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Conversations about dying and end-of-life care are among the toughest discussions we may ever have with those near and dear to us. They force us to confront the devastating reality that our time with loved ones is finite and that one day, we may need to make crucial decisions about their health care during their final days. These conversations can be distressing, uncomfortable, and even awkward.
Despite their difficult nature, end-of-life conversations are essential for ensuring that our beloved family members receive the care and support that aligns with their values and wishes. Here, we explore the significance of these discussions and provide guidance on how to approach them with care, compassion, and understanding.
Are you or a loved one living with a chronic or terminal illness?
The Sage Family of Companies is here to help.
Are you or a loved one living with achronic or terminal illness?
The Sage Family of Companies is here to help.
The Importance of End-of-Life Conversations
The first step in broaching end-of-life conversations with family members is understanding why they’re so vital. By addressing issues around end-of-life care proactively, you can help ensure that your loved ones’ wishes are honored. Without such discussions, you may never know their preferences should the unthinkable happen, such as an accident or medical crisis. This can place a tremendous burden on families during an already distressing time.
If your loved one has a terminal illness, having end-of-life conversations early can relieve anxiety for all involved. Everyone will know the patient’s final wishes are being honored. These discussions also help strengthen bonds as they demonstrate mutual love and respect. They can help provide closure for family members too, letting them move on without guilt or regret, since they know nothing was left unsaid.
End of Life Conversations Guide: Topics to Discuss
End-of-life conversations with family can often feel uncomfortable and overwhelming. That’s completely normal, and you may even be wondering where you should start. To stay on track and make sure you cover all the ground you want to in a caring and compassionate way, it can be helpful to have specific talking points to help guide the discussion.
Here are some topics that are important to cover during end-of-life conversations with families.
Wishes for How You’d Like to Receive End of Life Care
If a medical emergency or crisis arises, or your loved one has been diagnosed with a terminal illness, you’ll need to know how they wish to be cared for at the end of their life. This can be a very delicate and upsetting conversation, but remind them that your only goal is to honor their wishes. Once you get speaking and they’ve expressed their desires, it’s important to document their wishes.
Advance Healthcare Directives
Advance directives are legal documents that state your loved one’s preferences about how they wish to receive end-of-life care. They serve as a clear and reliable means to convey healthcare wishes to both family members and medical professionals, ensuring that there’s no ambiguity in the event of a medical emergency. These include the following:
Living Will: A legally recognized document, a living will details your loved one’s desired medical treatment preferences in situations where they can’t articulate their own decisions. It lets them offer specific guidance to healthcare providers, specifying the emergency treatments they want to receive, those they want to decline, and the conditions for each directive.
Health Care Power of Attorney: A healthcare proxy is an individual entrusted with the authority to make medical decisions on someone else’s behalf, if they’re unable to do it themselves. A healthcare power of attorney is a legally binding document that designates a healthcare proxy and can serve as a supplementary or alternative tool to a living will. It provides a proactive strategy to address unforeseen healthcare emergencies, ensuring that your loved one’s preferences are honored.
Last Wishes
Your loved one may have specific thoughts about how they want to be honored after death, whether it’s a funeral, religious ceremony, or memorial service. They may also prefer burial or cremation. While talking about your loved one’s death may feel morbid, asking about their last wishes ahead of time should be an integral part of end-of-life conversations. It’s the only way to ensure that their wishes are honored.
Advice for Ensuring End-of-Life Conversations Go Smoothly
End-of-life conversations with families can be intimidating and uncomfortable for all those involved. Approaching these difficult discussions with empathy, gentleness, and tact are vital to ensure they are productive and move forward as smoothly as possible.
Consider the following advice when broaching end-of-life conversations with family.
Choose the Right Time and Place
Selecting an appropriate time and place for end-of-life discussions is crucial. Avoid bringing up these conversations during moments of crisis. Instead, try to create a comfortable, private, and quiet setting where everyone in your family can speak openly. Bear in mind that end-of-life conversations with family can be emotionally charged, so it’s essential to be patient and sympathetic throughout.
Listen Attentively
One of the most critical things to remember with end-of-life discussions is the importance of being a good listener. Allow your loved ones to express their thoughts, feelings, and concerns without judgment or interruption. Encourage them to share their fears, preferences, and values regarding end-of-life care.
Finally, refrain from asserting your own feelings and opinions. Listening attentively will provide emotional support and help your loved one feel safe and respected. It will also help you paint a clearer picture of their desires.
Empathize and Validate Their Feelings
Empathy is the key to ensuring end-of-life conversations are productive and smooth. Your loved one may be afraid of the unknown or feel uncertain about their choices. Anxiety, sadness, and even guilt are quite common at this time. Be empathetic, and validate their emotions by assuring them that their feelings are completely normal and justified, and that you’re there to listen to their fears and concerns.
Discuss Specific Scenarios
While discussing end of life care, it’s important to consider various scenarios and their preferences in each one. These may include issues like resuscitation, intubation, pain management, and hospice care. By discussing specific scenarios, your loved ones can make more informed decisions about how they want to be cared for during medical emergencies or at the end of their life.
Are you or a loved one living with a chronic or terminal illness?
The Sage Family of Companies is here to help.
Are you or a loved one living with achronic or terminal illness?
The Sage Family of Companies is here to help.
End of Life Conversation Starters
When choosing how to begin difficult conversations around end-of-life care, it’s often best to ask open-ended questions. These can help encourage your loved ones to share their thoughts more thoroughly and help you gain more insight into their wishes.
The following end-of-life conversation starters can help initiate thoughtful and compassionate discussions with loved ones:
- Could we discuss our values and beliefs when it comes to end-of-life care? What’s most important to you?
- What are your thoughts on quality of life versus quantity of life in healthcare decisions?
- Are there specific medical procedures or interventions you’d like to avoid if you were unable to communicate your preferences?
- Who would you want to make healthcare decisions on your behalf if you were unable to do it?
- Could you envision a scenario where you’d prefer to discontinue curative treatments if they prove to be ineffective?
- How do you feel about hospice care?
- Do you have a preference for where you’d like to spend your final days: at home, a hospice facility, or a hospital?
- What kind of funeral or memorial service do you envision for yourself?
FAQs
Here are some frequently asked questions about end-of-life conversations with families.
When is the Right Time to Start Conversations About the End of Life?
It may never feel like the right time to start end-of-life conversations with loved ones, but it’s important that you have them. Ideally, these discussions should start early, well before any medical emergencies or pressing health concerns arise. But ultimately, it’s important to initiate end-of-life conversations with family when you and your loved ones feel emotionally prepared and have the necessary information to make informed decisions regarding end-of-life care.
What Should You Not Talk About With Someone Who Is Dying?
When speaking to someone who is dying, remain compassionate and considerate. Avoid making unrealistic promises or offering false hope with phrases like “you’ll get better soon,” or “everything will work out in the end.” Similarly, make sure you’re not dismissing their feelings by telling them to “be brave” or that “everything happens for a reason.” If you’re unsure what to say, offer them a listening ear and ask how you can best support them.
What Are Some Common Feelings at the End of Life?
At the end of someone’s life, it’s common to feel a wide range of emotions, which may ebb and flow during the final days, weeks, and months. Fear, sadness, anger, frustration, denial, and grief are all common.
What are DNR and DNI Orders?
DNR (do not resuscitate) and DNI (do not intubate) are legal documents signed by you and your physician that instruct emergency responders or other healthcare providers what you want them to do in the event that you can’t communicate. A DNR means you prefer not to receive cardiopulmonary resuscitation (CPR) if your heart stops beating or you stop breathing. A DNI means don’t wish to have a breathing tube placed in your airway if you’ve stopped breathing.
End of Life Conversations: The Sage Family of Companies Can Help
Tackling end-of-life conversations with families can be incredibly challenging and feel overwhelming. The Sage Family of Companies is here for you and your loved ones to help you make difficult but necessary decisions around end-of-life care.
We’re available to provide any information you need about end-of-life care services like hospice care, and to answer any questions you may have.
References
- Family communications at the end of life Behavioral Sciences [2017]
- Advance care planning: Advance directives for health care NIH [2022]
- Preparing a living will NIH [2022]
- Power of Attorney StatPearls [2022]
