Facing the Elephant in the Room

When Alyssa left for her long drive back to college or for a vacation, she would always give her father a long, meaningful hug, and would reassure him that if something happened to him or her, that she loved him very much. Since she was always prepared for EVERYTHING, when she came home for holidays, she tried to bring up conversations about death and dying (and his wishes), but he felt uncomfortable, and often changed the subject. She gave up for a few years, until one Christmas, when her family was playing out front in the snow, he gave her a gift that would shape both her future and his remaining years: A frank conversation about his wishes for the end of his life.

Thanks to this, ten years later, when lymphoma threatened Alyssa’s father’s life, she knew that under no circumstances would he accept extraordinary measures of any sort to keep him alive should he ever reach a point where they’d be considered. He indicated in his conversation with her and in his incapacity planning documents, that there should be no heroic attempts to outsmart mortality at the price of his dignity or comfort.

Today, Alyssa is at peace knowing that her conversation with her father, held more than a decade before it became relevant in any way, gave him the opportunity to have a peaceful death — one that did not involve machinery or pain.

In life, we prepare for everything – college, marriage, a baby, retirement – but we rarely begin the conversation about death.This is because talking about death makes most people uncomfortable. But, as you can see from our example, such conversations are incredibly important.

Why are End-of-Life Conversations Important?

Talking about end-of-life issues is an expression of love and an opportunity for closeness. By confronting the topic of death and talking about it, we come to appreciate the extraordinary everyday moments of our lives.

These are some reasons why death is a topic that’s fundamental to us all:

So caregivers know what to do: The awareness of what a loved one wants and doesn’t want at the end of life enables those of us in caretaking roles to take whatever steps they can to ensure that those wishes are respected.

So doctors know the desired course of action to take: If the conversation/planning never takes place, the strong likelihood is that doctors and nurses who may have only met our loved one near the end are the ones who will choose a course of action. In many situations, that choice includes continuing medical interventions that only serve to prolong suffering and traumatize family members.

So bonds within families are strengthened: Talking about death sheds light on the meaning of our relationships and strengthens the bonds we share with those with whom we’re holding these conversations.

Getting the Conversation Started

Chances are, the conversation won’t be easy. But it’s one of the most important conversations you can have with your loved ones. How do you get started? Below are some helpful resources:

Eldercare.gov, or the Eldercare Locator, recently released “Let’s Talk, Starting the Conversation about Health, Legal, and End of Life issues”that includes tips on preparing for the conversation, starting the conversation, keeping the conversation going, and community resources to aid in the planning process.

-Pulitzer Prize-winning columnist Ellen Goodman co-founded The Conversation Project to help families have these important end-of-life discussions. In a recent U.S. News and World Report video, she shares her compelling reasons for helping start the group and how important it is for all family members to sit down and talk. She also shares a “Starter Kit” to help families have the conversation.

-A growing trend in gatherings, called Death Cafés, is gaining attention for presenting a comfortable way talk about death with others. Death Cafés bring strangers together in a public setting to have end-of-life conversations while sipping coffee and eating comfort foods like cake and cookies. Read our blog post on this topic for more details.

Be sure to explain that having this conversation is important for both of you and that by talking about it, you can avoid having things happen that your loved one does not want. If you are still facing reluctance, explain that this is the only way your loved one can have a voice in, and be part of, the decision-making process about the end of his or her life.

Having the End-of-Life Conversation with Your Doctor
Starting in January 2016, Medicare will pay doctors for the time they spend helping people plan for late-life care. The conversation can include more, such as your wishes about the quality of life you want, or the setting — home? nursing home?— where you want to spend your final days, etc. For more details on end-of-life conversations with your doctor, please read our blog post, “Why Take Advantage of End-of-life Care Talks?”
Once the important conversation with your loved ones (and your physician, if you choose) occurs, and important decisions are discussed, it is important to work with a Certified Elder Law Attorney, such as myself, to make sure that you have proper incapacity planning documents in place. These include not only the Advance Medical Directive, but also a properly-drafted General Power of Attorney and an Advance Care Plan, also called a Lifestyle Care Plan. When you or your loved ones are ready, please call us to set up an appointment for a no-cost initial consultation:
Fairfax Incapacity Planning Attorney: 703-691-1888
Fredericksburg Incapacity Planning Attorney: 540-479-1435
Rockville Incapacity Planning Attorney: 301- 519-8041
DC Incapacity Planning Attorney: 202-587-2797

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