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Tools & Resources > Conversation Guide

We'd like to think our loved ones will always be healthy, independent and able to make decisions for themselves, but things can change suddenly. They might have an accident or a serious illness and no longer be able to speak for themselves. When that happens, doctors often turn to their loved ones to speak for them. If that happens, will you know what care they would want?

Talking with loved ones now and helping them plan for future medical needs is the best way to make sure that their wishes will be respected. But talking about this is not always easy.

The Coalition for Compassionate Care of California has developed this guide to help you start the conversation. In it you will find:

  • Suggestions on how to raise the issue

  • Responses to concerns they might express

  • Questions you might want to ask

As your loved one reflects on and expresses her/his wishes, we recommend you encourage
her/him to:
 

  • Write her/his wishes down in an Advance Directive document. An Advance Directive is a statement, shared with both family and the doctor, about how she/he wants to be treated if she/he becomes seriously ill and cannot speak for herself/himself.
     

  • Appoint a spokesperson - a Healthcare Power of Attorney - you or someone else who understands her/his wishes and will be able to speak for her/him if she/he is unable to do so.

Once you start talking, don't feel that you need to get everything done at once. Rather, view it
as a process. Even after your loved one has made her/his wishes known, these wishes may
change over time. Once you've started, however, it will be easier to talk about changes or
related issues in the future.

Keep in mind that other family members and loved ones also need to understand your loved
one's wishes. Depending on how close they may be, geographically or emotionally, this can be
challenging. Encourage your loved one to talk to family members - one at a time or at a family
gathering. Offer to support her/him as she/he reaches out to any who may be resistant. The
more those close to your loved one are aware of her/his wishes, the more likely those wishes
will be carried out.

Ways to raise the issue

Talk about the recent illness or death of a relative or someone you know, or someone in the
news, like a celebrity. What did you think about what happened with so-and-so? Is that the kind
of care you would have wanted? Why or why not?

Share an article or story about the topic. Maybe there was a movie, a segment on the evening
news, or a TV show that got you thinking.  

 

Use the opportunity of a medical appointment or build on a financial planning session to discuss her/his wishes.

Responding to concerns

"I am feeling fine, so we don't need to talk about this now. We can wait and handle things
as they come up."

 

We'd both like to think that you will always be healthy and able to make decisions for yourself.

But things can happen suddenly. Things can change. You might have an accident or develop a
serious condition and not be able to speak for yourself. So, making your wishes known now will
help everyone, including the doctors, be able to care for you the way you want.

Or you might say...

You make decisions every day about your life and your healthcare. l've seen how independent
you've always been, how you have operated on your own for so long. That's why I want to
understand your wishes to make sure that you maintain your independence as long as
possible. Why leave really important decisions to chance?

There is no need to talk about this because "The doctor will make the decisions anyway,"
or "I trust you (your father, your brother) to know what to do," or "It's all in God's hands
anyway...

Though your doctor will help, she or he will still turn to us (your family) to make the choices for
you. It will be very difficult for us to know what to do if you haven't talked about your wishes.

And, it puts a real burden on all of us to have to make decisions on your behalf when we aren't
sure what you would want.

"My attorney has taken care of it all," or "l've already filled out the form."

 

It's great that you have already started the planning process. If the time comes that you can't

make decisions for yourself, it would help me and others who love you if we could understand
what care you would want. Perhaps we could start by sitting down together and reviewing your
form.

"This is too hard (or morbid or depressing) to talk about."

While it can be hard to talk about, it's very important for our family. If we have to guess what you
would like, we will feel anxious about making the right decision. And, we may disagree and not

know what to do. Talking about this now will be a wonderful gift you can give to me and all of us
who love you. Let's see how it goes.

Questions You Might Ask
  • If you could plan it today, what would the last day or week of your life look like?

  • Who would be there?

  • Where would you like to be?

  • What are your ideas and hopes about the end of your life?

  • What are your fears or concerns about the process of dying?

  • Have you thought about what kinds of care you might want during a severe illness or when you are dying?

  • Where would you prefer to spend your last days if you are ill? At home, with one of us, in a nursing home, or in the hospital?

  • Who do you want to make medical decisions for you if you are unable to speak for yourself?

  • Do you believe that life should always be preserved as long as possible? If not, what kinds of mental or physical conditions would make you think that life-prolonging treatment should no longer be used? For example, if you were:

  •      Unaware  of your surroundings
         Unable to appreciate or continue important relationships
         Unable to think well enough to make everyday decisions
         In severe pain or discomfort

  • ls there any particular music, flowers, photographs or art you would like to have around you near the end of life?
     

  • What are your wishes regarding a funeral? Burial vs. cremation?