process of answering difficult questions about your own wishes will help you clarify what’s most important to you and organize your thoughts.
  • Do your homework. Spend a little time on websites that deal with making your end-of-life wishes known, such as and Research the options for end-of-life care so that you are well informed before you start a conversation.
  • Choose the right time for a conversation. According to Paul Malley, a good time to bring up the subject could be during a relaxed family gathering where most of your significant loved ones are present, such as following a holiday dinner or celebration. For example, some people have successfully tied in an end-of-life conversation as part of their Thanksgiving celebration – naming what they are grateful for and “what really matters” to them at the end-of-life.
  • Start with a great introduction. Setting the stage well for this conversation can make all the difference in the success you achieve. When talking with elderly parents, begin by asking them to tell the story of when one of their own parents died. They will enjoy talking about the past and will often provide you with some great material for your conversation. For example, “So you were always disappointed that Grandma died all alone in the hospital. What would you like to be different when you reach that time?” If you are talking with younger loved ones, The Conversation Project recommends that you begin by saying, “I need to think about the future. Will you help me?”
  • Bring extra copies of the advance directive. Paul Malley suggests that you bring along several blank copies of the document you are using and invite your family member to complete it with you. Five Wishes is very easy to use for people of all ages and could be completed together as a family “group activity,” or you can find many other templates for advance directives online.
  • Don’t wait. The caveat for each of us is that NOW is the best time to do end-of-planning and have conversations about it with our loved ones. There are no guarantees in life and the sooner you make your wishes known for your own end-of-life, the sooner you will experience greater peace of mind about the future.


So get started today by doing some research, making a list of who you need to talk to, and thinking about the best opportunities you will have to begin the conversation. Remember that your loved ones love you and want you to be happy, so approach them in that spirit – ask for their help and support.


For more ideas on planning for the end-of-life you might enjoy listening to interviews at the Death Expo – a free online educational event in November 2014. Just go to to learn more and register. When you sign up you’ll receive the End-of-Life Preparedness Assessment to help you determine what you need to learn to be ready for the end-of-life.


About the Author:

(Dr. Karen Wyatt is a hospice and family physician and the author of the award-winning book “What Really Matters: 7 Lessons for Living from the Stories of the Dying.” She is a frequent keynote speaker and radio show guest whose profound teachings have helped many find their way through the difficult times of life. Learn more about her work at







Copyright ©2010 Karen Wyatt, MD

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