Sept. 24 (Bloomberg) -- At a Manhattan dinner party, former Citigroup Inc. executive Steffen Landauer gathered an eclectic mix of guests at his apartment off Fifth Avenue to sip pinot noir, dine on seared salmon -- and talk about death.
“I think about it a lot and talk about it very little,” Landauer said to the group, which included a filmmaker, a private school principal, and a professional storyteller. Not to be confused with a macabre parlor game, the evening was conceived to confront real-life issues wrapped up in death and dying that few people like to acknowledge, let alone talk about at a dinner party. Would I want a feeding tube? Does dad want to die at home? What happens to my kids if I die in an accident along with my spouse?
Those questions are getting asked more frequently. Over the past month, hundreds of Americans across the country have organized so-called death dinners, designed to lift the taboo around talking about death in hopes of heading off conflicts over finances and medical care -- and avoiding unnecessary suffering at the end of life. It’s a topic that is resonating as baby boomers, born from 1946 to 1964, deal with the passing of their parents, even as they come face-to-face with their own mortality.
About 70 percent of adults don’t have a living will, a legal document detailing the medical interventions they’d want or not want if unable to communicate, according to the Pew Research Center. As many as 30 percent of Americans 65 and older don’t have a will detailing what should happen with their assets, a Pew survey found. If those discussions don’t happen ahead of an illness or death, it can leave family members conflicted over what to do.
“Having family infighting is horrific,” said Dianne Gray, president of the Elizabeth Kubler-Ross Foundation, a nonprofit focused on end-of-life issues. “No parent wants their legacy to be that at the end of their life they created a family divided.”
For the generation that brought on the sexual revolution, led the anti-war movement and turned their midlife crises into a time for reinvention and self-improvement, baby boomers are trying now to have it their way right to the very end.
“The baby boomer generation got to call a lot of their own shots and make decisions and see those decisions through,” said Carole Fisher, chief executive of Nathan Adelson Hospice in Nevada, who held a death dinner last month for her extended family and friends in a Southern California beach town.
“And then you talk about death and dying and realize you have no control. The only thing I can control about it is to communicate what my needs and desires are.”
As the sun set over the Pacific, four generations of Fisher’s family shared pizza, salad, tiramisu -- and their views on what they’d like to happen at the end of their lives. Even working in hospice care, Fisher realized death was still a taboo topic around her home and she was anxious to broach the subject. Helping to lighten the mood, all 16 of her friends and relatives, from her 7-year-old granddaughter, Kaya, to her 73-year-old mother, Nan Schwartz, donned gag mustaches that Fisher passed out.
Death wasn’t always such an awkward topic. A century ago, with higher rates of infant and maternal death and shorter life expectancies, people were more likely to die at home with their families rather than in hospitals behind closed doors and surrounded by doctors and nurses. It was, for better or worse, more common, natural and visible.
Today, more than half of deaths take place in hospitals and medical facilities, often after extensive interventions including the use of ventilators, feeding tubes or other life-support devices. In a culture that talks of “fighting” illness and “surviving” cancer, where doctors and patients turn to technology for answers, dying is seen as losing the battle.
“This is much more of a death-denying society than it ever has been in the past,” said Don Schumacher, chief executive officer of the National Hospice and Palliative Care Organization, the largest membership group for hospice programs and workers. “We all participate in this myth that you can just keep on going. I’ve seen tragedy after tragedy of families that were convinced if they only did this or that, mom would recover and all would go back to normal.”
American families may not be able to deny reality much longer. By 2030, 3.3 million Americans will die a year, up 32 percent from the current death rate as baby boomers age, according to the National Funeral Directors Association. With population growth and medical advances that keep people alive longer, the number of Americans older than 65 will more than double to 92 million by 2060 -- accounting for 1 in 5 Americans.
That aging population will force countless family decisions over how best to send off their loved ones with dignity. Who will make those decisions for the patient if they are incapacitated? What type of medical interventions, like feeding tubes and respirators, should be used at the end of life? When the time comes, do they want burial or cremation?
From her work in hospice, Fisher was no stranger to what could happen to a family that had failed to confront death. Yet she was anxious to broach the subject with her own family, where emotions around dying were still raw following the death of her stepson’s mother from cancer several years ago and the recent loss of her brother-in-law’s friend. The silly mustaches combined with wine for the grownups and the pink sunset over the Pacific Ocean helped ease the mood. Soon, the emotions and words were flowing.
“I want to be cremated, I don’t want the box, it creeps me out,” Fisher’s husband Gary, 62, told the group, which included his in-laws, wife and sons from a previous marriage.
It was a somewhat controversial statement considering the family’s Jewish faith, which forbids cremations, Fisher said. She was glad her entire family got to hear her husband’s wishes so there will be no dispute when the time comes.
“Don’t tube me,” Fisher’s mother chimed in. “If I am pooping in my pants or in diapers, I’m out of here.”
“I won’t stop you,” Fisher’s husband joked.
It was the first time Fisher’s mother had told the entire family that she didn’t want any interventions to prolong her life.
Then came the debate over what happens after you’re dead.
“I can’t believe there is nothing else,” said Fisher’s niece Melissa Fisher Goldman, 33. “It is so scary to think there is nothing after.”
“That’s why you believe in it,” her father said. “People just want to believe.”
“I think your soul lives on,” piped up a tiny voice from the back of the patio. It was Fisher’s step-granddaughter Kaya who had been listening to the conversation from her mother’s lap.
Having a plan and talking about it with family is no guarantee that conflicts over finances and medical care won’t arise and the conversations can sometimes lead to more arguing while everyone is still alive. Yet, Fisher said she feels less angst knowing her family now understands what each member wants.
“That evening really prompted more sensitive conversations, not just about death and dying, but in general,” Fisher said by telephone two weeks after the dinner. “It changed people’s comfort level with each other.”
Get-togethers like Fisher’s are happening largely thanks to a group of master’s degree students and faculty at the University of Washington, who have started a program called “Let’s Have Dinner and Talk About Death.” It offers talking points, reading material on death, and how to word a death dinner invitation. Since starting last month, about 400 people have signed up to host dinners, the group said.
The idea came from Michael Hebb, a teaching fellow at the university and culinary impresario, who gained celebrity status in the Seattle and Portland, Oregon, food scenes for the underground theme-dinners he has staged since 1997. After walking away from a now-defunct group of Portland restaurants, Hebb has used food to tap into social and cultural trends, garnering him work with organizations such as the Bill & Melinda Gates Foundation and the Clinton Global Initiative.
Hebb said he chose death for his latest and largest dinner table discourse after a pair of doctors convinced him on a train ride to Seattle that Americans weren’t dying the way they wanted. The topic struck a chord with Hebb, who at the age of 12 lost his father to Alzheimer’s disease. His family was uncomfortable talking about the disease and Hebb regrets not having spent more time with his father before he died.
“This is a conversation that the entire country needs to be having,” Hebb said.
A few nights before Fisher’s gathering, it was a very different conversation at Landauer’s death dinner on a quiet Manhattan street a few feet from Central Park. Rather than a family looking for guidance, Landauer had brought together a group of social acquaintances to help air issues he has long been reluctant to tackle.
Despite having four children ages 1 to 23, Landauer, 54, confessed that he only recently started working on a will, to the surprise of the group given his age and large family. Now, for the first time, he and his wife are having serious conversations about who would take care of their children if both parents died.
“Two weeks of doing my will has caused us to talk about it more than in 17 years of marriage, and we aren’t even really talking about it that much, we’re exchanging text messages,” he said.
As the group ate zucchini pancakes with caviar around the formal dining table, Laura Simms, a professional storyteller said, that at 65 she, too, lacks a will and has avoided planning for the end of her life despite having been diagnosed with cancer twice.
“I often forget I’m going to die,” Simms said. “I mean to make a will, I mean to clean out my closet so there isn’t anything embarrassing in there. And then I just forget.”
For the six New Yorkers, some of whom had met for the first time that evening, having a venue to talk about death was like releasing a pressure valve. With baroque music playing in the background, for three hours they shared stories of near death and supernatural experiences and the deaths of loved ones. They agreed that death lurks in the back of their minds, yet isn’t something they were comfortable talking about before.
Simms recalled a near-death experience she had when she was mugged in Central Park, the memory of a knife pressed against her throat still fresh in her mind.
“I realized in a few seconds I could be dead and I completely relaxed,” she said.
As the server removed the dessert plates and Landauer’s young daughter began stirring upstairs, many of the guests said they felt a kind of catharsis.
Since the dinner, Landauer has finished and signed his will and he says it forced him to think more concretely about what he’d like to happen to his remains. He has now made sure to include instructions in his will for his children to spread his ashes near a specific mountain in Tibet that he once visited.
“There is a power in speaking about something,” Landauer said after the dinner. “That gives it a certain sense of reality that you don’t have if it’s just an idea in your mind.”
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