Thinking about death and dying can be difficult. Talking about it can be downright uncomfortable. But getting your affairs in order or knowing the wishes of a loved one can bring peace and allow you to enjoy your remaining time together.
While 90% of people think discussing end-of-life wishes is important, only about 27% have the conversation. Whether you want to share your wishes or learn about your loved ones’ preferences, having a plan can make the conversation easier.
We’ve put together an end-of-life conversation guide to help you navigate the discussion:
When should end-of-life conversations occur?
There are no hard and fast rules about when to talk to your loved ones about death and dying. But wait too long, and the discussion could happen under tense and stressful circumstances.
Not sure when to share your end-of-life wishes? You might be ready if you contemplate the end of your life and make a mental “to-do” list of things you’d like to accomplish before then.
If you’re waiting for a loved one to share their wishes and preferences, let them know you’re there to listen whenever they are ready. Explain that it’s important to honor their wishes when the time comes, and you’d love to discuss those wishes soon.
Preparing to discuss your end-of-life wishes
There are a lot of decisions to be made regarding end-of-life care and wishes. Before exploring the topic with loved ones, gather your thoughts about what matters to you.
The Conversation Project is a free resource from the Institute for Healthcare Improvement (IHI). Their guides suggest questions to consider and prompts to help you put your thoughts on paper.
You may want to think about:
- Conflicts or concerns you’d like to resolve such as unsettled relationships, financial issues or other personal matters
- A health care proxy or who you’ll ask to oversee your medical care
- End-of-life care preferences, including who you want to be involved, which treatments you want or don’t want, and how you feel about hospice care
- How you’d like to spend your final days, including whether you’d like to be at home or in a hospital and who you’d like to see
- After-life arrangements, including your thoughts on burial versus cremation and how you envision your memorial service
Setting up an end-of-life discussion
Even when you’re prepared, discussing death and dying may seem overwhelming. But remember, you don’t need to discuss everything in one conversation — this can be the beginning of an ongoing discussion.
While setting up an end-of-life discussion, consider:
- Who should be involved: Choose trusted people who need to know about your health care preferences. The discussion doesn’t have to be limited to family — it can also involve close friends, health care providers and clergy members.
- When to schedule it: If the people involved don’t live nearby, you may want to set up the discussion before or after a family gathering when people are relaxed. Or you may decide not to meet until the first sign of a significant health problem. But whenever possible, try to meet before a health crisis occurs.
- Where to meet: Find a comfortable place to talk. It can be at home, out at a restaurant or even while taking a walk together. Consider a more private space if you expect emotions to run high or disagreements to happen.
How to start the conversation
An end-of-life discussion is about one thing: your wishes and preferences. But you may have to remind your loved ones and set that tone.
Consider opening the conversation with the statement, “What matters to me at the end of life is…” and fill in that blank to reflect your feelings. You can work on your statement ahead of time and practice it with a close friend, say it to yourself in the mirror or write it down. Having your opening words in place may help to ease any anxiety you feel.
Divide the conversation into three parts:
- Outstanding items to address now
- End-of-life care
- After-life wishes
It should feel like a natural progression as you work through the decisions you’ve reached. Be patient if people get upset or need a minute to gather their thoughts. You can stop at any point and pick up the conversation another day.
Steps to take after an end-of-life conversation
Having the conversation before a medical crisis allows time to put end-of-life wishes into effect. After the meeting, the family should:
- Keep the conversation going: Wishes and feelings may change over time, so keep the lines of communication open.
- Create an advanced directive: Creating a legal document ensures everyone — family, friends and health care providers — is on the same page. The advanced directive is an opportunity to officially appoint a health care proxy and create a living will listing your preferences for health care.
- Document wishes that aren’t part of the advanced directive: Specific wishes about funeral arrangements, an obituary or anything else can be documented in a dated letter or email for your loved ones.
- Share your advanced directive and documented wishes: Provide copies to your children and loved ones so everyone is on the same page. Make sure your health care provider and health care decision-maker know how to access your documents.
