The Final Frontier

Trojan Family Weekend attendees conquered death and dying taboos courtesy of the USC Davis School of Gerontology's Susan Enguidanos, Ph.D., MPH
By Jonathan Riggs

Photo By Marissa DeCoteau

The big sleep. Kicking the bucket. Dying.

No matter how you say it, very few people enjoy contemplating their own mortality.

"The fact is, whether we’re prepared or not, it’s going to happen," said Susan Enguidanos, Ph.D., MPH, of the USC Davis School of Gerontology. "That’s one thing we all have in common: we’re all going to die."

Facing reality with good science and good humor, Enguidanos delivered a Trojan Family Weekend presentation to parents, family members and students entitled "Conquering Taboos: Talking to Your Family about Death and Dying." Although the subject matter was at times serious and sobering, Enguidanos radiated warmth and the audience responded in kind.

"At age 86, I am an inhabitant of a retirement home. We don’t talk about death there: we talk about USC football and how bad the food is," a man volunteered. "Rarely does the subject of death come up. We know it’s inevitable, but the reason our children are interested in it is to find out what’s in the will."

Opening with a description of how the current mortuary system and cultural attitudes towards death took root in the Civil War era, Enguidanos explained how, all too often, the idea that shielding people from the reality towards this intrinsic part of the life cycle is, in fact, damaging.

"We became separated from the process, which is a disservice, especially to our kids," she said. "We’re not allowing them to observe an inevitable process and what it means when somebody passes away."

Focusing on advance directives—a written statement of your wishes, preferences and choices regarding end-of-life health care decisions—Enguidanos distributed copies of the "Five Wishes" living will. She discussed how crucial it is to make these plans now, to avoid potentially enormous financial, legal and emotional repercussions for family left behind, invoking the tragic case of Terri Schiavo, a woman who lived on life support for seven years while her husband and parents battled it out in court to determine whether or not to take her off it.

"The situation isn’t one is right and one is wrong: it’s how do we avoid these situations? It’s about honoring individual preferences," she said. "How do we keep our families from going through these difficult decisions? Deciding not to put in a feeding tube or not to use a ventilator is different than deciding to take one out."

Enguidanos dispelled urban legends about life support and organ donation, discussed cultural differences relating to death, and shared anecdotes from her courses, including GERO 437: Social and Psychological Aspects of Death and Dying.

"Their midterm assignment is to develop an advance directive for themselves, as well as for one parent," she said. "One of my students emailed me the summer after the class to say that her father had a stroke and died. She felt so comforted because she knew what he wanted, in terms of decision-making, care and his funeral service, down to the last detail. Having that discussion was life-changing for her and her whole family."

The most common question of the day was how, exactly, to broach this potentially uncomfortable and frightening subject, especially with loved ones.

"You can’t have a plan if you don’t have a discussion. We need to include everybody in this discussion and be really clear on what kind of things we want," she said. "Studies show people without advance directives will get aggressive care at end-of-life, which may result in poorer quality of life and more complicated grief for their families. We also find that people without advance directives are more likely to die in a hospital, while 80% of people would prefer to die at home."

Ironically enough, all the frank talk about death and dying seemed to help participants leave on a life-affirming note.

"What a wonderful thing today was," said Diane Morin from Palo Alto, California. "I would love to continue this discussion with my college-age daughter."

"I have aging parents myself," said Julie Schoenfeld from Seattle, Washington. "I came to get some knowledge that would empower me to start this conversation with them. This was fascinating."

.Photo By Marissa DeCoteau