Conversations about end-of-life wishes are among the most important—and most avoided—family discussions. Yet having these conversations while your loved one can participate leads to better outcomes: less family conflict, care that aligns with wishes, and peace of mind for everyone involved.

Why These Conversations Matter

According to The Conversation Project, 92% of people say it's important to talk about end-of-life wishes, but only 32% have actually done so. This gap creates problems:

  • Family members left guessing about wishes
  • Unwanted aggressive treatment at end of life
  • Family conflict over decisions
  • Guilt and regret after death
  • Financial and legal complications

Key Topics to Discuss

Medical Care Preferences

  • CPR and resuscitation preferences
  • Mechanical ventilation
  • Artificial nutrition and hydration
  • Hospitalization vs. comfort care
  • Pain management priorities

Quality of Life Values

  • What makes life worth living for them?
  • What conditions would be unacceptable?
  • How do they define dignity?
  • What are their fears about dying?

Practical Matters

  • Where do they want to spend their final days?
  • Funeral and burial preferences
  • Financial and legal document locations
  • Who should make decisions if they can't?

How to Start the Conversation

Choose the Right Moment

  • Not during a crisis or illness
  • When you have uninterrupted time
  • When everyone is calm and rested
  • Use natural openings (news story, friend's experience, movie)

Conversation Starters

  • "I was thinking about what I'd want if something happened to me..."
  • "Remember when Uncle John was sick? What did you think about how that was handled?"
  • "I want to make sure I know your wishes so I can honor them..."

Understanding Common Medical Scenarios

Help your loved one understand what decisions might need to be made:

If the Heart Stops

CPR (Cardiopulmonary Resuscitation): Chest compressions and possibly electric shocks to restart the heart. Questions to consider:

  • In what situations would you want CPR attempted?
  • Would your answer change if brain damage was likely?
  • What if CPR might prolong dying rather than restore meaningful life?

If Unable to Breathe

Mechanical ventilation: A machine breathes for you through a tube. Consider:

  • Would you want this temporarily while recovering from illness?
  • What about indefinitely if you couldn't recover?
  • Under what circumstances would you want it stopped?

If Unable to Eat or Drink

Feeding tubes: Provide nutrition through a tube in the stomach. Think about:

  • Short-term use during recovery?
  • Long-term if unable to eat permanently?
  • In advanced dementia when someone forgets how to swallow?

Resources for Planning

Several organizations provide free tools for end-of-life planning:

Involving Healthcare Providers

Doctors can help facilitate these conversations:

  • Ask your parent's physician to discuss prognosis and likely scenarios
  • Request a palliative care consultation for complex situations
  • Use annual wellness visits as natural opportunities for planning discussions
  • Ensure the healthcare team knows about completed advance directives

Essential Documents

Advance Directive/Living Will

Documents medical treatment preferences for situations when someone can't communicate.

Durable Power of Attorney for Healthcare

Designates someone to make medical decisions if the person cannot.

POLST Form

Physician Orders for Life-Sustaining Treatment—medical orders based on patient wishes.

Will and Estate Documents

Addresses property distribution and final arrangements.

Frequently Asked Questions

What if my parent refuses to discuss these topics?

Don't force it. Express why it matters to you and leave the door open. Sometimes writing a letter helps. Consider asking their doctor to raise the topic. Try again later—people often become more open with time or after health events.

Do these conversations need to involve the whole family?

Initial conversations may be easier one-on-one. Once wishes are understood, a family meeting can ensure everyone is on the same page. The goal is clear communication and documented wishes—however that's best achieved for your family.

Can wishes be changed after documents are signed?

Yes, advance directives can be updated anytime while the person has capacity. Encourage regular review—wishes often evolve with age, health changes, and life experiences.

What if family members disagree with the stated wishes?

Documented wishes should be followed regardless of family disagreement—that's why documentation is so important. The healthcare proxy has legal authority to ensure wishes are honored. Family counseling may help with acceptance.

How do adult family homes handle end-of-life care?

Many AFHs provide excellent end-of-life care in partnership with hospice services. Residents can often remain in their familiar environment with caregivers they know. Discuss end-of-life capabilities when choosing a home.