Once you understand the importance of talking to family members about end-of-life decisions, it is time to have “the conversation.” While talking about dying and end-of-life care can be difficult, it does not have to be. These important habits to have can help you talk about end-of-life decisions with your loved ones in a healthy, positive way.
Many people are uncomfortable discussing death. Rather than starting the end-of-life conversation by asking how your loved one wants to die, try bringing up the story of someone else's death. Then share your thoughts about that person's death—whether it seemed hard on the person and family, or a nice, peaceful transition—and ask your loved one his or her thoughts.
There are a myriad of decisions that accompany end-of-life care, and the topic can seem overwhelming. Help your loved one hone in on end-of-life preferences by making a simple “what matters to me” list. It might be eating independently, being able to have a conversation or recognizing children. Once “what matters to me” is defined, it becomes easier to consider end-of-life decisions in the context of these quality-of-life priorities. Also, in a medical crisis, it can help family members communicate to doctors what abilities are most important and which should be pursued through treatment.
When talking to family about end-of-life decisions, remember not everyone shares the same views of end of life, and that’s OK. Some people may prefer to spend their last days at home, while others do not want to burden family with caregiving responsibilities or the memory of death in the home. Some people like the idea of a hospice facility, where professional caregivers deliver comfort care. Still others want to be in a hospital, surrounded by 24-hour care and immediate-response teams. All are appropriate. Try to listen to your loved one’s wishes without injecting your own opinions about which setting or what type of care you think is best.
Any end-of-life conversation should include a discussion of who will be the person’s healthcare agent. An agent is someone who is designated to make healthcare decisions if a person is unable to make them for himself or herself. In addition to understanding a person’s preferences for specific end-of-life decisions, an agent should also understand the person’s overall values and priorities so they can make appropriate end-of-life decisions. A power of attorney is a legal document that gives the healthcare agent authority to make decisions on the patient’s behalf. In other words, the agent is the person and the power of attorney is the legal document giving the agent decision-making authority.
Advance directives are legal documents that allow people to communicate their wishes about future medical care. If end-of-life decisions are not documented, family members will not know and may disagree about end-of-life care. A living will and power of attorney are important advance directives to complete. A physician orders for life-sustaining treatment (POLST), sometimes called medical orders for life-sustaining treatment (MOLST), is a newer advance directive that is designed to supplement the living will. It is a more detailed form with more specific information on which actions to take in the event of an emergency, such as whether or not a person wants CPR, to be taken to a hospital or receive artificial nutrition. For all advance directives, it is important that family members know where they are stored. A copy should also be given to all doctors, if possible.
Learn more about advance directives and explore online tools in End-of-Life Decisions Resources.