03/01/11

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Pennsylvania-based medical director Dan Haimowitz, MD, CMD, discusses how to make hard talks easier for everyone.

Getting a family member/friend to decide about care they want at the end of life (EOL) can be hard. But it is better to talk about this when loved ones can be involved, when there is no health care emergency, and there is time to calmly think about all the options.

You can start the talk with a simple question: “If something happened to you, what would you want us to do?” Make it clear that following your family member/friend's choices is your top priority.

Don't press your own beliefs and wishes on your family member/friend. End-of-life choices are very personal; not everyone wants the same things. Of course, people's feelings may change if they get ill, are injured, and/or become mentally impaired. So it is key to revisit EOL choices and plans when there is a health crisis or condition change.

To avoid family conflicts, it is best to put choices in writing via a Living Will or Advance Directive. The Advance Directive includes a Durable Power of Attorney for Health Care, which allows people to name the person they want to speak for them and make medical decisions if they become unable to do so. Your physician can help you get a document that is legal in your state.

▸ Questions to Ask Your Physician:

• What are the pros and cons of respirators/ventilators, cardiopulmonary resuscitation (CPR), tube feeding, and other treatments that can extend life?

• What form should we use to document my family member/friend's choices?

• How do we make sure our family member/friend gets end-of-life wishes that don't go on a form, such as special foods or music therapy?

• What happens if family members disagree about what care our family member/friend should get?

• What can we do if our family member/friend just won't talk about end-of-life plans and/or gets angry when we bring it up?

▸ What You Can Do:

• Pick a time/place to talk with your family member/friend where everyone can relax and talk freely.

• Don't judge your family member/friend; respect his/her beliefs and choices.

• If the person has questions you can't answer, talk to your physician or other professional and follow up quickly.

• Make sure your family member/friend puts his/her wishes in writing with an Advance Directive or Living Will. Urge him/her to share wishes with other family members.

• Use the talk as a chance to express love for your family member/friend and let him/her know that you will respect his/her wishes.

For more information

• Alzheimer's Plan Tailored for Dementia Patients: Association Urges Planning for End-of-Life Care as Soon as Diagnosis is Made:

www.caringfortheages.com/article/S1526-4114(07)60237-6/fulltext

• Palliative and End-of-Life Care:

www.amda.com/consumers/palliativecare.cfm

• Download Your State Advance Directive:

caringinfo.org/i4a/pages/index.cfm

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