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| Conversations of a Lifetime™ |
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Discussing what you want for the end of life is one of the most difficult and one of the most important conversations you will ever have. If you are the subject of the conversation, expressing your end-of-life wishes will be an opportunity to exercise some control over your last months and days. At the same time, you will be giving a final gift to your loved ones by making decisions in advance, thereby easing their burden. If you are the caregiver, you will be making a commitment to your loved one to carry out their wishes, as a final gesture of appreciation to them for a lifetime together. While we may understand the importance of this conversation, people find discussing end-of-life to be an emotional, intimidating and perhaps frightening experience.
At Hospice of Cincinnati, we’ve spent 35 years helping thousands of families have open and honest conversations about end-of-life. This page contains some of the lessons and tips we have learned to ease that conversation.
If you need more help, please call us at 513-792-6900 to talk to a nurse consultant regarding your situation and circumstance.
Many people feel they want to have the conversation, but the time never seems right. Sometimes it helps to take advantage of situations that occur, using them as an entry point for the conversations. Here are a few examples.
- Pending surgery or procedure for you or a loved one
- When you’ve bought or are considering life insurance
- After seeing a movie or play where a character dies
- Upon the death of a friend or relative
- When reading a newspaper or magazine article about a celebrity death
- Upon attending or hearing about a pending funeral
- Upon hearing of a friend’s serious illness, diagnosis, surgery or accident
- When meeting with a lawyer or financial planner
- After a visit with a physician for a checkup
- When discussing retirement plans
- On the anniversary of a friend’s or relative’s death
- Following a family reunion or get-together
| How Often Should We Have the Conversation? |
Many families find their individual comfort levels with the frequency for discussing the end of life. It could be a very in-depth conversation. Or it could be a topic that you revisit frequently in a series of smaller talks. One good rule of thumb called “The Five Ds” is used by many families. The rule is to revisit the topic when any of the following occur:
- Death of a friend or family member
- Divorce has occurred in the family
- Diagnosis of a significant medical condition
- Decade has passed since the last talk
- Decline of physical condition
| Conversation Starter Kit from TheConversationProject.org |
| A Few Conversation Starters. |
You know best how to relate to your friends and family. But we’ve put together a few sample conversation starters that you can alter to suit your situation, your personality and the relationship you have with your loved one.
Adult child to parent:
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| “You know, Dad (Mom). I’ve been thinking
about life and about how we all want to live out
our remaining time. And I wanted to talk with
you about it. I saw how you took care of my
grandparents in their last months and I want you to
know that whatever happens, I’ll be here to do the
same for you, if that time comes. I’ll give you the
best care available and do everything just the way
you’d want it done. But I don’t want to make any
assumptions. I was hoping that we could talk about
this and you could share your thoughts with me.” |
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| “Mom (Dad), I’ll never forget how you took care of
me and the other kids in the family when we were
young. You are a true caregiver at heart. I’ve been
thinking that I owe you the same kind of love and
care, if the time comes that you can’t take care of
yourself. That’s how I can repay you in some part for
everything you’ve done for us. It would mean a lot
to me. But, in order to do that, I need to talk to you
a little about what you want so that I’m certain that
I respect your wishes.” |
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Adult sibling to sibling:
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“Steven, you and I have spent our lives together, as
kids and growing up. One of the things I like most
is the way you can take charge and get things done
the right way. It’s a real talent. So, I was thinking
that I would like to name you in my advance
directive, to see to it that my wishes are respected
if I ever come to the point where I can’t take care of
myself. If you would do that, it would mean a lot to
me. And, if you want, I’ll do the same for you. We
just need to share with one another exactly what
we would like to have happen. Can we have that
conversation and exchange some written guidelines?” |
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Spouse to spouse:
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“When we were married, we promised to take care
of one another forever — in sickness and in health.
I intend to keep that promise to you and I know
you’ll do the same. That means there could come
a time when one of us will need to take care of the
other as we near the end of life. If that happens, I
want to make sure I know exactly what you want
and that you know what I want. That will be easiest
for both of us, regardless of who is caring for whom.
Could we begin discussing those things? It’s hard,
but I think we’ll both feel better when we’ve talked
about it.” |
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Parent to adult child:
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“You know, I’ve thought a lot about what it was
like taking care of you as a child. The irony is, the
children we take care of when they are young are
often the very people who take care of us when we
get older. That’s the part I’ve been thinking about. If
something happens and I can’t take care of myself, I
want you to know what to do. I want to make the
decisions now, so you won’t have to make them later.
All you’ll have to do is see to it that my wishes are
carried out. It’s an important responsibility, but it
will be a lot easier if we talk about these things now,
when there isn’t so much pressure.” |
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Adult child to an ill parent:
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| “Dad (Mom), I know you are doing your best to be
well. That’s what we’re all focused on. But, if things
don’t go the way we want them to, I want you to
know that I will always be right here by your side,
looking after you, the same way you’ve stood by me
for my whole life. I’ll make sure you have great care
and that you are taken care of exactly the way you
want it. But that means I need to know the answers
to a few details, just so there is no question that
your wishes are being respected. Can we talk a little
about that?” |
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Patient to doctor:
This is a different type of conversation. As a patient,
it is important for you to be aware of your physical
condition and disease state, or that of a loved one.
Each of us needs to take ownership of our healthcare
by asking our doctor to always be up-front with
information. You want to be very candid regarding your
desire to know the truth about your prognosis and life
expectancy, should your disease take its normal course.
This can actually be a great relief to the physician, as
you are giving them permission to be honest and open
and sometimes deliver bad news.
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| “Doctor, we know that your primary focus is always
on healing. We respect that. And you know that we
have also been focused on getting better. But it is
important to us that we can count on you to be very
candid in sharing information about the condition,
the prognosis and the likelihood of recovery. We
would like to be prepared if things don’t go the way
that we want them to. In that event, we will have
things we’ll want to do in the time remaining. Can
we agree to an up-front sharing of all information?” |
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| Overcoming Conversation “Non-Starters.” |
We’ve learned that people try to avoid the very delicate
topic of end-of-life as we have not normalized this
language in our daily lives. In an effort to deny the
reality of death, there are typical responses used to stall
the end-of-life conversation. Here are a few of those and
some possible responses.
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“We don’t need to discuss this right now.
There’s time.”
“I know we don’t feel it’s imminent, but unplanned
things happen, like accidents, or a medical event or
an illness that progresses rapidly. Making decisions
in a crisis may lead to the wrong decision because we waited too long. I would feel better about it
if we were prepared. In fact, you prepare your
information and I’ll prepare mine, too. We’ll do it
together.” |
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“I’m sick right now, but I think I’m going to get
better. I’ll beat this.”
“I know how hard you are trying to be well. But if
we have some plans in place, it will just be one less
thing to worry about. We can stop thinking about
it and focus on getting better. And if things go great
and we don’t need them…what does it hurt?” |
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“Let’s just leave it up to God.”
“I know how much your faith means to you. It’s
important to me too. But after we are gone is when
it’s really in God’s hands. Until then, God has given
us free will to make decisions about what happens
in our lives. I believe thinking, planning and
working together are things God expects us to do.” |
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“Let’s not talk about it. If we talk about it,
it might make it happen.”
“I’m far more concerned that something could
happen without us ever talking about it. I want
what is right for you. And to make sure that
happens, I’d like to have this discussion.” |
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“You already know I don’t want a lot of heroics.
We can skip the conversation.”
“Well, I’m not sure about your exact wishes. And
more to the point, there are a number of things to
consider besides heroic measures. Like where you
want to be, how you feel about organ donation and
several other important aspects.” |
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| Some of the Decisions You’ll Want to Discuss |
- Designation of a healthcare proxy
- Where you want to be — home, hospital, hospice facility, nursing home, etc.
- Life support — ventilator, hydration, nutrition, CPR, etc.
- Procedures you want to receive or avoid
- Pain medications
- Organ donation
- What hospice is and what it offers. Consider an
informational interview with a hospice nurse
consultant.
| Discussing End of Life Issues with your Doctor |
Dr. Rebecca Bechhold, our Medical Director at Hospice of Cincinnati, has written a 4-page article describing many of the talking points related to end of life planning that you should review with your doctor, including sample questions and conversations. Click here to read the full article >
| Where Should the Information Be Kept? |
Once you have made decisions and put them in writing,
it is important to keep them in a safe place and share
them with people who may need them later on. A few
suggestions include:
- Spouse or partner
- Designated proxy or proxies
- Relatives
- Children
- Parents
- Brother and sisters
- Close friends
- Physicians and other healthcare providers
- Attorneys
- Pastor, priest, rabbi or other faith leader
- Other caregivers
- In a clearly marked file
- In your safe or safe deposit box
- In the refrigerator in a clearly marked tube or
envelope
| Four Things You Should Say. |
These phrases are wonderful conversation starters and
simple statements to help you verbalize feelings of
forgiveness, appreciation and love. They are words to
use when parting from someone for an hour, a day or at
the end of a lifetime.
The Four Things (by Dr. Ira Byock)
“Please forgive me.”
“I forgive you.”
“Thank you.”
“I love you.”
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