Many people are uncomfortable having conversations about serious illness and death. As a result, they are often unprepared to address the overwhelming physical, spiritual, and emotional issues related to life’s final transition. Sadly, individuals and their families are often forced to make decisions in the midst of a health crisis with little direction or information.

You may have similar fears and believe that if you don’t talk about bad things, they won’t happen to you. However, talking about dying and preparing for illness allows better quality of life as you approach the end of it.

Thinking about the type and extent of care you want during a severe illness, and sharing your feelings with family will give you more control over your care. Decisions about end-of-life care and hospice services are deeply personal, based on your values and beliefs. Because it’s impossible to foresee every type of circumstance or illness, it’s essential to think in general about what is important to you. Conversations that focus on your wishes, beliefs and the rationale for your decisions will relieve loved ones and health care
providers of the need to guess what you would want in the event you cannot communicate.

Talking with your loved ones
 When discussing your end-oflife wishes, you should consider your overall attitude toward life, including the activities you enjoy and situations you fear; your attitude about independence and control; your religious or spiritual beliefs and moral convictions; and your feelings toward doctors and caregivers.

Remember, it’s up to you to take the initiative and express your wishes. Others are not likely to raise the issue for you. To ensure that your end-of-life wishes are honored, it’s essential to discuss your wishes now – before a crisis hits. Opportunities for having conversations include while you are drawing up your will or doing other estate and financial planning; before and after annual medical checkups; during holiday gatherings; and around significant life events, such as marriage or retirement.

Sometimes sharing your personal concerns and values, spiritual beliefs, or views about what makes life worth living can be as helpful as talking about specific treatments and circumstances. Discuss for example the aspects of your life that give it the most meaning or the importance of physical independence and staying in your own home. An important part of communicating your end-of-life wishes is discussing with your loved ones what you may need from them. Some questions that you may want to ask are:

• Will you seek out information about my disease, advance directives, your roles as caregivers, and what to expect as I get sicker and near the end of life?
• Will you respect my wants and needs, even if they’re different from what they used to be and if you don’t agree with my choices?
• If I cannot communicate for myself, will you advocate for me to make sure that what I want is done, even if you would not make the same choices yourself?
• Will you stay with me even if the going gets rough?

Talking with your doctor
 Do not wait until a crisis occurs before discussing concerns about end-of-life treatments with your doctor. Chances are that he or she is waiting for you to start the conversation. When you discuss your concerns and choices, let your doctor know that you will be providing advance directives and confirm that he will follow your wishes. Ask your doctor to explain possible treatments and procedures before you complete your directives, and talk about pain management options and other details. Follow up by giving your doctor a copy of your completed directives.

Be sure to reassess your decisions over time. These are not simple questions and your views may change. It is important that you review these issues and discuss your choices as your personal health or circumstances change.

By embracing the opportunity to share your feelings with your family and doctor about how you wish to be cared for – you reclaim control of one of the most important transitions of your life and how your loved ones will remember their final days with you.

For more information on end-of life care planning, visit www.keystonecare.com.