The Selfish Dying

How the regrets of the terminally ill reveal the influence of others.

Posted May 31, 2012

In my book, The Self Illusion: how the social brain creates identity, I argue that when it comes to personal identity, our sense of self is largely influenced by those around us in ways that are both obvious and also in ways that are more subtle and covert. Our autobiographical self is a collection of past experiences and encounters that are selectively filtered and reframed by cognitive biases that serve to maintain a persistent characterization of who we think we are and more importantly, how we would like to be perceived by others.

I think that there is considerable evidence from social psychology to support this argument but I came across another source that struck me as a coup d’etat of reason to believe that we lead our lives as a reflection of those around us or, “the reflected self” as I call it in the book. We lead such busy lives that we often fail to take stock of it until it is too late.

Bronnie Ware is an Australian palliative care nurse, caring for patients in the last weeks of their lives. In her book, The Top Five Regrets of the Dying, she documents the clarity of vision of the terminally ill patients whom she interviewed about having regrets. These were the top five regrets:

1. I wish I'd had the courage to live a life true to myself, not the life others expected of me.

"This was the most common regret of all. When people realize that their life is almost over and look back clearly on it, it is easy to see how many dreams have gone unfulfilled. Most people had not honored even a half of their dreams and had to die knowing that it was due to choices they had made, or not made. Health brings a freedom very few realize, until they no longer have it."

2. I wish I hadn't worked so hard.

"This came from every male patient that I nursed. They missed their children's youth and their partner's companionship. Women also spoke of this regret, but as most were from an older generation, many of the female patients had not been breadwinners. All of the men I nursed deeply regretted spending so much of their lives on the treadmill of a work existence."

3. I wish I'd had the courage to express my feelings.

"Many people suppressed their feelings in order to keep peace with others. As a result, they settled for a mediocre existence and never became who they were truly capable of becoming. Many developed illnesses relating to the bitterness and resentment they carried as a result."

4. I wish I had stayed in touch with my friends.

"Often they would not truly realize the full benefits of old friends until their dying weeks and it was not always possible to track them down. Many had become so caught up in their own lives that they had let golden friendships slip by over the years. There were many deep regrets about not giving friendships the time and effort that they deserved. Everyone misses their friends when they are dying."

5. I wish that I had let myself be happier.

"This is a surprisingly common one. Many did not realize until the end that happiness is a choice. They had stayed stuck in old patterns and habits. The so-called 'comfort' of familiarity overflowed into their emotions, as well as their physical lives. Fear of change had them pretending to others, and to their selves, that they were content, when deep within, they longed to laugh properly and have silliness in their life again."

When I read this list, I think that it is easy to see how each of these top regrets can be seen in the context of the Self Illusion where we live our lives constantly trying to match up to others' expectations. People have a belief that they had a true self that was always shackled by circumstances, relationships, pursuit of status and generally constrained by others.

Of course, you may reject my interpretation as unfounded or at least not really informative. However, try to imagine asking the same question of a hunter-gather in the Pleistocene period. I wonder what our ancestors would have regretted.

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