Most families never have the conversation about death and dying until they are in a crisis — when decisions must be made urgently and your person may not be able to participate. Having the conversation early, when there is time and space, is one of the most loving things you can do for your person and for your family.
Why the Conversation Doesn't Happen
- Magical thinking: "If we don't talk about it, it won't happen." But it will happen — and the conversation becomes much harder when you're in the middle of it.
- Protection: "I don't want to upset them." Most people who are seriously ill have already thought about dying. Your unwillingness to talk about it often feels like abandonment.
- Fear of conflict: What if we disagree about what to do? Disagreement is better discovered before the ICU than inside it.
- Discomfort with the topic: Our culture avoids death. This avoidance has a significant cost — families make decisions under pressure without knowledge of what their person would want.
What to Talk About
Values and priorities
"What makes your life feel worth living to you?" "What are you most afraid of?" "Is there anything you want to make sure happens?" These open questions are better than medical specifics as a starting point.
Medical treatment preferences
CPR, ventilators, feeding tubes, aggressive treatment vs. comfort focus — these are the decisions that will need to be made. "Have you thought about how much medical treatment you would want if you became very ill?"
Where they want to be
Home, hospital, hospice facility? "If you were very ill, where would you want to be cared for?" The most common wish — to die at home — is thwarted most often by the absence of advance planning.
Who should decide
"If you couldn't speak for yourself, who do you trust to make decisions for you?" This is the healthcare power of attorney conversation — and it needs to be formalized in a legal document.
Advance Directives — The Documents
- Healthcare Power of Attorney (HCPOA) / Healthcare Proxy: Designates a specific person to make medical decisions if your person cannot. The most important document to have in place.
- Living Will / Advance Directive: Specifies your person's wishes about specific medical interventions — typically resuscitation, ventilators, feeding tubes, and comfort-focused care.
- POLST / MOLST: Physician Orders for Life-Sustaining Treatment — a physician-signed medical order (not just a personal preference document) that specifies resuscitation preferences, hospital transfer wishes, and treatment preferences. Carries force across care settings.
Understanding Hospice
What hospice provides:
- Physician-directed comfort-focused medical care
- Nursing visits at home (often several times per week)
- Social work, chaplaincy, and bereavement support for the family
- Medications and supplies related to the terminal diagnosis
- Respite care for family caregivers