Dying Isn’t Fighting Death

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How do you describe someone who is lying in a hospital bed, dying? Chances are you’ve heard a nurse, a relative or a close friend tell you that the person is “fighting death.” You might even say it yourself. People with cancer “fight” the disease. People who are in remission are “survivors” or “warriors.”

But what are they fighting against, exactly? How does one go about fighting death? Patients aren’t exactly getting into a boxing match with a cluster of uncontrolled, abnormal cells. What’s worse, when someone is lying in a hospital bed, they don’t look like a fierce warrior ready to do battle with a worthy enemy. They look fragile and vulnerable.

The problem with using words like “fighting” and “survivor” to describe the end-of-life process is that it puts undue stress and unrealistic expectations on patients and their loved ones.

Writer Kate Granger explains that when doctors, nurses or friends tell her that she will “win her battle” with cancer, she feels pressure to “beat” the disease. But that’s really something she has no control over. It also sets up an unsavory alternative. If she fails to fight hard enough, then the cancer wins. It defines her. Rather than focusing on the accomplishments she had in life, people will focus on the fact that she lost her fictional battle with an uncontrollable disease.

The same unrealistic, victim-blaming expectations are true for caregivers.

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When K. Anne Smith decided to instruct the hospice facility where her mother was dying to stop feedings and fluids, she knew it was the right decision. However, she didn’t realize how long her mother could live without food or water. It can take some patients up to 20 days to die after these interventions are stopped. After days of standing vigil at her mother’s bedside, Smith asked the nurses why the dying process was taking so long. She worried that her mother was suffering.

The nurses responded, over and over, that Smith’s mother was “fighting death.” The word never sat right with Smith. It made her feel as though her mother was consciously doing everything possible to stay alive while Smith was standing around doing nothing. In short, it made her feel like an uncaring daughter.

Smith decided to research what the end-of-life process is actually like for patients, and she discovered that it was far more peaceful than the nurses made it sound with their battle-focused language. In reality, her mother’s body was not fighting. Every muscle was slowly relaxing and every cell was shutting down, like lights going out one-by-one in a skyscraper.

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Imagining her mother “relaxing” rather than “fighting” allowed Smith to sit patiently with her until the moment of death.

So, if battle-centered verbs aren’t the right words to describe death, what should you use instead? That depends on the person. Linguistics expert Elena Semino says that some patients like imagining themselves as warriors because it helps them retain hope. But as a terminal illness gets into its latter stages, many patients are better-served by more peaceful descriptions. It’s important to ask people how they are feeling and adjust your language accordingly.

Here are a few phrases that you might want to avoid:

• Battle language (fight, beat, win, lose) – This can blame patients/caregivers after death
• “He/She is in a better place” – Assumes religious belief and implies that the person’s life wasn’t already wonderful
• “There is a reason for everything” – Implies that a patient’s illness or a loved one’s death is somehow justified

And here are a few alternatives:

• Express how much you care about them
• Offer to help in any way you can
• Share your favorite memory of the person who died or is in the process of dying

The goal is to give patients and their loved ones space to grieve without unintentionally adding to their stress.