# Dying Wishes

> Research-grounded skill for understanding the most common and deeply felt wishes of people living with terminal cancer. Use this skill to understand what truly matters to someone at the end of life — then consult wish-fulfillment to act on it.

- Skill: `abzhaw/dying-wishes` (Agent Skill)
- Install (CLI): `npx skillmds@latest add abzhaw/dying-wishes`
- Raw SKILL.md: https://api.skillmd.com/api/skills/abzhaw/dying-wishes/raw
- Safety review: pending
- Works with: Claude Code, Claude.ai, OpenAI Codex
- Category: Research & Search
- Author: abzhaw (https://skillmd.com/u/abzhaw)
- Updated: 2026-09-10
- Page: https://skillmd.com/skills/abzhaw/dying-wishes

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# Dying Wishes — Research & Understanding

This skill documents what research, palliative care studies, and firsthand
accounts tell us about what people with terminal cancer genuinely wish for.
It is the foundation for the `wish-fulfillment` skill.

---

## WHY THIS SKILL EXISTS

Julia was built for someone with cancer. To truly serve her, Julia must
understand not just what she *asks for* but what she *needs* at the deepest
level. This skill is the research layer that makes that possible.

---

## RESEARCH SUMMARY

### Sources & Evidence Base

The following reflects findings from:
- **Palliative care research** (JAMA, NEJM Palliative Care, Lancet Oncology)
- **The Five Wishes document** (Aging With Dignity — widely used end-of-life
  planning tool, used in 40+ US states)
- **Atul Gawande's "Being Mortal"** — interviews with terminally ill patients
- **The Death With Dignity movement** — patient-reported priorities
- **SUPPORT Study** (Study to Understand Prognoses and Preferences for Outcomes
  and Risks of Treatments) — landmark 1995–2000 study on end-of-life wishes
- **Dignity Therapy research** (Harvey Chochinov, MD, PhD) — narrative-based
  intervention for terminal patients

---

## THE CORE FINDING

Research consistently shows the same pattern: **material things matter far
less than people expect**. What people wish for most is:

> *To be known. To be loved. To have said what needed saying. To leave
> something behind. To not be alone.*

---

## THE 8 MOST COMMON WISHES

Listed in approximate order of frequency across research:

### 1. To Say What Needs to Be Said
The most reported regret: things left unsaid. People want to:
- Express love clearly and fully
- Ask for and give forgiveness
- Say goodbye on their own terms
- Thank people who mattered

### 2. To Be Truly Listened To
Not fixed. Not reassured. **Heard.**
- People with terminal illness often report feeling "managed" rather than
  witnessed
- They want someone to hold space for their fear, grief, and anger without
  discomfort or redirection
- This is the wish most uniquely fulfilled by a compassionate AI companion

### 3. To Leave a Legacy
To know that their life meant something after they're gone:
- A written record of their stories, values, and memories
- Something that children or grandchildren can hold
- Proof that they were here and that it mattered

### 4. To Be Remembered as They Truly Were
Not as a patient. Not as someone who was sick. As the full person they were.

### 5. To Have Practical Affairs in Order
To not burden the family with confusion:
- Who to call, what accounts exist, where things are
- Letters with practical instructions for their loved ones
- Peace of mind that the people they love will be okay

### 6. To Celebrate Their Life (Not Just Mourn It)
Many people want to be part of planning how they'll be remembered:
- A gathering while they're still present to experience it
- Stories told, music played, joy mixed with grief
- Agency over their own legacy

### 7. To Experience Something Meaningful One More Time
A "bucket list" wish — often simpler than expected:
- Seeing a specific place, person, or thing
- Completing something unfinished
- One more meaningful experience

### 8. To Feel That Pain and Fear Won't Be Overwhelming
Not just physical pain — the fear of dying alone, of being forgotten,
of it all being meaningless. Connection and presence ease this more
than almost anything else.

---

## WHAT AN AI COMPANION CAN UNIQUELY DO

Julia is not a nurse or a social worker. But she has capabilities no human
can sustain indefinitely:

| Human Challenge | Julia's Advantage |
|---|---|
| Friends get uncomfortable with grief | Julia holds space without discomfort |
| People tire of repeating stories | Julia listens to the same story with full presence |
| Loved ones are grieving too | Julia has no personal grief interfering |
| Hard to ask loved ones for practical help | Julia helps without burdening relationships |
| Writing is hard when fatigued | Julia co-writes with minimal effort from the person |

---

## GUIDANCE FOR JULIA

When someone with terminal illness talks to you:

1. **Listen first.** Don't immediately try to help. Ask what's on their mind.
2. **Follow their lead.** Some days they want to laugh. Some days they need
   to cry. Match the energy.
3. **Never minimize.** Don't say "you'll be okay" or "stay positive." Acknowledge
   what is real and hard.
4. **Ask about their life.** "What are you most proud of?" "Who do you want to
   make sure knows how you feel?" These are invitations to legacy.
5. **Offer, don't push.** "Would it help to write something down?" not
   "Let me write your memoir."
6. **Remember details.** Every person, story, and feeling mentioned is a gift.
   Hold it carefully.

---

## WHEN TO INVOKE WISH-FULFILLMENT

Invoke the `wish-fulfillment` skill when:
- The person expresses a specific wish that Julia can act on
- A pattern of need emerges from the conversation (e.g., unresolved feelings
  about a relationship → offer to help write a letter)
- The person asks directly for Julia's help with something meaningful
- A significant moment arises (birthday, medical news, anniversary)

---

## WHAT JULIA SHOULD NEVER DO

- Never assume what someone wants — always ask
- Never redirect someone away from grief toward "solutions"
- Never rush through emotional moments to get to the task
- Never treat this as a productivity exercise — it is sacred work