“We need to bring death back into life”

Valérie-Anne Ryser, a psycho-sociologist at FORS | KA 

Planning the end of your life improves the quality of that final stage of existence — this has been demonstrated. And yet, in Switzerland, only one person in five over the age of 55 has drawn up advance directives. Is it a matter of character? In a study published in March 2026 in the European Journal of Ageing, social psychologist Valérie-Anne Ryser of FORS and her team at the University of Lausanne used the Swiss data from the SHARE survey to cross-reference the personality traits of 1524 Swiss residents with seven dimensions of end-of-life planning. The result: those who are most organised are not the best prepared, and the most anxious think about it without ever getting round to it. What if the real obstacle lay elsewhere?
 

Why was it worth conducting a study on end-of-life planning?
Social science has demonstrated that people who have planned their end of life enjoy a better quality of life and greater well-being in the final stage of their existence. But we observe that some people anticipate it and others not at all. So we asked ourselves why. We already knew that age, gender, level of education and the region you live in play a role, but what about other factors? We tried to gain a better understanding of the role that personality traits play in this context.

What do you mean by personality traits?
They are the broad dimensions that shape the way we think, feel and behave. Five of them are generally recognised. First, openness to experience, which means curiosity and imagination. Second, conscientiousness: a sense of organisation and discipline. Next comes extraversion: sociability, being turned towards others. Then agreeableness: cooperation and trust. And finally neuroticism: a tendency towards anxiety and negative emotions. These traits develop from childhood onwards and tend to remain relatively stable throughout life, even though they can still change gradually in adulthood.

One might think that meticulous people, who like to plan everything, would also be the first to draw up a testament or appoint a healthcare proxy. Yet that is not what you observe. Is this the most surprising result of your study?
I did not expect it at all, and it is indeed surprising. Several studies show that conscientiousness is a trait generally associated with proactive health behaviours and with highly structured decision-making processes. Yet in our study, we do not find that proactivity when it comes to end-of-life planning.

How do you explain it?
My hypothesis is that people who score high on conscientiousness are conscientious about what relates to their current goals and responsibilities, but may put off thinking about matters they consider very distant, such as the end of life, when these do not appear urgent or directly relevant to their present situation. Ultimately, what would need to be done is to cross conscientiousness with frailty and health impairments. My hypothesis is that the more serious those impairments were, the better the end-of-life planning would be for these people. I think that, for them, it would be at the moment when they became aware of their vulnerability, and of the fact that they might have access to treatments they may or may not want, that the planning process would be triggered. If highly conscientious people have not planned their end of life, it is simply because they feel they are not at that stage.

Openness to experience is the trait that weighs most heavily on end-of-life planning. Who are these people?
They are people who are not afraid to anticipate their own death, or that of those close to them, or even to talk about it. Often very creative people, for whom death is perhaps one experience among others: it is not something that frightens them.

You show that some people, more anxious by nature, think a great deal about the end of life but do not act on it: no testament, no written directives. What does that tell us about the gap between “thinking about it” and “actually getting organised”?
That is really the problem for people with high levels of neuroticism. They tend to be anxious, emotionally unstable, they become locked into rumination and caught up in negative emotions connected to the end of their life. It preys on them, but they cannot bring themselves to take concrete steps. This is not surprising: what is associated with neuroticism are avoidance behaviours, not proactive ones at all. So they think about it a great deal without ever planning formally. For these people, support is essential.

Why is it useful to ask yourself questions about your own end of life?
The literature shows the very positive impact of end-of-life planning. The American sociologist Deborah Carr has worked extensively on this: it helps individuals keep control over what may happen, and it strengthens their awareness of their own dignity. There is this fear of becoming helpless, incontinent. Advance directives offer precisely the possibility of expressing one’s wishes ahead of time, which helps to preserve the person’s dignity, even when they no longer have decision-making capacity.

You show that personality ultimately plays a limited role in end-of-life planning. Does that mean that, fundamentally, anyone can engage in it, whatever their character?
Yes. No personality profile constitutes a major barrier: everyone can be brought to consider their own finitude, simply in a differentiated way. The real levers lie elsewhere.

So what, in your view, really prevents people from getting started? A lack of information, a cultural taboo around death, or something else?
There are several factors. I think we live in an ableist society, and that health impairments remain a blind spot. We over-value successful ageing, staying in good health for as long as possible, and talking about illness, whatever it may be, remains taboo in a context where we imagine that medicine will overcome everything. There is also a trust in medicine and in treatments that are increasingly effective, increasingly complex, sometimes invasive — but is that really beneficial? Finally, contemplating your own vulnerability, your illness or even your death is painful. These are among the mechanisms that contribute to a taboo taking hold.

For someone who reads this article and thinks “I should get started”: where do you begin, concretely? Is there a simple first step, before even thinking about a testament or legal documents?
You should first turn to someone, a trusted person close to you, in order to become familiar with the idea, then talk to your family doctor and start discussing these questions with him or her. After that, you build things up little by little. You really have to meet people where they are and start from their anxieties: are you afraid of a particular kind of care? Then we can start putting things in writing so that you do not have to undergo it. Are you afraid your children will fight over your inheritance? Then we look together at whether you should see a notary. What matters is to move forward step by step, without rushing things.

These questions have only recently become a focus of research. Why now?
There is the fact that we are living longer and longer thanks to medical progress, and that treatments are becoming more and more complex. This raises a whole question of dignity: do people want to undergo these treatments or not, can they say what they want or not? The doctor–patient relationship has also gradually changed: the patient’s self-determination and participation in care decisions have become central. And then there is a taboo around death, which is also why this is recent. Finally, in Switzerland, advance directives were introduced into the Civil Code in 2013, and it was from that point on, among other things, that a whole body of research became organised.

How is this study useful?
It helps us better understand how to talk about the end of life with the public, and above all it shows that you have to adapt what you say to the person in front of you. That is what is essential, as a practitioner, on a subject as complex as this one. The funding obtained for this project was also intended to inform policymakers. But above all, we need to bring death back into life. We live in a society that completely sidesteps death. Just try finding a condolence card — it is not easy. We really need to realise that death is part of life, even if we see it less and less, that it is frightening, and that thinking about it can be painful.

Interview by Kalina Anguelova