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by Vicki Rackner MD
Mary was packing to be with her 80-year-old mother about to undergo a heart valve replacement. When her husband asked whether her mom had a living will, Mary said she didn’t know. He said, “Well, Mary, you’re the oldest and the closest to your mom. I would imagine she would have you to make her choices. Haven’t you two talked about this?” Marry said, “No. And, frankly, the thought of talking to Mom about death—scares me to death!”
If you resist talking with your parents about their end of life plans, you are not alone. We live in a culture that reveres youth and treats death as a shameful defeat.
On top of that it’s hard to imagine your parents not being there. Ed says, “You never outgrow the need for Mommy and Daddy.” Jan was almost 70 when she lost her mother. She says, “A few months after Mom died I started sobbing when I realized I was an orphan.”
Terri Schiavo’s family showed us why overcoming the resistance is so important.
Parent Care Irony
Do you remember how hard it was for your parents to talk with you about the birds and the bees? Their discomfort at talking about how you life began may be matched by your discomfort at talking about how theirs ends.
Patients have an important job; they make medical choices, and often exercise the option of letting the doctor decide. While these decisions are called medical choices, they are really personal choices, reflecting your values, preferences and spiritual beliefs. That’s why, according to US law, medical ethics and common decency, the patient has the right to choose.
One day your parents may not be able to make choices for themselves. The medical and legal systems have provided mechanisms to honor the choices they would make for themselves if they could. Patients have the right to name who will decide for them, and offer guidelines about what they would want if their hearts stopped or they were dependent on machines to keep them alive.
No matter how well you think you know someone, you do not necessarily know what medical choices they would make. The only way you’ll know for certain is to have the conversation. Here are some tips to get started:
Get your own affairs in order. Here are the three best reasons. If you’re hit by a bus tomorrow you know your family will have a roadmap to navigate some treacherous territory. Second, it’s easier to ask your parents to do something you have done yourself. Third, you’ll have a convenient way to ease into the conversation. “Hey, Mom and Dad, guess what I did today?”
Rehearse what you will say. Here are some possible words: “Mom and Dad, I'm so happy that you're in good health. I would like to believe that you will live forever, but so far no one has done that. One day you might not be able to make medical choices for yourself. I love you and want to make sure your wishes are honored. If you cannot speak for yourself, who would you like to speak for you? What would you want if you were in Terri Schiavo's condition?”
Reach for the best argument. What propels your parents to action? It’s usually one of three basic persuasive strategies:
- Do it for you: “I want to make sure that you get exactly what you want.”
- Do it for me: “I can just imagine all of us agonizing about what you would want. You would make it so much easier for us of we knew your wishes.”
- Do it out of duty. “Mom and Dad, you have dedicated yourself to doing the right thing as parents. Thanks in advance for taking care of this final act of a dutiful parent.”
Time it. Look for openings in conversations that could lead naturally to the topic. If there’s a news story that comes close to making medical choices, or you have a family member or a friend struggling trying to make choices for a loved one, seize the moment. Be alert to even the smallest hint that your parents want to talk about end of life issues.
Frame it. You may find yourself initiating this conversation when your parents face risky treatment. As Tom said, “I hate to bring this up now. I don’t want Dad to think I think he will die.” Here’s what you may say. “Dad, I’m glad you have such terrific doctors and I’m optimistic you’ll get through this. You get insurance when you buy a house or a car, not because you’re expecting to get in a car accident or have the house burn down, but to be protected if it happens. In that spirit let me ask: Who would make the choices for you if you not make them yourself?”
Document it. Write down the conversation about your parents’ wishes as if it were a movie script. Imagine a heated argument with your siblings about whether Dad should get a feeding tube. If you can pull out these notes and read exactly what you said, your family could have an easier time reaching consensus.
You can say no. What if your parents ask you to make their choices, but you learn these are choices you cannot imagine doing, like taking them off the breathing machine. You can ask them to ask someone else.
The documents are just pieces of paper. The paperwork includes the Medical power of attorney ( identifies who makes the choices), the living will ( what kind of treatment you want to sustain your life) and the “DNR” order( what happens if the heart stops). You need to know where the documents are and what they say. However, completing the paperwork does mean you will arrive at an easy answer.
These conversations help. Once you start talking you may be pleasantly surprised. Often it’s harder to harder to avoid the conversations than to have them. Plus the conversation about how to die often leads to a renewed vitality of how to live.
About Dr. Vicki
Vicki Rackner, MD is a board-certified surgeon and clinical faculty member at the University of Washington School of Medicine. She left the operating room to be on the cutting edge of healthcare consumerism. She is now a full-time patient advocate, helping people get the health care they want, need and deserve. Dr. Vicki is an author, speaker and consultant.
