grieving

How to Talk to Loved Ones about Your End-of-Life Wishes

I talked last week about how important it is to make your end-of-life wishes known before it is necessary. I emphasized that you need to have difficult conversations with whoever you anticipate will be a decision-maker for you in the event that you can’t make decisions.

Even if you can make your own end-of-life decisions when the time comes, it’s a good idea to make your wishes known beforehand to avoid surprising anyone, which could lead to conflict when you have the least energy to deal with it. For example, if your loved ones don’t know that you do not want to be on chemo if it will only extend your life for a few months, then if you are told that chemo could extend your life by a few months and you decline it, family members are less likely to argue with you and try to change your mind.

Unfortunately, there is no way to guarantee that family members will not argue with you. However, as long as you are of sound mind and able to communicate your wishes, decisions are yours to make.

Here are some tips for having conversations about your end of life wishes.

  1. Include anyone likely to be making decisions for you if you are unable to do it as well as anyone who will be impacted, such as parents, teenage and adult children, and partners. Children who are younger than teenagers may be included or not, depending on their maturity level. In the conversations I have with end-of-life care teams, most people think it makes sense to include even fairly young children in these conversations because it helps to demystify death and normalize it as a part of every life.
  2. Ask people to set aside an hour or so for the conversation rather than springing it on them when they may not be able to focus. Arrange for a quiet, distraction-free setting. My husband and I had some of our best discussions about end-of-life while we were on road trips, driving for hours on end.
  3. Let whoever you are talking to know why this topic is important to you. You can say, “I want to be sure you know what my end-of-life wishes are so that if you ever have to make decisions for me, you can do it without feeling guilty or worrying if you did the right thing.”
  4. You can use games or guides to help with the discussion. The End-of-Life Deck is a set of cards with questions that prompt you to consider what you may want at the end of your life. This website offers a few conversation starters, as well as additional resources that might be helpful for thinking through what you want.
  5. Ask the person you are talking to what questions they have and answer them thoughtfully.

Be sure to also put your wishes in writing. I highly recommend the Five Wishes guide to end of life care. 

If you anticipate that someone will argue with you about your wishes, there are a few things you can do. First, I would suggest that you try to choose someone to carry out your wishes who will not argue. Of course, that is not always possible, so you might consider having the conversation with that person with a therapist, a chaplain or clergy member, or social worker who can facilitate.

It can also help to acknowledge the difference in views. For example, you could say, “I know this is not what you would choose for yourself, but this is what I want for myself.”