Yes, Talk to Children About Death

(Below is an edited version of an article written in Spanish and first appearing May 21 in Voces Mexico. The author is a professor of bioethics at the National Autonomous University of Mexico, vice president of the World Federation of Right to Die Societies, and a long-time supporter of Final Exit Network. — Kevin Bradley, Editor)

The COVID-19 pandemic has forced us to face death with a greater frequency than we were used to, even though it seems we never “get used to” death. We prefer to think that traumatic or early death only happens to others. But death has had more of a daily presence for over a year now, especially for health personnel in hospitals, but also for many people who have lost family and friends. Children have also experienced the death of close relatives, but it often happens that we try to hide death from children in a misguided attempt to protect them. Far from helpful, this confuses children and prevents them from handling the pain of the loss they have suffered.

We are never prepared for the death of someone we love, but even less when it occurs in such a large and unforeseen way as has happened in this pandemic. People infected with COVID-19 went from being healthy (or apparently healthy) to becoming seriously ill and dying within days. It’s a very different situation that someone who suffers from a chronic disease, which gradually leads to death. As painful as it is to anticipate the final outcome, dying gradually has the advantage of allowing everyone to prepare themselves for the expected separation, both for the person whose life ends as for those who survive. There is a place for farewells, for accompanying each other, and saying things that are needed and can still be said.

Before the pandemic, the opportunity to say goodbye to people who are about to die was not always taken because we are part of a society in which prevails an attitude of denial in the face of death. We prefer not to talk about what is happening, partly as an attempt to protect ourselves against a sad reality, but also because we did not learn to have direct and clear conversations about death. This explains why adults do not know how to talk about it with children. Possibly, when they were children themselves, they asked questions related to death without getting answers and realized they should not talk about it. They grew up without learning to talk about death, also assuming that death was a bad thing and that it should not be talked about.

It is one thing for death to cause pain and anguish, yet another to believe that death is bad. Of course, there are deaths that we would like to prevent or at least postpone. We feel it is terribly unfair that certain people die, perhaps because they are leaving children behind who are not yet grown, or perhaps they are children themselves. But the truth is that from the moment we start living we can die for many different reasons. This is the case for all living beings and children confirm it at an early age, either with animals that are sometimes their pets or with relatives. Children perceive death with curiosity, as they do everything else, but they regard it as natural, as long as adults do not transmit their own prejudices and limitations.

Many adults wonder how to talk to children about death when a family member dies. The importance of speaking the truth must be emphasized, but at the child’s level and using words that he understands. Children understand much more than adults generally suppose and need answers to their questions when they have perceived that something has happened, but they must also simply be informed if they have not realized it for themselves. It is essential to give explanations rather than evasions. Phrases like “he went on a trip” or “he went to live somewhere else” do not help to understand why that dear person left without saying goodbye. Such explanations can lead to feeling abandoned or betrayed. Likewise, telling a child that a deceased person is “sleeping” makes no sense and often results in the child being afraid to go to sleep.

Children who get sick are obviously familiar with the concept of disease. Most children have experience with toys or clothing wearing out. There is no reason to think children cannot understand somebody dying because a body was worn out or because of a disease that could not be cured. The child may ask a few questions, such as whether others will die of the same cause or if he himself might die. Always, the best advice is to tell the truth, but also to ask what the child thinks or how she feels about the situation. Perhaps what worries her most is what will happen to her if a certain person dies, and she must be assured that there will be someone to take care of her. It’s important to answer the questions honestly, but also to allow the child to be part of what they are experiencing as a family, even if it means sharing the pain. The child can be invited to express what he feels or what he would like to say to the person who is no longer there. Of course, this will depend on his age. An older child might write a letter, while a younger child might prefer to draw a picture. In this way, the child can say goodbye, honor the person who has been part of his life, and be part of a shared ritual—an important element when grieving. There is an extensive body of literature available to help parents introduce the topic of death to their children.

I have had the opportunity to listen to the experiences of my medical students, now 21 or 22 years old. They remember how the death of a grandfather, uncle, or cousin was kept from them when they were children of 5, 6, or 7 years old. It was not the case for all, as some do remember how they were told about death and how beneficial it was for them to be able to participate in the rituals that followed. But those who were not informed agreed that they knew something very important was happening, because they perceived strange behaviors and emotions from adults.

An often-ignored fact is that children are usually very sensitive to the actions of adults, especially their parents and close relatives. Avoiding the discussion and acting as if nothing happened is a mistake. Children recognize that something sad and even life changing has happened, but they lack the understanding needed to process how it will affect them. It will surely hurt them to know that someone they love has died, but they are prepared to hear that news. What affects them most is not understanding the reason for the absence. Without that understanding, they will give themselves their own explanation and may come to think that the person left because of something the child did or did not do.

Several of my students spoke of sadness and anger because they were not able to participate in a funeral and it took so long to learn that a family member had died. There are people who carry a great pain throughout their lives because they were denied the opportunity to express it when they were very young. Some of my students have later talked to their parents about their experience. The parents explained that they believed they were doing the right thing, protecting their child, or that they simply did not know how to do things differently. These discussions have been very enriching for my students. They are clear about how to talk to children when an important person dies, and they will have the opportunity to recommend the same when in their practice as physicians they must give this advice to the relatives of a patient who dies.

It is very important to educate children about death from a young age. Teach them that it is a part of life and show them, when they face it (in a pandemic or not), that the pain that accompanies death is also part of life but need not—and should not—be faced alone. In this way, they will learn to comfort and allow themselves to be comforted. This requires teachers, parents and adults in general who understand and can speak with children with clarity and empathy, allowing them to ask all the questions they need. Adults who are not prepared for this would be well served to seek guidance. Children deserve to be respected in their right to be informed and included when they suffer a death in their life.

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