When we think about the end of life, many of us imagine bucket lists filled with adventures—skydiving, traveling to exotic places, or checking off dramatic experiences. But palliative care doctor Dr. Kathryn Mannix reveals a surprising truth: as death approaches, most people’s priorities shift dramatically. What truly matters in our final days isn’t grand adventures—it’s something much simpler and more profound.
Dr. Mannix, who has cared for countless people at the end of life, has observed that nearly everyone wants to do three specific things before they die. Understanding these universal wishes can help us plan more meaningfully for our own future and support our loved ones through their final journey. More importantly, planning ahead for a good death increases the chances that we’ll accomplish what truly matters most when our time comes.
What People Really Want at the End of Life
Mending Broken Relationships
The first thing people consistently want to do before death is repair damaged relationships. Dr. Mannix explains that old grudges and conflicts lose their power as life draws to a close. What once seemed important—arguments over money, misunderstandings, or years of silence—suddenly feels trivial compared to the desire for peace and reconciliation.
People facing death often reach out to estranged family members, former friends, or anyone with whom they’ve had a falling out. These conversations don’t always require lengthy apologies or explanations. Sometimes, simply acknowledging the rift and expressing a desire to move forward is enough to bring closure and comfort.
The emotional weight of unresolved conflicts becomes heavier as death approaches. Making peace allows people to face their final days with less regret and more emotional freedom. For those left behind, these reconciliations provide comfort and reduce complicated grief.
Expressing Gratitude
The second universal wish is to thank the people who have made a difference in their lives. Dr. Mannix notes that dying patients want to acknowledge teachers, mentors, friends, caregivers, and family members who shaped their journey.
These expressions of gratitude aren’t about grand gestures. They’re simple, heartfelt acknowledgments—thanking a childhood friend for their loyalty, expressing appreciation to a spouse for years of partnership, or recognizing a nurse’s compassionate care. These moments of gratitude create meaningful connections and provide comfort to both the person dying and those receiving thanks.
Expressing gratitude also helps people reflect on the positive aspects of their lives. Rather than focusing on regrets or what they didn’t accomplish, thanking others allows them to celebrate the relationships and experiences that brought joy and meaning. This shift in perspective can bring profound peace during the final days.
Saying “I Love You”
The third and most powerful wish is simply to tell loved ones “I love you”. Dr. Mannix emphasizes that this expression of love is the most consistent theme she’s witnessed in her years of palliative care. People want to ensure their loved ones know they are cherished, valued, and will be remembered.
These declarations of love aren’t limited to romantic partners or children. People express love to siblings, parents, grandchildren, close friends, and even caregivers who have shown them kindness. The words themselves carry tremendous power—they provide comfort, strengthen bonds, and create lasting memories for those who remain.
Dr. Mannix points out that many people assume their loved ones already know they’re loved, but hearing these words spoken aloud matters deeply. Saying “I love you” removes doubt, heals old wounds, and ensures that nothing important remains unsaid. This simple expression often brings more peace than any medical intervention could provide.
Why Bucket Lists Change When Death Approaches
From Adventures to Relationships
Most of us create bucket lists filled with experiences—climbing mountains, seeing the Northern Lights, or learning new skills. These adventurous goals seem exciting when death feels distant. However, research and clinical experience consistently show that when people face their mortality, their priorities shift dramatically.
The desire for adventures and achievements fades, replaced by a focus on relationships and emotional connections. A study of patients in palliative care found that most last wishes centered on spending quality time with loved ones, having meaningful conversations, and strengthening bonds rather than checking off experiences. This transformation reflects a deeper truth: human connection provides more comfort and meaning than any adventure could offer.
People nearing the end of life often express that they wish they’d spent more time nurturing relationships rather than pursuing career success or material possessions. The five most common regrets of the dying include wishing they’d stayed in touch with friends and expressed feelings more openly. Understanding this shift can help us prioritize what truly matters while we’re still healthy enough to make meaningful changes.
The Lesson from the Twin Towers
Dr. Mannix shares a powerful example that illustrates these priorities: the phone messages left by people trapped in the World Trade Center on September 11, 2001. When these individuals realized they were facing death, not one message focused on bucket list regrets or unfinished adventures.
Instead, every single message carried the same themes. People called to say they loved their families, to thank those who mattered to them, and to seek peace with anyone they’d had conflicts with. No one said, “I wish I’d traveled more” or “I regret not getting that promotion”. In their final moments, only love, gratitude, and reconciliation mattered.
This profound example demonstrates what humans instinctively know when faced with mortality: relationships are what give our lives meaning. The lesson for all of us is clear—we don’t need to wait until we’re facing death to focus on what truly matters. We can choose now to prioritize love, express gratitude, and mend broken relationships.
Planning for a Good Death Makes Dreams Possible
How Advance Planning Creates Opportunities
One of the most essential truths about end-of-life care is that planning increases possibilities. People who engage in advance planning for a good death have more opportunities to accomplish their meaningful goals than those who avoid these difficult conversations. This isn’t coincidental—it’s the natural result of preparation meeting opportunity.
When you plan ahead, you create space for what matters most. You can identify which relationships need attention, decide how you want to spend your remaining time, and ensure your healthcare wishes are documented. This planning gives you control over your final chapter rather than leaving it to chance or crisis decision-making.
Studies show that people with comprehensive advance directives experience less aggressive end-of-life care, spend more time at home with loved ones, and report a higher quality of life in their final months. Their families also experience less stress, guilt, and conflict because they know they’re honoring clearly stated wishes. Planning ahead transforms the end-of-life experience for everyone involved.
The Cost of Avoiding End-of-Life Planning
Many people avoid thinking about death, hoping that ignoring it will somehow make it less frightening. Unfortunately, this avoidance comes with significant costs for both the person dying and their loved ones. Without clear plans, people often receive medical care they wouldn’t have wanted and miss opportunities for meaningful experiences.
When someone hasn’t documented their wishes, family members face agonizing decisions during emotionally devastating moments. They may disagree about appropriate care, leading to conflict and lasting guilt. Healthcare providers default to aggressive treatments because they lack clear guidance about the patient’s preferences.
Perhaps most tragically, people who avoid planning often run out of time for what truly matters. They may not have the opportunity to mend relationships, express gratitude, or say “I love you” because they’re too sick, sedated, or experiencing a medical crisis. The three things people most want to do before death require clarity of mind and emotional energy—resources that diminish as illness progresses. Planning ahead preserves these precious opportunities.
The Role of a Life Transition Coach
What Is a Life Transition Coach?
A life transition coach provides guidance and compassionate support as you navigate life’s most significant health challenges. Unlike doctors, nurses, or hospice teams who focus on medical care, life transition coaches take a holistic approach that addresses emotional, practical, and lifestyle needs. They serve as partners who help you feel informed, supported, and never alone during difficult transitions.
These professionals don’t replace your medical team—they complement it. While your doctors diagnose conditions and recommend treatments, life transition coaches help you understand your options, make decisions that align with your values, and coordinate care among different providers. They bridge the gap between medical care and the human experience of facing serious illness or death.
Life transition coaches work with people at all stages of the health journey. They support healthy individuals who want peace of mind through advance planning, people facing new diagnoses who need help understanding their illness, family caregivers feeling overwhelmed, and those approaching end-of-life who want to make their final days meaningful. Their services adapt to your unique situation and changing needs.
Project Managing Your Health Journey
One of life transition coaches’ most valuable services is project management of your healthcare journey. Think of them as coordinators who ensure all aspects of your care work together smoothly. They help you navigate the often confusing and fragmented healthcare system so nothing falls through the cracks.
This coordination includes helping you communicate effectively with doctors, specialists, and other providers. Life transition coaches can attend medical appointments with you, help you ask the right questions, and ensure you understand the information being shared. They also facilitate communication between different members of your healthcare team who may not talk directly to each other.
Life transition coaches help you adapt your care plan as your health changes. They ensure your advance directives stay current, coordinate transitions between care settings like home to hospital to hospice, and advocate for your wishes to be honored. This ongoing support provides continuity and peace of mind throughout your health journey.
Beyond Medical Care: Holistic Support
Life transition coaches recognize that facing serious illness or death involves much more than medical decisions. They provide holistic support that addresses your emotional, spiritual, practical, and relational needs. This comprehensive approach helps you maintain quality of life and focus on what matters most.
Emotionally, these coaches offer a safe space to process difficult feelings about illness, loss, and mortality. They help you work through anticipatory grief, fear, and uncertainty without judgment. Many people find sharing certain worries with a coach easier than burdening family members with their deepest concerns.
Practically, life transition coaches assist with creating legacy projects, planning meaningful activities with loved ones, and organizing important information. They can help facilitate the difficult conversations needed to mend relationships, express gratitude, and say “I love you”—the three things people most want to do before death. This practical and emotional support makes it possible to accomplish meaningful goals even while facing serious illness.
Key Services Life Transition Coaches Provide
Creating Complete Advance Directives
One of life transition coaches’ most important services is helping you create comprehensive advance directives. These legal documents ensure your healthcare wishes are known and honored when you cannot speak for yourself. While many people have basic living wills, truly complete advance directives address far more than simple yes-or-no questions about life support.
Life transition coaches guide you through thoughtful consideration of various scenarios. They help you think about quality of life issues, pain management preferences, where you want to receive care, and what treatments align with your values. They also ensure you’ve chosen the right healthcare agent—someone who understands your wishes and has the strength to advocate for them even under family pressure.
These professionals make sure your advance directives include all necessary components: a living will stating your treatment preferences, a healthcare power of attorney naming your decision-maker, and specific instructions for different situations. They also help you review and update these documents regularly as your health or preferences change. Complete, current advance directives give you control over your future care and provide tremendous peace of mind.
Medication and Lifestyle Reviews
Life transition coaches can help you comprehensively review your medications and lifestyle. As people accumulate multiple prescriptions from different doctors, medication burden often increases without anyone taking a holistic look at the total picture. Coaches work with you and your medical team to ensure every medication serves a purpose and aligns with your current goals.
These reviews are especially valuable when someone’s focus shifts from life-prolonging to quality-of-life care. Medications that made sense earlier in treatment may no longer benefit you and could even reduce comfort. Life transition coaches help you have informed conversations with doctors about which medications to continue, adjust, or stop.
Beyond medications, coaches examine lifestyle factors that affect your health and well-being. They discuss nutrition, activity levels, sleep patterns, and stress management. For people with chronic illness, they can suggest modifications that may slow disease progression or improve daily functioning. This comprehensive approach ensures you’re making the most of every opportunity to maintain quality of life.
Healthcare Advocacy and Coordination
Advocacy is a crucial service that life transition coaches provide. They ensure your voice is heard and your wishes are respected throughout your healthcare journey. This is particularly important during medical appointments when you may feel overwhelmed, intimidated, or too unwell to speak up for yourself.
Life transition coaches can attend appointments with you to help ask questions, take notes, and ensure you understand the information being shared. They advocate for your treatment preferences, care settings, and end-of-life decisions. Having a knowledgeable advocate beside you helps level the power dynamic in medical settings and ensures nothing important gets overlooked.
These professionals also coordinate care among your various providers. They help ensure your primary doctor, specialists, home health nurses, and hospice team all understand your wishes and work together effectively. This coordination prevents conflicting instructions, duplicate tests, and gaps in care. When someone serves as the central point of coordination, your healthcare journey becomes smoother and more aligned with your goals.
Legacy Planning and Meaningful Activities
Life transition coaches help you create legacy projects and plan meaningful ways to spend your remaining time. These projects preserve your story, values, and wisdom for future generations. They might include recording oral histories, writing letters to loved ones, creating memory books, or organizing photos and keepsakes.
Legacy work serves multiple purposes. It gives you a sense of continuity, knowing part of you will remain with your loved ones after you’re gone. It provides meaningful activity during a time when you may feel your life is shrinking. Most importantly, it creates healing pathways for both you and your family members.
Beyond legacy projects, coaches help you identify and plan activities that bring joy and meaning to your remaining time. This might include special meals with loved ones, visits to meaningful places, celebrations of important relationships, or spiritual practices that bring comfort. By proactively planning these experiences, you ensure you have opportunities to mend relationships, express gratitude, and say “I love you”—the three things that matter most at the end of life.
Planning While You’re Healthy
Peace of Mind Through Preparation
One of the greatest gifts you can give yourself and your family is planning ahead while you’re healthy. When you create advance directives, choose a healthcare agent, and document your wishes during a time of wellness, you can think clearly about your values without the pressure of a health crisis. This thoughtful preparation brings profound peace of mind.
Knowing your wishes are clearly documented allows you to live more fully in the present. You don’t have to worry about becoming a burden to your family or experiencing unwanted medical treatments. You’ve already addressed these concerns and made decisions that reflect your values. This preparation is empowering, not morbid.
Planning ahead also gives you time to strengthen important relationships before any crisis occurs. You can focus on mending broken connections, expressing gratitude regularly, and saying “I love you” often. Rather than waiting until you’re dying to prioritize these three universal wishes, you can make them part of your daily life now. This approach creates a richer, more meaningful life and reduces potential regrets.
Having Important Conversations
Meaningful conversations about end-of-life wishes are essential, yet many families never have them until crisis forces the discussion. Life transition coaches help facilitate these important talks in gentle, productive ways. They provide frameworks for discussing difficult topics and support family members through the emotional aspects of these conversations.
These conversations should happen in calm, private settings with plenty of time. They’re not one-time events but ongoing dialogues that evolve as circumstances change. Topics to discuss include your healthcare preferences, who you’ve chosen as your agent, what quality of life means to you, your spiritual or cultural beliefs about death, and your wishes for medical interventions.
Life transition coaches help you navigate family dynamics during these conversations. They can mediate when family members disagree, help you explain your reasoning, and ensure everyone understands your wishes, even if they wouldn’t make the same choices. Having these conversations early prevents misunderstandings and conflicts during stressful times.
Reducing Worry for Loved Ones
When you plan ahead, you dramatically reduce the burden on your loved ones. Family members who must make healthcare decisions without clear guidance often experience agonizing stress, guilt, and conflict. They worry about making the “wrong” choice and may disagree with each other about what you would have wanted.
Clear advance planning eliminates this guesswork. Your family knows exactly what you want because you’ve told them explicitly and documented your wishes legally. Instead of spending their emotional energy on difficult decisions, they can focus on being present with you and supporting each other.
This preparation also prevents family conflicts that can damage relationships permanently. When everyone understands your wishes and knows you made these decisions yourself, there’s less room for disagreement and resentment. Your family can unite in honoring your choices rather than fighting about what’s best. This gift of clarity is one of the most loving things you can do for the people you care about.
Support During Illness and Caregiving
Navigating New Diagnoses
Receiving a serious diagnosis can feel overwhelming and frightening. Life transition coaches provide crucial support during this challenging time by helping you understand your illness, explore treatment options, and make informed decisions aligned with your values. They translate complex medical information into language you can understand and help you formulate essential questions for your healthcare team.
These professionals help you think through the practical implications of your diagnosis. They discuss how your condition might progress, what to expect at different stages, and when various types of care might become appropriate. This education reduces fear of the unknown and helps you plan proactively rather than reactively.
Life transition coaches also provide emotional support as you adjust to your new reality. They create space for you to process difficult feelings about your diagnosis, your future, and the changes ahead. Many people find it valuable to work through some of these emotions with a coach before discussing them with family members. This support helps you move from shock and fear toward acceptance and empowerment.
Supporting Family Caregivers
Family caregiving can be one of life’s most meaningful yet exhausting experiences. Life transition coaches provide essential support to family members caring for seriously ill loved ones. They offer education about what to expect as illness progresses, practical caregiving strategies, and emotional support for the caregiver’s own grief and stress.
Coaches help caregivers understand their loved one’s condition and needs. They teach comfort measures, explain symptoms, and help caregivers feel more confident in their ability to provide good care. This education reduces anxiety and helps caregivers recognize when situations require professional intervention.
Perhaps most importantly, life transition coaches remind caregivers to care for themselves. They help caregivers set boundaries, ask for help, and balance caregiving responsibilities with their own needs. They also support caregivers through anticipatory grief—the sadness that comes from watching a loved one decline. This comprehensive support helps caregivers avoid burnout and be more present for their loved ones.
Coordinating Multiple Healthcare Providers
As illness progresses, people often see multiple healthcare providers who may not communicate well with each other. Life transition coaches serve as central coordinators who ensure all members of your healthcare team understand your goals and work together effectively. This coordination prevents conflicting instructions and ensures continuity of care.
Coaches help you keep track of different providers’ recommendations, medication changes, and test results. They can identify gaps in care, duplicated services, or conflicting advice. When providers aren’t communicating effectively, coaches facilitate information sharing to ensure everyone is working toward common goals.
This coordination becomes especially valuable during transitions between care settings—from home to hospital, hospital to rehabilitation facility, or any setting to hospice care. Life transition coaches ensure your advance directives travel with you, new providers understand your wishes, and your care plan remains consistent with your goals. This seamless coordination reduces stress for both patients and families.
Making Your Final Days Meaningful
Focusing on What Truly Matters
When time grows short, clarity about priorities becomes essential. Dr. Mannix’s insights remind us that people facing death consistently prioritize mending broken relationships, expressing gratitude, and saying “I love you”. Understanding these priorities can help you and your family focus on what will bring the most comfort and meaning during your final days.
Life transition coaches help you identify which relationships need attention and facilitate the conversations necessary for healing. They can mediate difficult discussions, suggest meaningful ways to express gratitude, and create opportunities for heartfelt expressions of love. Their support makes it possible to accomplish these important goals even when physical energy is limited.
These final acts of connection provide profound comfort for everyone involved. People who take time to mend relationships, express gratitude, and declare their love typically experience less anxiety about dying and greater peace. Their loved ones carry these final exchanges as precious gifts that ease grief and provide comfort for years to come. Focusing on what truly matters transforms the end-of-life experience from something to fear into something meaningful.
Creating Special Moments
Life transition coaches help families create meaningful experiences during the time that remains. These don’t have to be elaborate or expensive—some of the most treasured moments are simple and intimate. They might include favorite meals shared together, music that evokes happy memories, looking through photo albums, or simply sitting quietly holding hands.
Special moments can also include small celebrations of relationships—thanking someone for their friendship, sharing favorite memories, or expressing what someone has meant to you. These conversations fulfill the three wishes people consistently express at the end of life: mending relationships, expressing gratitude, and saying “I love you”.
Life transition coaches can also facilitate legacy activities that create lasting connections. Recording stories, creating memory books, writing letters to be opened in the future, or making videos for special occasions all provide ways for your presence to continue beyond death. These activities give your final days purpose and provide tremendous comfort to loved ones who will treasure these gifts long after you’re gone.
Ensuring Dignity and Comfort
Proper planning is essential for maintaining dignity and comfort at the end of life. When your wishes are clearly documented and your healthcare team understands your priorities, you’re more likely to receive care that aligns with your values. This includes appropriate pain and symptom management, your preferred care setting, and the presence of loved ones.
Life transition coaches advocate for your comfort needs to be prioritized. They ensure your healthcare providers understand that quality of life matters more than length of life when death is approaching. This advocacy can prevent unwanted aggressive treatments and create space for the meaningful activities that bring peace and joy.
Maintaining dignity means different things to different people. For some, it means dying at home surrounded by family. For others, it involves spiritual practices, cultural traditions, or simply being free from pain. Life transition coaches help you articulate what dignity means to you and work with your healthcare team to honor those preferences. This personalized approach ensures your final days reflect your values and provide the comfort you deserve.
Call to Action: Connect With a Life Transition Coach
Why Consider This Support
Working with a life transition coach provides invaluable benefits throughout your health journey. These professionals offer comprehensive support that medical teams typically don’t provide—helping you navigate complex healthcare decisions, coordinating care among multiple providers, facilitating difficult family conversations, and ensuring your wishes are honored. Their guidance increases the likelihood that you’ll accomplish what truly matters most.
Perhaps most importantly, life transition coaches help you focus on the three things people consistently want at the end of life: mending relationships, expressing gratitude, and saying “I love you”. By providing practical support and project management for your healthcare journey, they create space for these meaningful priorities. Their services transform the experience of serious illness from crisis management to intentional, values-based living.
Planning with a life transition coach isn’t about giving up hope—it’s about taking control of your future care. Whether you’re currently healthy and want peace of mind, facing a new diagnosis, caring for a seriously ill loved one, or approaching end-of-life yourself, this support can help you navigate the journey with greater confidence, clarity, and peace.
What to Look for in a Coach
When seeking a life transition coach, look for professionals with specific qualifications and experience. Many have backgrounds in healthcare—nursing, social work, or palliative care—combined with specialized training in end-of-life support, advance care planning, or grief counseling. This combination ensures they understand both the medical and emotional aspects of serious illness.
Essential qualities include strong communication skills, cultural sensitivity, and the ability to remain calm during difficult situations. Your coach should make you feel heard, respected, and supported without judgment. They should work collaboratively with your existing healthcare team rather than competing with them.
Ask potential coaches about their experience with situations similar to yours. Inquire about their approach to advance care planning, how they support families through difficult decisions, and what services they provide. Many coaches offer initial consultations to help you determine if they’re a good fit for your needs. Trust your instincts—you should feel comfortable discussing sensitive topics with this person.
Three Important Steps to Take Now
No matter where you are in your health journey, you can take meaningful action today. Here are three essential steps:
1. Ensure you have complete and thorough advance directives. Don’t settle for basic forms that only address extreme situations. Work with a life transition coach or healthcare professional to create comprehensive documents that reflect your values, preferences, and wishes for various scenarios. Make sure your healthcare agent truly understands your priorities and has the strength to advocate for them.
2. Establish a relationship with someone who can review your medications and project-manage your healthcare journey. This might be a life transition coach, a patient advocate, or another qualified professional who can coordinate care among your various providers. Having someone in this role ensures nothing falls through the cracks and your care remains aligned with your goals.
3. Find support for advocating for a good life and a good death when the time comes. Connect with professionals in your area who offer life transition coaching or similar services. These relationships don’t have to wait until crisis strikes—establishing them while you’re healthy makes the support more effective when you eventually need it.
Remember that planning for the end of life is ultimately about living fully today. When you know your wishes are documented, your care is coordinated, and you have support for the journey ahead, you’re free to focus on what truly matters: nurturing relationships, expressing gratitude, and telling the people you love exactly how you feel. Don’t wait for a health crisis to prioritize these three things that bring the most meaning and peace at the end of life. Start today by taking these important steps toward planning for both a good life and a good death.
At present, no official organization oversees end-of-life doulas (EOLDs). Remember that some EOLDs listed in directories may no longer be practicing, so it’s important to verify their current status.
End-of-Life Doula Schools
The following are end-of-life (aka death doula) schools for those interested in becoming an end-of-life doula:
Remember that there is currently no official accrediting body for end-of-life doula programs. It’s advisable to conduct discovery sessions with any doula school you’re considering—whether or not it’s listed here—to verify that it meets your needs. Also, ask questions and contact references, such as former students, to assess whether the school offered a solid foundation for launching your own death doula practice.
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