How to Talk with Your Parents About End of Life Planning and Death

Having worked for more than two decades in long-term care as a nurse, then a number of years in social service as an advocate for those 65 years and older, I am all too familiar with what can happen when parents or other close family members haven't taken the steps to talk about end-of-life planning or completed advance directives.

Perhaps even more than parents dread those talks to their children about sex, adult children are often anxious about talking to their parents about end of life planning.

Death and the possible disability or lengthy chronic illness that may precede it are emotionally charged subjects. Even though logically you know that everyone will die at some time, confronting the eventual loss of your parents can be heart-wrenching.

What I can tell you that may bring some comfort is that among the people I know and have worked with, those that had an end of life discussion with their parents did not regret it afterward.

Before I talked with my parents about end of life planning, I couldn't get the first few words out of my mouth without being reduced to tears. Before I could talk to them, I had to go through a type of pre-mourning period. When I was able to think and talk about the topic rationally, I knew it was time to broach the subject with my parents.

Choose a time and setting where all of you can be relaxed. Don't choose a time of crisis unless one of them has become acutely ill--then you may not have a choice.

You might choose to begin the discussion by asking your parents if they've ever considered what they want to happen should they become ill or incapacitated. Chances are, this is something they have given much thought. If so, explain that you'd like to have an idea of what their wishes are so you can act accordingly, if need be.

If your parents haven't considered the possibility of a need for care at end of life, ask them to give it some consideration. As their adult child, you aren't being morbid, you are being realistic. In a few weeks, approach the subject again. Hopefully at this point your parents will begin having some ideas about what they would want.

Your parents may react in a matter-of-fact manner to your concerns or the conversation may become emotional. There is no right or wrong response.

You may need to help them understand what options are available to them as choices in end of life care. It isn't necessary to determine every detail. The most basic information to cover is what would they want if the need for CPR or the use of a ventilator to extend life were needed?

In addition to your parents sharing this information with you, they should complete and sign a living will. Copies should be provided to their health care providers and one to you and any siblings. If a health emergency should occur, ensuring that a copy of theirliving will is available to physicians will make sure their wishes are followed.

Advance directives such as the living will and a durable power of attorney for health care ease the burden of decision-making on adult children. It is one thing if one or both of your parents have chosen not to have CPR or life extended by artificial means--it is a very different thing if you are the one who has to make that choice for them.

It's important for you and your parents to understand that without a living will directing physicians in the desired direction, everything will be done to sustain life. This can mean feeding tubes, repeated cardiac resuscitation and other life-prolonging treatment. And if that's what they want, that's okay, too. You just need to know what their wishes are ahead of time.

Other topics that should be addressed in your parents' end of life planning could include their views on organ donation and what would they want should they need care provided? If you're open to it, you can offer to become a family caregiver. Other considerations may be another sibling or family member, assisted living, nursing home, or in-home care.

The ramifications of your parents' choices may affect you for years to come. Talk a deep breath and resolve to talk about end of life planning with your parents sooner than later.