Make Wishes Clear
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Talking with Family

Why Talk About Medical Preferences in Advance?

Communication is the single most important step in health care planning. Talk about your wishes with the people who may be called upon to speak or decide for you. Why?

  1. No matter what your Advance Directive says, others will not fully understand your wishes. The more thoroughly you communicate, the easier it will be for everyone to honor and respect your wishes.
  2. Communicating will help you think about what you want. Others will ask you questions or tell you things that will make you think about your wishes in another way.
  3. Communicating will help your loved ones make difficult decisions with less pain, doubt, and anxiety.
  4. Communicating may save money. Sometimes families continue medical treatments long past the point where they are helpful, simply because they are unsure what their loved one would have wanted. This is emotionally and financially costly… and unnecessary.
  5. Communicating may even bring your family closer together.

There’s no right way to start, nor is there a “right” time to talk about your wishes. The discussion does not necessarily have to be somber and mournful. Here are some suggestions for getting started:

  • Start with a story of someone else’s experience
    • “Do you remember what happened to so-and-so and what his family went through? I don’t want you to have to go through that with me. That’s why I want to talk about this now, while we can.”
    • “Neither Richard Nixon nor Jackie Kennedy was placed on life support. I wonder if they had Advance Directives and made what they wanted clear in advance.”
  • Blame it on your attorney
    • “Mr. Darrow, my lawyer, says that before I complete some legal documents, I need to talk over with you some plans about end-of-life medical care.”
  • Use a letter, tape, or video recording as a starting point. At first, it may be easier for people to hear what you have to say if you are not there. Afterwards they may be more ready to sit down and talk with you.

Resistance to discussion is common. See the sample responses to resistant comments.

Family Member's Comment Your Response
“Mom, I don’t see what good it does to talk about such things. It’s all in God’s hands anyway.” “Yes, death is in God’s hands, but how we live until that moment is in our hands, and that’s what I need to talk to you about.”
“Dad, I already know you don’t want any heroic measures if things are really bad. There’s nothing more we need to discuss about it. We’ll do the right thing if the situation arises.” “I know this makes you feel uncomfortable, but I need you to listen, to hear what I have to say. It’s very important to me.”
“I just can’t talk about this. It’s too painful, and talking about it just makes it more likely that it will happen.” “If it is too overwhelming for you right now, I understand. But let’s make an appointment for a specific time to sit down together to discuss this. All right?”

Remember:

  • Be firm and straightforward.
  • Point out the possible consequences of not talking now.
  • Ask someone to be your spokesperson. 

If you are able to connect well with one family member or friend, ask this person to initiate and lead the discussion with other family members or your doctor. This may make your job of explaining, clarifying, and answering questions easier.

Adapted from Utah Commission on Aging Financial Security Guide (2007), published by AARP.

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