Americans tend not to discuss death or dying openly. Some of us may find it awkward to speak with a loved one, such as a parent or grandparent, about their final wishes. 

But if someone doesn't talk about their wishes or write them down, no one will know about them! It's easier to discuss an advance health-care directive when a loved one isn't on their deathbed and has time to consider their plans. If you're not comfortable doing so, ask someone for help, such as a relative, your loved one's doctor, or an elder law attorney. But if you plan to handle the conversation on your own, considering how you'll begin and what you'll say can prepare you for one of life's most meaningful discussions.

Thinking Before You Speak

1. Consider what you will discuss. You can ask your loved one about the following:

    • What matters most to them
    • Any of their concerns about their health-care, now or later
    • Who the loved one wants to make decisions for them (their health-care proxy)
    • Who else they might want to discuss their end-of-life decisions with (clergy, doctors, other family members, etc.)
    • Whether to have doctors update them on their chances to live or expected lifespan if they have a serious illness
    • The amount of information doctors should share with others
    • Their wishes for end-of-life health-care
    • Milestones they might like to be present for, such as a grandchild's birth
    • How to handle any changes in their health condition at the end of life
    • Where they prefer to spend their final days
    • Whether they want to be alone or with loved ones near the end of life
    • Other things to be settled, such as other legal documents, finances, personal property, and relationships.

2. Framing the conversation. Be prepared for your loved one's reaction, but don't assume anything. Responses can range from surprise to concern and acceptance; they may already be aware of the importance of an advance directive, but have put off making one. Don't judge. Be patient and try to listen more than you talk. Their reaction can help you steer the discussion. Some reasons for asking include the desire to know their wishes in case something happens and to show love for them. The person may also need more time to think. If so, ask if they want you to leave a copy of an advance directive form or planning worksheets with them. Don't expect to cover everything at once. 

3. Consider the setting, the people involved, and the timing. Family gatherings can be appropriate times to start the conversation. Some loved ones may prefer to talk one-on-one. If possible, ask another trusted person to support you and help guide the discussion. Where you hold the conversation is also crucial. A quiet and private setting, such as at home, during a walk, or in a park may be ideal.

Breaking the Ice

You may ease into the topic and decide what to say in the following ways: 

Be the example - If you've created an advanced directive, health-care power of attorney, or living will mention it. Or, if you're still planning one, use it as an excuse to talk about your wishes, then go into the other person's plans.

    • "Though I'm OK now, I'm worried I might die unexpectedly someday, and I want to be prepared. Could we talk about some things that matter to me?”
    • "Now that I've shared my wishes, have you thought about your plans for your end-of-life care if you can't make decisions?"

Bring up the dearly departed - If someone you both knew passed away recently, the topic can lead to a discussion about your loved one's plans.

    • “Remember what happened to ____?  It made me realize ____.”
    • "Uncle Charlie often talked about wanting to live life to the fullest. It reminded me that ___..." 

Use the news - Recent events, such as a public figure's death or a well-known battle over end-of-life care, may provide good talking points. 

    • "When ___ died, do you think their loved ones respected their wishes toward the end of their life?"
    • "Like what happened with ____, I want to help you in situations like end-of-life care. Have you thought about that?"

Upcoming events - A funeral, a medical check-up, and other occasions can be conversation starters.

    • "When you go to your doctor's appointment, they may ask to keep an advance directive on file. Have you considered that?"
    • "I'm interested in going to a talk about end-of-life care at the senior center. Would you like to join me?"

Life transitions - An upcoming retirement, an empty nest, and other turning points are excuses to bring up end-of-life plans:

    • "Now that you're going to retire, have you thought about your plans for other milestones, such as your care in your later years?"

Play games - Card games such as Go Wish, Hello, and Heart2Hearts® stimulate conversations about sensitive topics, including end-of-life care. They offer a chance to discuss final wishes.

    • "Would you like to join us for a game about things that matter most in life? We all might find the answers interesting and have fun at the same time."

Artistic expressions - Books, TV and audio programs, articles, movies, and other works of art have depicted death and dying. Enjoying them together may help you transition to the topic of an advance directive. 

    • "I heard/read/saw an interesting ___ about end-of-life planning, and it got me thinking about doing it for me and for you.”

Try the Conversation Project Starter Kit - This nonprofit organization offers tips for discussions about end-of-life care.

    • “I answered some of the Conversation Project's questions about things that matter to me regarding my end-of-life care. I'd like to talk to you about it.”

When you've decided how you will start talking, you can do a "dry-run."

Practicing and Planning 

Rehearsing what you will say and how you will say it may make you feel more comfortable. For example, you can talk to a friend or relative or write a letter to the person you want to speak with.

Make sure you get your loved one's wishes in writing. Once you've started the conversation, future discussions may become easier. Over time, keep the conversation going to check for changes of plan. 

When you make an advance directive, a lawyer can ensure you state everything properly. If you need help starting the conversation about an advance directive or want to create or review one, call (207) 377-6966 or contact us online. We're ready to assist you.