Talking About End of Life Decisions

“Two things are certain in life. . . death and taxes.” Most everyone has heard this quote and either chuckled or groaned.  I attended a presentation recently about “The Conversation Project” whose goal it is to inspire people to talk with their loved ones about their desires at the end of their lives. None of us knows when we are going to die so it is best to having these conversations early and more than once.

I Don’t Want to Deal with Death

Some people have the mistaken belief that if they don’t think about it or talk about it, they won’t die. Most humans have a need to feel in control. Death is one of those things in life over which we have little control.

End of Life – Things to Talk About Now

Photo of two distressed women difficult end of life healthcare decisionsWho will make your healthcare decisions if you are unable to make them yourself?

 What will making those decisions do to those you love? 

How will it effect their relationships if they don’t agree with each other?

The only way for you to have control over your the decisions made if you become incapacitated is if you have a Living Will or Medical Power of Attorney (aka Healthcare Proxy or similar terms). These are both documents that legally designate your decision-makers if you are ever in a situation in which you are unable to do so for yourself. It is important to designate 2 or 3 people (Put them in order. More than one is important in case your designee is unavailable). You need to have regular conversations about your wishes. Be specific about your desires. If your proxy knows what you want, it is a much easier decision, and your loved one(s) can be at peace knowing s/he has followed your wishes.

Advanced Directives – Who Will Be Responsible? What Will Be Done?

photo of woman in hospital bed with person holding a living will in the foregroundLiving Will

A Living Will is a Type of Advanced Directive. It is a document that dictates your desires if you are unable to do so yourself. It gives written legal instructions regarding your medical care preferences. The Living Will can address the administration of life sustaining procedures.

Medical Power of Attorney

A Medical Power of Attorney, also called a Healthcare Proxy, designates a decision maker who will act on your behalf and in accordance with your wishes. This is why it is so important to talk about your desires. You should also designate alternates in the event that the your first choice is not available. This is the most important document to complete!


Do Not Resuscitate (DNR)

dnr2A Do Not Resuscitate order, commonly called a DNR, is an advanced directive medical order that directs medical personnel not to resuscitate in the event that the breathing ceases or the heart stops beating. It is a decision only about CPR. It does not include decisions about pain medications or nutrition. Unlike a Living Will or a Medical Power of Attorney, which are typically drafted by an attorney, a DNR is a form discussed, completed and must be signed by your doctor.

Please note, if you call 911 and there is no DNR in place, Emergency Medical Personnel must perform CPR. Here is a great article that discussed this issue.

If The Worst Happens

Completing the documents above and discussing your wishes with your love ones can protect you from worst case scenarios.

  • If you haven’t legally designated someone to make these type of health care decisions for you if you are unable, then who will? It could be a person or persons who are completely unrelated to you and don’t even know you.
  • Without advanced directives you may lie there in a vegetative state while your loved one go through a lengthy and costly legal process to establish guardianship and take control of your healthcare.
  • If you haven’t designated a proxy (and ideally more than one) to make decisions, your family members may not agree which could cause unresolvable family problems.
  • You may be resuscitated against your wishes.
  • You could only be partially resuscitated. If the heartbeat starts again but your are not strong enough to breath on your own, a machine called a ventilator may be employed to move air in and out of your lungs indefinitely.
  • You could be in a persistent vegetative state with no one able to override the decisions of healthcare professionals.

How to have a Conversation About End of Life Decisions

Here are some conversation starters:

  • What do you think about growing older?
  • What do you think about dying?
  •  What matters most to you at the end of life?
  • What can you not imagine living without?
  • What do you value most?
  • Who do you want to be the primary and secondary decision makers?
  • What would be worse than death?
  • What do you fear about dying?
  • What would be a good death?
  • How involved do you want you loved ones to be?
  • How long do you want to receive medical care?

If you are uncomfortable dealing with these issues, I can help. We can meet privately in your home or my Boulder office to explore your feelings and wishes on the subject. Then, when you are ready, I can help create a safe environment for you to communicate your wishes to your loved ones. For more information, call me at (303) 444-2003.

Hospice Resources

Hospice care focuses on comfort, care and quality of life for people in the final phases of life. Hospice care can be done at home, in a hospital or in a separate hospice care facility. National Hospice and Palliative Care Organization has a website with resources to help in choosing a hospice.

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