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Setting the scene for end-of-life care conversations

Updated: Feb 19, 2021

What would matter most to you if you were at the end of your life? Would you want to be at home, if possible, or in a care facility or hospital? Would you want visitors? Would you want to be kept alive if that meant being on a respirator, unable to speak?

Chances are that you are in the group of 92% of people who think that it’s important to talk to your loved ones about your wishes for your end-of-life care. But, despite our best intentions, only 32% of us have actually done so. In my experience, I see people delay those critical conversations for two reasons: 1) we have no idea where to start, and 2) we worry it might upset our loved ones.

We’ll talk about how to deal with the feelings around these conversations in a different post, and for now, we’ll address the first point: Where do you even start?

Well, talking about death – or, rather, talking how you want to live your life – requires some thought and planning. Before you have the conversation, you should think about three things: the setting, the characters and the script. You can think about taking charge of the conversation about your end-of-life care as being the playwright and director for your life story.

First, decide on the setting: There’s no right or wrong place and time to have the conversation; it depends on your family and how you gather and relax. Here are a few ideas:

1. The family dinner: people feel more relaxed around food, and many good, connected family conversations happen over dinner. The conversation itself doesn’t need to be a depressing one (we’ll help you with the script in a later post), so it’s possible that holiday dinners are an appropriate time, depending on your family. If you are not hosting, you can tell your host in advance that you want to raise this issue at dinner. Encourage everyone in the family to share their wishes for their own care.

2. “Windshield” time: if you have raised teenagers, you know that they speak most openly during car rides, perhaps because difficult conversations can be easier when not directly face to face. I would include in “windshield” time any activity that is conducive to conversation but that does not require the intensity of direct face-to-face interaction - for example, taking a walk, spending time at the beach or cooking together.

3. On the phone: the phone is not the ideal place for the conversation, but with many families living far apart, it may be your only option. If you decide you want to have this conversation by phone, be sure that your family member has time to concentrate on the call. Calling someone at work, late at night, or after they’ve had a rough week is probably a bad idea. If you must talk by phone, consider keeping the conversation relatively short and following up with another call later, or plans to see each other in person soon.

4. After a movie, radio show or book that you’ve experienced together. Sometimes stories about other people's lives provide context for the topic. After a show about someone in a critical state, you could turn to your family member and casually say, “I know that’s just a show, but if that ever happened to me, …” and you’re off and running.

The truth is, people have these conversations about their wishes for end-of-life care wherever and whenever works best for them and their families. The most important thing about timing the conversation isn’t whether you’re on a walk, or at the beach, or at dinner, but to talk about all of this while you are still healthy.


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