A Guide to Advance Care Planning: How to Talk to Family About End-of-Life Decisions
The Commission on Law and Aging under the auspices of the American Bar Association (ABA) (3/4/2014) suggests the following tools to aid conversations with loved ones regarding Medical Preferences and After Death Decisions.
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Why Talk About Medical Preferences In Advance?
Communication is the single most important step in health care planning. Talk about your wishes with the people who may be called upon to speak or decide for you.
Why is this important?
No matter what you or advance directive says, others will not fully understand your wishes. The more thoroughly you communicate, the easier it will be for everyone to respect your wishes.
It will help you think about what you want. Others will ask you questions or tell you things that will make you think about your wishes in another way.
It will help your loved ones make difficult decisions with less pain, doubt, and anxiety.
It may save money. Sometimes families continue medical treatments long past the point where they are helpful, simply because they are unsure what their loved one would have wanted. This is emotionally and financially costly and unnecessary.
It may even bring your family closer together.
How to Initiate the Conversation about End of Life Care
According to the Commission, “There is no “right way” to start. Nor is there a “right” time. Nor does the discussion necessarily have to be somber and mournful. Here are some suggestions for getting started.”
Start with a story of someone else’s experience. For example: “Do you remember what happened to Jack and what his family went through? I don’t want you to have to go through that with me. That’s why I want to talk about this now, while we can.”
Blame it on your attorney: “Mr. Doe, my lawyer, says that before I complete some legal documents, I need to talk over with you some plans about end-of-life medical care.”
The Commission finds that common forms of resistance to this type of discussion usually present as follows:
“Mom, I don’t see what good it does to talk about such things. It’s all in God’s hands anyway.”
“Dad, I already know you don’t want any heroic measures if things are really bad. There’s nothing more we need to discuss about it. We will do the right thing if the situation arises.”
“ I just can’t talk about this. It’s too painful, and talking about it just makes it more likely that it will happen.
The Commission suggests the following responses:
Be firm and straightforward, for example:
“I know this makes you feel uncomfortable, but I need you to listen, to hear what I have to say. It’s very important to me.”
Or,
“Yes, death is in God’s hands, but how we live until that moment is in our hands, and that’s what I need to talk to you about.”
Or,
“If it is too overwhelming for you right now, I understand. But let’s make an appointment for a specific time to sit down together to discuss this. All right?”
Point out the possible consequences of not talking now. For example:
“If we don’t talk about this right now, we could both end up in a situation that is even more uncomfortable. I would really like to avoid that if I could.”
Ask someone to be your spokesperson.
If you are able to connect well with one family member or friend, ask this person to initiate and lead the discussion with other family members or your doctor. This may make your job of explaining, clarifying, and answering questions easier.
In our next blog, we will explore the Commission’s recommendations for selecting a Health Care Agent or Proxy.
