In his essay, "Reflections On War and Death," Sigmund Freud wrote:Our attitude had not been a sincere one. To listen to us we were, of course, prepared to maintain that death is the necessary termination of life, that everyone of us owes nature his death and must be prepared to pay his debt, in short, that death was natural, undeniable, and inevitable. In practice we were accustomed to act as if matters were quite different. We have shown an unmistakable tendency to put death aside, to eliminate it from life. We attempted to hush it up … We cannot, indeed, imagine our own death; whenever we try to do so we find that we survive ourselves as spectators. The school of psychoanalysis could thus assert that at bottom no one believes in his own death, which amounts to saying: in the unconscious every one of us is convinced of his immortality. In a piece titled, "I do not fear death," the late Roger Ebert wrote:I don't expect to die anytime soon. But it could happen this moment, while I am writing. I was talking the other day with Jim Toback, a friend of 35 years, and the conversation turned to our deaths, as it always does. "Ask someone how they feel about death," he said, "and they'll tell you everyone's gonna die. Ask them, In the next 30 seconds? No, no, no, that's not gonna happen. How about this afternoon? No. What you're really asking them to admit is, Oh my God, I don't really exist. I might be gone at any given second." This inability to imagine our own deaths carries a high price. With each passing day, it takes a larger toll on individual Americans and the country as a whole.
"Both individually and collectively, we are paying an enormous emotional and financial price for being silenced by our society's taboo against talking about death and dying," writes Judith Johnson. "Other societies educate their members about the reality of death and the processes of dying and grieving. We do not. We are left to figure it out for ourselves, relying on doctors and funeral directors to tell us what to do once we are face to face with death. We don't know what to say, what to do, how to cope or to grieve."
She cites the $55 billion Medicare paid in medical bills in 2009 solely for the last two months of patients' lives, one-quarter to one-third of which is estimated to have had no meaningful impact.
Another costly byproduct of our fear of death, she says, is the tendency for medical professionals and organizations to continue to try to cure terminally ill patients with rounds of costly and unnecessary tests and procedures, rather than offering palliative care and respecting the patients' rights to die in a dignified, peaceful manner.
Beyond the dollars and cents, there is also, of course, the toll taken on the patients and their families.
"Unless we can start conversations about dying, we end up with people receiving unwanted medical attention or leaving behind an emotional mess for their families who feel they weren't able to fully support the dying person," says Hilary Fisher, director of Dying Matters, an umbrella group of the National Council for Palliative Care that promotes public awareness of dying, death and bereavement.
If given a choice (and forced to think about it), most of us want to die at home, in our sleep and without warning. But, of course, that's not the way it usually happens. Only 1 in 10 will get to die at home, according to research by public policy organization Demos. Instead, approximately two-thirds will die in hospital, even though only 7 percent of people say they would choose to die there, while one-fifth will die in a care home. "Unless we can devise ways to get people to talk about how they want to live while they are dying, our efforts to improve services will be like groping in the dark," write the study's authors.
Clearly, changing the conversation is a huge undertaking that will require a concerted and ongoing effort from a number of directions. And advisors are on the front lines, wielding enormous influence and shouldering a great responsibility. What steps can they take to help their clients confront and address their biggest fears?
Rather than bombarding clients with scary statistics in the hopes of initiating a fear-based conversion, Stephen Forman suggests a different strategy. "We need to move to a consequences-based presentation," he says. "Basically, throw the statistics out the window and say, 'It probably won't happen, but you have people in your life who you love that are very close to you. You've made commitments to them.' It changes the whole conversation.
"Never underestimate the ability of people to pay for something they want, to pay for something that's important to them," Forman continues. "There's never urgency in people's lives for something they believe will never happen to them. That's where we've been in the past. But never underestimate the ability of people to come up with money from nowhere to pay for something that's important to them."
Approaching clients at the right time is also key, according to Dr. Anne Brennan Malec, a clinical psychologist and financial therapist in Chicago.
In an article published in the Wall Street Journal last year, she noted that while it's tempting to avoid the topic of death when dealing with middle-aged clients, this is actually the time when people are often most receptive to the subject. Talking about death with older clients could hit too close to home, while younger clients often see it as a nebulous event sometime in the distant future, rather than something that must be addressed immediately.
To bring up the subject in a delicate manner, Malec suggests discussing the idea of preserving a client's legacy. If advisors say they would like to set up the estate "to honor [client's] beliefs," it can "provide a framework for tackling touchy subjects like powers of attorney and funeral arrangements, and getting to the details of providing for loved ones during and after a protracted illness."
In the same article, Kristine Porcaro, co-founder of Lexington Wealth Management, points out that while subtlety works well in many cases, it isn't always enough.
"If you tried to get at the topic of death by talking about legacies, some of our clients would say, 'What are you talking about?'" Porcaro says. "In some cases we have a history together of talking very plainly. So you always have to be aware of the person you're with."
Advisors are a seasoned bunch who are accustomed to tough conversations with their clients. But it looks like it's time to make them even tougher. After all, so much is at stake, and things simply aren't improving.
"Love is the only thing that we can carry with us when we go, and it makes the end so easy."
— Louisa May Alcott, "Little Women"
At the end of the day, yes, death is scary. But guess what? So is life. And it becomes even harder when someone you love leaves you with crippling debt or full-time caregiving responsibilities. No one wants to grow old; this has been true for as long as humans have had the ability to conceive of their own mortality. Fear of death doesn't make us special or inculpable, it just makes us human. And this fear can no longer be seen as an acceptable
excuse for an entire nation of adults who continue to look the other way at the expense of their financial futures and those of their children and grandchildren. No one's suggesting that advisors call their clients names or browbeat them into submission, but at the end of the day, we're all responsible for our actions, for those we love and care for. And being uncomfortable or scared doesn't change that.
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