How to discuss end-of-life choices with your loved ones


Advance care planning often starts with a tough conversation. This talk can be difficult for just about anyone. However, there are certain key steps you can take to make this task less daunting.

One tip is to get a head start when you are healthy – advance care planning is not just about old age. A medical crisis can occur at any time, which could leave you unable to make your own health care decisions. If you start this process early, your primary decision will simply be to identify the person who will make decisions for you if you are unable to make decisions for yourself. The next step is to talk to that person so he or she knows what you value.

Once you have identified a family member or friend, a bit of preparation can help make the conversation a little easier. For those of us who find it difficult to broach this topic with their loved ones, your preparation would include identifying what matters to you as a person. You may want to explore why you are thinking about these topics in the first place. Is this due to a particular event in your life or someone close to you? What else motivated you to have these discussions and conversations now? If you are able to answer these questions for yourself, you will be better prepared to have this discussion with your loved ones. You might also want to explore your basic principles, values and how they would still apply near the end of your life. It’s important to keep in mind that the first conversation on end-of-life issues may be the start of a learning process.

If you have this difficult conversation when you are healthy, it may make the process easier as you age. As your age advances and you develop new medical conditions, or your functional ability declines, it is important that you revisit your choices and decisions. This self-reflection will help you identify anything has changed since the last time you talked to your loved one. If that is the case, then you should approach them again explaining what led you to change your decisions or choices.

As a physician, I can tell you that it is equally hard for health care team members to talk to patients about these issues. However, if our patients give us permission to talk about end-of-life choices, then it becomes easier for us – as your trusted health care partners – to guide you through this process. So, once you have done your preparation and have spoken with a loved one, please take the next step and talk to your health care team member. No one knows your preferences and values better than you do. Your health care team members can help guide you in that decision-making process, but they cannot make decisions for you. As such, the more you share with your health care team, the better they will understand your end-of-life wishes.

At WellSpan, this process is emphasized in our Horizon Planning® initiative, reflecting an understanding that everyone has a health horizon and we are here to help plan for it. For more on our Horizon Planning initiative, visit its website.

By taking these steps and starting conversations early, you will ensure that your care in the future will be exactly how you planned. More importantly, you will diminish the chances of moral distress that your loved ones could face when making decisions for you.

Vipul Bhatia, M.D., is medical director for Post-Acute Services at WellSpan Health and director of WellSpan’s Horizon Planning program.