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Successful Aging: The things that matter when having end-of-life conversations

Q My sister is critically ill and has had a long and difficult relationship with her daughter. I would hate to have my niece live with unresolved issues with his mother for the rest of her life. It would be a big burden. Do you have any suggestions about what she can do to at least come to some resolution before she dies?

— B.P.

A Dear B.P.:

I am sure many of us can identify with the situation you describe. Intentionally or unintentionally, we may have hurt someone close to us. At the end of life some of these issues can become more evident, which makes the goal of a peaceful death and closure more difficult.

Dr. Ira Byock, chief medical officer of the Providence Institute for Human Caring and author of “Dying Well: The Four Things That Matter Most,” addresses what a dying person must do before saying goodbye to loved ones. The set of tasks he describes also applies to individuals who have an unresolved relationship with a dying person such as a daughter with her ailing mother.

• Task 1: Ask for forgiveness.

Byock writes that at the end of life, the most important healing is not physical wounds; it’s emotional wounds. To heal physical wounds we need to clean the wound, remove all dirt and infected tissues and wash it away. To heal emotional wounds, Byock continues, we also need to remove all toxic material; this time the removal relates to unresolved issues between two people. Boyack advocates that the best way to accomplish this is to ask for forgiveness. This task may not be easy particularly if one believes that his or her behaviors and actions were justified. Yet it can be a freeing experience that leads to the next task.

• Task 2: Offer forgiveness.

If one believes that a person hasn’t earned your forgiveness, this task could be challenging. We actually are not forgiving that person’s behavior; rather we are doing this for ourselves, freeing us of possible anger and resentments, notes Byock. Offering self-forgiveness may be the ultimate act of self-kindness.

• Task 3: Offer heartfelt thanks.

Thank you are two words easily taken for granted. We may assume partners, mates, friends, teachers or co-workers know they are appreciated and consequently do not offer words of appreciation such as “thank you.” Yet we teach our children to say these two words as often as necessary for gifts, a trip or a piece of chocolate. Although it may be difficult at times, the task is to find something of value in every relationship. It might even be the gift of life.

• Task 4: Offer sentiments of love.

Byock notes that this task might sound “mushy” or a bit “touchy feely,” yet he suggests we not skip it. For some people, saying “I love you” might be difficult, he writes. If speaking these words does not work, love can be expressed in a card or letter. The sentiments of love also can be expressed beyond words. A simple act of touching can convey love and caring.

 • Task 5: Saying good-bye.

This task goes beyond the four mentioned in Byock’s book and may be particularly difficult because of its finality. Yet, good endings are important for family members and friends as well as those who are facing death. Endings can be painful; we can avoid them being tragic.

To summarize, here are the four phrases that can help us face the “undone business” in relationships toward the end of one’s life. “Please forgive me.” “I forgive you.” “Thank you.” “I love you.”

The tasks described can help us live with no regrets knowing that after a person dies, the air has been cleared, amends have been made and appreciation and love have been expressed. More forgiveness, appreciation and love can strengthen relationships at any life stage — in sickness and health. And maybe, such expressions could even create a better world.

B.P., hopefully this framework will be helpful to your niece in addressing the challenges she faces with her mother. It is never too late. And note, after every ending there is an opportunity for a new beginning. Thank you for asking a very important question.

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