End-of-life topic avoidance among gender-diverse young adults: the importance of normalizing gender-affirming end-of-life conversations

This qualitative interview study examines the perceived challenges and obstructions that emerging transgender and gender-diverse adults (TGD, ages 18–30 years) face when considering end-of-life conversations (EOL) with their family members. While not yet normalized in the trans community, gender-affirming EOL conversations are critically important in a population where episodes of postmortem identity distortion have been observed. Data collected suggest that most of the participants have not engaged in such conversations and that many anticipate difficulty initiating a conversation that includes not one, but two, traditional communication taboos: death and queerness. Among the challenges to open discourse were group identity factors including the family’s religious beliefs, cultural norms, and political affiliations, as well as hesitancies to enter into discussions that might suggest an impending death or suicide. Results also showed that the anticipation of a more positive conversational outcome was consistent with a reduced desire to participate in avoidance behavior. For many, however, it was simply considered too “weird,” “awkward,” or “harsh” for a young adult to discuss their own death with their parents. This “awkwardness” is considered normative throughout U.S. culture, but repercussions for TGD individuals are significant. For those who exist outside the mainstream gender binary, the normalization of gender-affirming EOL is indicated in order to make such conversations more accessible, effective, and nonawkward.