Recent studies indicate the single most powerful thing a person can do to improve the chance for gentle dying is — simply and courageously — to talk about it. Effective communication with those who will be called upon to make decisions on your behalf is key to the likelihood that your wishes are carried out. It is never too early to get started.

When to have the conversation

Death is like having an elephant in the room, even if no one mentions it, everyone knows it’s there. How do you begin?

One approach is to consciously create time to initiate the conversation. You might choose a family gathering for holidays or special events or when illness and doctor visits provide an opening.

Another approach is to stay alert to spontaneous opportunities. You might prepare to introduce the topic of end-of-life wishes when a particular subject arises, such as concerns about losing various aspects of your independence.

Decide if it would work better to have individual conversations with specific family members first or a group discussion. You might begin by giving family members a copy of your Advance Directives.

Who to talk to

First and foremost, talk to your family and personal physician, who have the greatest impact on your care choices. The other people who need to know about your end-of-life concerns and wishes could include your agent, estate attorney, caregivers and friends.

It is possible in conversation with your physician or others that you may realize they do not support your wishes. You have the right to change physicians and to name a health care representative who supports your desires. If you anticipate that other family members may strongly disagree, communicate directly (verbally and in writing) with those you anticipate will not support your wishes and be clear that you do not want them involved in decision making and why.

What to talk about

Your discussions should include feelings about how you would want to be treated in a variety of situations. Identify your main concerns, worries and fears. Those close to you need to know what you would prioritize if you were living with physical pain, disability, terminal illness, dementia and debilitating chronic illness.

Consider who you want to make choices if you can no longer make your own decisions and let people know who that person will be.

Talk to your doctor about specific treatments that could come up, particularly given your current medical condition. Before talking with your physician, you will want to prepare questions about what they can and will do based on your advance directive. For example, if you specify that you do not want a specific treatment, would this doctor ensure that you were kept comfortable? Will the doctor do his/her best to fully explain all treatments, alternatives and risks to you and/or your family/ representative(s)? Are there religious affiliations and/or policies at the local hospitals that would limit your provider or the facility from complying with specific parts of your directive?

Conversation Starters

“It’s important to me to be able to talk honestly with you about my concerns and wishes if I ever become seriously ill or unable to speak for myself…”

“My doctor/ attorney, _____, says I need to go over my advance directive …”

“I want to make sure that I get the best care possible and the type of care that I want, so there are things we should talk about…”

“I want to make it as easy as possible for my family to make medical decisions on my behalf if I ever become incapable of communicating my wishes…”

“If you are ever in a position where you need to make health care decisions for me, it will be most helpful to you if you know what I really want…”

With your physician:

“I just read about a study that found all that high technology at the end of life doesn’t work and just causes suffering. Do you know I wouldn’t want that?”

“I love so much about my
life – being active, loving
my family. If none of that were possible anymore, I’d like to go out peacefully, without a lot of heroics. Does that fit with