How to start a conversation about death

Why the first sentence is the hardest part

Before SIRE's 2022 campaign on talking about death, only 39% of Dutch people believed that talking about death reduces fear of it; after the campaign, 53% did. Talking helps, and more people now know it. Even so, many people delay the conversation until a crisis forces it. By then, the choices are no longer abstract. They are made under fluorescent light, often by exhausted family, often without the dying person's voice in the room.

The Rijksoverheid lays out four practical reasons to talk in time: to understand what care is available, to make sure your huisarts (general practitioner) knows your preferences, to inform family and friends, and to designate someone who can speak for you if you cannot. None of those four reasons depend on illness. They depend only on the conversation having happened.

What makes the first sentence hard is the assumption it carries: that to bring up death is to summon it. This assumption is so universal that the most useful thing you can do is name it out loud. "I'm not sick. I'm not planning to die soon. I just want you to know what I think, while it's easy to say."

Four ways to open the door

There is no single right opening. There are several that work, depending on who you're talking to and what kind of person you are. These four are a practical summary, drawing on international advance care planning work.

1. Open through a document. Sit down with a wensenboekje (wishes booklet) or a wilsverklaring (advance directive) template, and use the form itself as the conversation. NVVE members can draft and store its three directives (medical power of attorney, treatment ban, euthanasia request) free in MijnNVVE; the niet-reanimerenpenning is available to non-members too. Funeral providers like DELA and Monuta publish a free wensenboek anyone can download and fill in, even if they're not a customer. The advantage of opening through a document is that the questions are already written. You aren't inventing them. You're answering them, together.

A way in: "I'm filling out a wensenboekje. Some of the questions are about you. Can we sit down for half an hour?"

2. Open through the news, or someone else's story. A neighbour died. A friend lost a parent. A film, a podcast, a news article about euthanasia statistics. These are openings that don't put either of you on the spot, because the subject is technically someone else.

A way in: "I read that more than half of people who die in the Netherlands are over 80. It made me think I haven't told you what I'd want."

3. Open through yourself, with a small disclosure. This is the approach The Conversation Project, an international initiative widely used in advance care planning, recommends. Their methodology is values-first: not "what's wrong" but "what matters." You start by saying something small and true about yourself, with no demand on the other person to respond.

A way in: "When I think about the end of my life, the thing I most want is to be at home. I don't know if I've ever told you that."

4. Open through a child or grandchild. For some people the easiest entry is the next generation. A grandchild asks a direct question. A young parent realises they have no plan if anything happened. The frame is responsibility, not mortality.

A way in: "If something happened to me tomorrow, would you know what I'd want? I'd hate for the kids to have to guess."

What hospice and palliative professionals say works

Dutch palliative care, whose guidelines are published on Palliaweb (run by PZNL), frames end-of-life conversations as proactieve zorgplanning, proactive care planning. The emphasis is on the word planning. It is a process, not a single talk, covering four dimensions, physical, psychological, social and spiritual, and revisited as circumstances change.

Several practical patterns help:

• Side by side, not face to face. A walk, a drive, washing dishes together. Direct eye contact can feel like interrogation. Shoulders aligned in the same direction usually doesn't.
• Choose a calm moment, not a crisis. A weekday evening with no agenda is better than the day after a hospital scare. Adrenaline is a poor editor.
• One question at a time. Don't try to settle everything in one sitting. The wensenboekje has dozens of items. You don't owe each other a complete answer today.
• Permission to stop. "If this is too much for now, we can come back to it" is not a failure line. It is a line that protects the conversation so it can continue.
• A spokesperson (woordvoerder). If a family is large, designate one person to relay information so the patient or planner doesn't have to repeat themselves to every relative. This small piece of structure prevents enormous fatigue.

The KNMG, the Royal Dutch Medical Association, publishes guidance for physicians on tijdig praten over het levenseinde, talking about the end of life in time. The guidance is aimed at doctors, but its core advice transfers directly to families: name the subject, listen more than you speak, write down what you hear, and check whether the person wants to continue or pause.

Tools that turn the conversation into a record

A conversation that isn't written down often dissolves within weeks. The Netherlands has an unusually rich set of tools for fixing what was said into something usable later. A short orientation:

• Kiezen & Delen. A free deck of 52 conversation cards developed by PZNL and KWF (the Dutch cancer society). Designed for anyone, ill or healthy. Available at kiezenendelen.nu.
• Gesprekskaarten voor het onbesprokene. 131 cards based on the Ars Moriendi model, covering autonomy, suffering, farewell, guilt and hope (hoop). Often used in pastoral and palliative settings.
• DELA Wensenboek and Monuta Afscheidswensenboek. Structured wishes booklets you can download as PDF or fill in online. Cover ceremony, body care, music, who speaks, whether the casket is open or closed.
• NVVE directives. NVVE members can draft and store three directives free in MijnNVVE: a medische volmacht (medical power of attorney), a schriftelijk behandelverbod (written treatment ban) and a schriftelijk euthanasieverzoek (written euthanasia request). The niet-reanimerenpenning (do-not-resuscitate medallion) is a separate item and is also available to non-members.
• KNMG handreiking "Tijdig praten over het levenseinde". The KNMG's guide on talking about the end of life in time (2021). The Patiëntenfederatie publishes a companion brochure for patients with the KNMG, "Praat op tijd over je levenseinde".

The point of the tools is not the paperwork. It is that the act of writing forces specificity. "I want a small ceremony" becomes "I'd like fewer than 30 people, classical music, and no religious texts." That kind of clarity is what your nabestaanden (next of kin) will use later, when they are no longer asking you.

When the other person isn't ready

Sometimes the person you most want to talk to closes the door. A partner changes the subject. A parent says "let's not talk about that now." It is possible to keep the door open without forcing it.

Three small moves help. First, say what you wanted to say in writing instead. A short letter or email is harder to deflect than a question. Second, leave the document somewhere visible: a half-filled wensenboekje on the kitchen table is its own invitation. Third, find a third party. A huisarts, a notaris, a death café (informal meet-ups, modelled on the international Death Cafe format that has run in around 100 countries since 2011), a hospice volunteer trained by VPTZ. Sometimes a stranger asks the question that family cannot.

If the other person never opens the door, you have still done your half. Your wishes are recorded. Your trusted person knows where to find them. That is not nothing. That is most of what the conversation was supposed to do.

In the app

In the Telling People module you note, at your own pace, who you want to talk to, how you want to tell them, a good moment to start, and who could tell them if you cannot. Your farewell wishes and your letters live in their own modules. Everything you fill in becomes part of your Zorgmap, a private PDF you print or hand over to the person you trust; your family cannot open the app itself.

Request access →

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Sources

1. Rijksoverheid - "Op tijd praten over wensen levenseinde". https://www.rijksoverheid.nl/onderwerpen/levenseinde-en-euthanasie/op-tijd-praten-over-wensen-levenseinde
2. NVVE - the three written directives (medische volmacht, schriftelijk behandelverbod, schriftelijk euthanasieverzoek) in MijnNVVE, and the niet-reanimerenpenning. https://www.nvve.nl/wilsverklaringen
3. KNMG - Handreiking "Tijdig praten over het levenseinde" (2021); Patiëntenfederatie Nederland with KNMG - brochure "Praat op tijd over je levenseinde". https://www.knmg.nl
4. Palliaweb (PZNL) - Dutch palliative care guidelines, including proactieve zorgplanning. https://palliaweb.nl
5. The Conversation Project - Conversation Starter Guide and What Matters to Me Workbook. https://theconversationproject.org
6. Death Cafe - format and global directory. https://deathcafe.com
7. SIRE - public campaign on talking about death ("De dood. Praat erover, niet eroverheen", 2022): before the campaign 39% believed talking about death reduces fear of it, afterwards 53%. https://www.sire.nl/campagne/de-dood-praat-erover-niet-eroverheen/6650
8. CBS - deaths by age: more than half of people who die in the Netherlands are 80 or older. https://www.cbs.nl/en-gb/news/2026/11/173-thousand-deaths-in-2025