The Gift of Making Your End-of-Life Wishes Known

Some advice on how to start the conversation

Hand signing a contract

We are a culture and society, unfortunately, with a phobia about death and end-of-life issues.

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The result is that countless people have faced the end of their life without having communicated their wishes about how they will go through the experience.

Instead, important decisions regarding medical care and comfort often are left to family members, who can only guess at how their loved ones want them answered. It’s deeply saddening that as a society, we don’t do more to ensure that we have a death we have thought about and helped to shaped as much as possible.

Little or no thought

A recent survey by Pew Research Center reveals that a sizable minority of people in the United States has not considered the kinds of medical decisions that people increasingly face as they age.

  • A little more than a quarter of adults (27 percent) say they have given little or no thought to how they would like doctors and other medical professionals to handle their medical treatment at the end of their lives.
  • About one in five Americans ages 75 and older (22 percent) say they have neither written down nor talked with someone about their wishes for medical treatment at the end of their lives.
  • Three in ten of those who describe their health as fair or poor have neither written down nor talked about their wishes with anyone.

Giving some thought and discussion and expressing your wishes about how you wish to meet the end of your life can be among the greatest gifts you can give your loved ones. It gives your survivors peace from knowing they have cared for you by carrying out your expressed wishes.

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Often the discord we see in families over decisions made before and after a family member’s passing is due in part to guilty feelings about whether the decisions represent what the loved one would have wanted.

Making choices for a ‘good death’

End-of-life planning usually includes making choices about:

  • The goals of medical care, such as whether to use certain medicines during the last days of life.
  • Where you want to spend your final days.
  • Which treatments for end-of-life care you wish to receive.
  • What type of palliative care and hospice care you wish to receive

Advance directives can help make your wishes clear to your family and health care providers.

Tips for the conversation

When you’re ready to make your wishes known, be courageous. Find an ally – someone with whom you feel most at ease – and say:  I know that no one lives forever. When my time comes, the most important thing to me is … whatever that may be. The most important thing could be being physically comfortable. Or maybe you’re a fighter and you don’t want to leave any stone unturned. Those are very different messages and you will have to spend some time beforehand thinking through these concepts to decide what’s right for you.

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If you want to broach the subject with a parent or other loved one, look for the teachable moment. Wait for your loved one to bring up the topic obliquely – such as talking about a family member’s death – then use that as an opportunity to initiate the conversation.

It helps if the conversation can be private and your loved one’s frame of mind is relaxed and focused. A good place would be familiar and comfortable, like sitting around the kitchen table. Aim for an unhurried, calm pace.

Take time

Everything does not have to be decided right away. Know and communicate that this conversation can take place as a series of talks over a period of time, as you and your loved one think deeply about this topic and explore it together.

I often refer people to The Conversation Project, which has several good resources for how to initiate, explore and move through this profound and rewarding discussion on your behalf or on behalf of a loved one. There is no more important conversation you might have.

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Eric Kodish, MD

Eric Kodish, MD is the Director of Cleveland Clinic's Center for Ethics, Humanities, and Spiritual Care.
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