We will all face death one day, but our attitude towards this is individual. How can our understanding of mortality shape our approach to life? Palliative care doctors and death doulas, who spend their careers supporting those at the end of their lives, offer unique insights into how an awareness of our finite time can profoundly shape the way we choose to live.
Dr. Rachel Clarke is a palliative care doctor who works at an NHS hospital in Oxfordshire and is the author of several books, including The Story of a Heart. “I have learned what matters to my patients as they approach the end of their life,” says Clarke. She emphasizes that the way to live a life that is rich and deeply fulfilling is to build human connections, noting that this matters more than anything else.
At the end of life, repairing relationships can be crucial, says Dr. David Holland, a palliative care consultant who works in Norfolk. He notes that people often have things they want to say, such as “I’m sorry,” “I forgive you,” “Forgive me,” “I love you,” or “Thank you.” Not addressing those unsaid feelings can lead to people having regrets.
“If something is important to you, do as much of that as you can,” says Holland. He explains that he values his work, which builds him up as a person, but he also balances this with other priorities. Holland says that he values “running a kids’ football team, having an input in village life and building relationships with neighbours.”
However, it is important not to get too caught up in your career, says Ruby Love, an end-of-life doula in Bristol. “I’ve never met someone at the end of life who regretted not working more or not having a bigger house,” she says. Instead, she encourages people to value small moments, like when the leaves return on trees in the spring or enjoying a good cup of tea, as these are the moments of joy, awe, and wonder at the world around us.
“Pleasure is a very superficial experience,” says Clarke. “It can be a distraction: you can eat or drink yourself into a stupor and have a fabulous time doing it, but it isn’t going to give you a sense of fulfilment.” Deeper experiences matter more, she says. Working with people who are dying can be emotionally stressful, and Holland finds relief through cultivating a plot of land. “I have always found great interest in wildlife and biodiversity,” he says. “I really enjoy being out in nature and helping things to grow.”
“The richness of life comes from our relations with other living creatures, human and also non-human,” Holland adds. “It could be animals or birds or plants, but it is living connections with the wider world that sustain us.” This sentiment is echoed by Tan Ming Li, an end-of-life doula in Singapore and the founder of the Life Review, a charity that helps to normalise talking about death and dying. “Most of my life was spent focusing on living without regrets,” says Tan.
Tan recalls that one day someone told her: “If you don’t have any regrets, you are not living life enough, you’re not daring to try things, you’re just feeling safe.” This caused Tan to have a rethink. She says the secret to a life well lived is “not just about joy but what lights a fire in your belly.” For example, she notes, “I have a dog and I love grooming him.” It is not easy and it takes a lot of effort, but it provides a sense of purpose.
People often think about legacy at the end of their lives, says Holland. “I’ve had people who have wanted to hand over something important. This could be a business, memories or the building of a family legacy.” He notes that the time when people are really poorly is important, because the knowledge of life being limited allows memories to be made and legacies to be left. Regarding his own bucket list, he says, “My son and I always talk about going to Costa Rica and seeing lots of wildlife.”
Love suggests focusing on achievable and regular goals, such as wanting to get really good at making focaccia. “That way, if you suddenly get hit with an accident or a terminal diagnosis, hopefully you won’t have a long list of things that you’ve never done,” she says. Clarke agrees, noting that a good death occurs when someone is at peace with the life they have lived. She envisions her own future: “My fantasy is to be a 90-year-old woman who is still engaged in and fiercely commenting on how she thinks the world should be, but also enjoying a glass of champagne with her grandchildren and doggedly going out at 5am trying to spot an otter.”
“The doctor in me makes me want to look after myself,” says Holland. “But, at the same time, I see a lot of patients where medical issues happen for no reason that we can identify. Therefore, it is important to live well now.” Love adds that society often tries to make people feel distressed about aging, such as wrinkles or grey hairs, to sell products, but these are natural parts of life. As one person in their early 30s noted, they are already starting to do their own planning to ensure they live a life they can be proud of. The report also notes that “I have about 100,000 things I want to do and experience before I die,” says Clarke. The report also notes that “All the irrelevant stuff is stripped away. The report also notes that if we can find a balance between what we need to live on and what we need to be happy, I think that is key.”. The report also notes that it could be through artistic or creative endeavour. The report also notes that “All of those stigmas associated with ageing are a blessing and a privilege to have. The report also notes that but equally, ascetic lives are pretty hard and constrained. The report also notes that “So, try to be healthy, but don’t beat yourself up for things that are often construed as minor sins of living, like eating delicious food and drinking beautiful wine. The report also notes that we are sensual creatures and celebrating that is part of living life richly.