No one gets out of life alive — but one expert says we can take steps to make sure we leave the earthly plane riding the high of a “good death.”
“While 80% of people want to die at home surrounded by loved ones, only 30% actually do,” End Well founder Dr. Shoshana Ungerleider told The Post. “This massive gap reflects our system’s inability to honor what patients actually value.”
As our cultural relationship to mortality has changed, Ungerleider notes that we have become disconnected from the process of death and, in turn, fail to plan appropriately for it.
But if you’re not sure where to start, she has a helpful checklist of everything you should be doing to avoid a “bad death.”
“One of the biggest and most heartbreaking mistakes people make is waiting too long to have the important conversations — or assuming that comfort will ‘just happen’ on its own,” she said.
These days, when approaching death, most people focus on intervention, medication and hospital visits.
“We treat death as a medical failure rather than a human experience. We default to aggressive, invasive care in institutional settings because that’s what our training and incentives reward, not because it’s what patients want.”
To prepare for the inevitable end and to support a personal path, Ungerleider recommends the following preemptive measures.
Define what matters most to you — and talk about it.
Transparency can ensure your exit strategy aligns with who you are and what you need. These discussions should be ongoing and evolve alongside your life journey.
“The conversations people should be having to prevent ‘bad deaths’ start with values-based discussions,” she said.
“Ask yourself: ‘What makes life worth living for me? What do I fear most about serious illness or dying? When would I feel like treatment is doing more harm than good?’
“Share your thoughts with the people closest to you and your care team. These conversations can shape every decision that follows.”
Ask about palliative care early
“If you’ve been diagnosed with a serious illness — like cancer, heart failure or advanced lung disease — palliative care can help” said Ungerleider, who stressed that it’s not the same as hospice.
“Palliative care can be given alongside curative treatment and focuses on improving your quality of life. Ask your doctor: ‘Can I speak with a palliative care team? What options are available to help manage pain, nausea, breathlessness, or fatigue?’”
In her experience, a lot of people wait too long to incorporate palliative care.
“These teams are experts in managing pain and other distressing symptoms, but also in supporting emotional, spiritual, and family needs. Too many families miss out on this because they think it’s ‘only for the very end,” she said.
Define what comfort means to you.
Comfort is personal and end-of-life goals vary. Ungerleider recommends making a list to share with loved ones that answer these questions:
● What physical needs must be met to keep me comfortable?
● What emotional or spiritual support do I want?
● Who do I want by my side — and who don’t I?
Get clear on your wishes — and put them in writing
Ungerleider recommends having clear, written advance directives in the form of a living will and a Physician Orders for Life-Sustaining Treatment (POLST) form.
She also advises everyone to choose a trusted advocate who can make decisions about your care in the case that you can’t.
“Planning for death can actually help us live more intentionally every day, just like preparing for birth helps us welcome new life more meaningfully.”
End Well founder Dr. Shoshana Ungerleider
“Have a candid talk with them about your wishes, including what kinds of treatments you’d want (or not want), and under what circumstances,” she said.
“Healthcare providers and anyone else who might influence your care setting and treatment decisions need to understand what matters most to you.”
Ask hard questions
While fear and uncertainty are common, asking the hard questions can help clarify what the end of life will look like for each individual.
Ungerleider recommends that patients ask care providers the following:
● What is my prognosis, really?
● What will the last phase of this illness likely look like?
● How will my pain and symptoms be managed as things progress?
● What should I expect in terms of support at home or in a facility?
End-of-life planning should be treated with the same intentional preparation and support as birth planning, the doc says.
“Just like birth planning, end-of-life planning should involve understanding your options, choosing your care team, preparing your environment, and having your support people know your preferences.
“Both experiences are deeply personal and should reflect your values, not just medical convenience.”
While many shy away from the subject of death, preferring to pretend it can’t or won’t happen to them, Ungerleider said, planning for the end keeps her alive in the moment.
“I often find that the idea of death kind of keeps me awake to my own life. Planning for death can actually help us live more intentionally every day, just like preparing for birth helps us welcome new life more meaningfully.”
