Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

The Art of Talking About Death


The clinically excellent clinician engages in honest conversations about death and dying with patients and their families.

This is a piece on what I learned on death and dying at the DotMD conference, the “Festival of Medical Curiosity,” in Galway, Ireland. This is a conference focused on how medicine can be explored using a creative approach. 


Palliative care physician Dr. Kathryn Mannix, author of “With the End in Mind: How to Live and Die Well,” began her talk with a question:“How many of you have been involved in the death of another individual?”


I looked around the room—nearly all hands were raised.


Dr. Mannix continued, “How many of you have been involved in the death of tens of individuals? Hundreds? Thousands?”


With each question, hands dropped until only a few remained in the air. As a palliative care physician, Dr. Mannix explained that she has been involved in the deaths of thousands of people. While each individual’s death, just like their lives, is inherently unique, Dr. Mannix spoke candidly of the commonalities involved. She focused on characteristic patterns of death as she tactfully navigated arguably one of the most difficult conversations a person can have.


Dr. Mannix shared a story about one of her patients, Sabine, who asked for the details about what a typical death, her own death, would entail. Dr. Mannix, as she had done for patients before and since, spoke of the details surrounding dying. She explained each physical signs with the corresponding physiology. She spoke of the parts of dying that may seem scary to those at the bedside, but actually mean that the body is reacting normally, and without pain.


It is graceful narration of the deathbed that Dr. Mannix has found to be deeply appreciated by her patients. For too long, dying has been referred to through metaphor and poetic speech, dancing around the realities of the deathbed. Over time, some of us have distanced ourselves from death. Sometimes it feels taboo to have open dialogue about death.


Dr. Mannix’s talk concluded with a call to action for physicians: to work towards changing the public understanding of dying. To have sometimes uncomfortable conversations about the process of dying with patients and their families. To encourage and foster conversations about death and dying.


In her words, “it’s time to re-claim the D-words. It’s time to talk about dying.”