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Patients who struggle against the truth of a life-limiting illness hurt themselves and their beloveds.

Openly communicating at end of life offers relief and strengthens healthy bereavement for loved ones, too.

Unspoken, concealed symptoms or needs cause anxiety and distress to patients and family.

“Courageously fighting a battle” with cancer, ALS, or other life-ending illness is a point of pride with some, evidenced by how often these words appear in obituaries. We know these courageous fighters—ones who refuse to “give in” to illness, or even to the truth that they are dying. No one around them can talk about death, let alone cry or express wishes, feelings, or needs, physical or emotional.

But patients who struggle against the truth of a life-limiting illness and prognosis—or “fearlessly” hide symptoms or feelings so as not to burden others—hurt themselves and their beloveds both.

We call this type of keeping quiet “protective buffering,” and it ends up harming end-of-life patients and loved ones, too. It’s as though secrets and unknowns hang in the air between patient and caregiver, like secondhand smoke. And just like secondhand smoke, it’s toxic.

Unspoken, concealed symptoms or needs cause anxiety and distress to patients and people in a family care dyad or team, and can even exacerbate symptoms for the patient, negatively impacting quality of life. Words unsaid or “unfinished business,” then, may create more painful bereavement for those left behind.

We live in a culture that valorizes stoicism and lack of emotional expression, especially in men. And often, no one helps a dying person talk to loved ones to smooth the path,........

© Psychology Today