Talking at the End of Life

WebMD Feature

July 3, 2000 -- A conversation about death is never easy, but Karen A. Davie, president of the National Hospice Foundation, says it's critical. If someone is getting on in years or having life-threatening health problems, it's a good idea for close family members or someone directly involved in the person's care to initiate such talks. "When we avoid candid discussions, we sacrifice knowing the final wishes of our parents, family members, and very close friends," she says.

Many people, understandably, find it hard to begin such conversations. Here are some tips that can make it easier for all concerned:

1. Choose the setting. Find a private, quiet place in which to talk. Make sure you are both physically comfortable.

2. Ask permission to discuss the end of life. Try "I'd like to talk about how you would like to be cared for if you got really sick. Is that OK?" Or "If you ever got really sick, I would be afraid of not knowing the kind of care you would like. Could we talk about this now? I'd feel better if we did."

3. Use a warm and caring manner. Allow your loved one to set the pace, and use nonverbal communication to offer support by nodding your head, holding your loved one's hand, reaching out to offer a comforting touch or tissue, or whatever is comfortable for both of you.

4. Be a good listener. Be sure to hear what the person is saying. Listen for the wants or needs that your loved one expresses. Show empathy and respect by addressing these wants and needs in a truthful and open way.

5. Do your homework. Before having the discussion, find out what kind of end-of-life care options are available in your community. You can also talk to the dying person's doctor about what's available and which options are appropriate for your loved one. Then ask your loved one questions like "Would you like to spend your final days at home? Are you worried about being in pain? Would you like emotional and spiritual support?"

Jane Meredith Adams has written for WebMD, Health, The Boston Globe, and other publications. She lives in San Francisco.

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