Facing the End of Life

WebMD Live Events Transcript

Recent events have again shown us how important it is to have open, honest discussions with our loved ones about the end of life. But how do we begin? What are the issues we must deal with and how can we best address them? Laura Larsen, RN, author of "Facing the Final Mystery: A Guide to Discussing End-of-Life Issues," was our guest on June 29, 2005.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Welcome to WebMD Live, Laura. Thank you for joining us today. Are most people reluctant to emotionally admit that there is an end to life?

LARSEN:
Yes. It is one of the most difficult subjects to discuss with those we love. There are many reasons behind this, but the fact is, this is a very, very difficult topic. That is why I wrote the book.

MODERATOR:
So given that, how do we begin conversations with those we love about the end of life?

LARSEN:
I have found there is usually one person in the family system that becomes interested in speaking about end-of-life issues. That doesn't include all families for sure. But let's go to where the conversations at least have a possibility of taking place, which means somebody will instigate it.

What I like to suggest is that this person keep the conversation about themselves. That is, they might say for example, "Mom, Dad, I need to know these things about your end-of-life decision. It makes me anxious to not know what you think or want or need in just the practical terms, let alone how you're feeling about these issues." That way, the person is less likely to be defensive.

You may have to do that a couple of times, with different reasons, but always keeping it from your point of view, the person willing and interested in having these conversations.

"When these conversations have not taken place and the dying process begins, especially if the dying person cannot speak, it becomes much more difficult. Problems will ensue, as if it isn't difficult enough to lose somebody that you love."

MODERATOR:
Does it help to express our own wishes about our end-of-life choices?

LARSEN:
That is an excellent way to begin a conversation. For example, if somebody received a diagnosis that is serious, they can approach other family members and say something like, "Look, I'm going to do everything I can to make myself get better, but in the meantime I want you to know in case I come to some place where I can't speak for myself, I want you to know what my wishes are." Sometimes the other family members don't even think about that and will tell you that you're going to be just fine. This person may say again, in a slightly different way, "I intend to be, but this is serious, so here's what I want. I want this person in our family to speak for me if I cannot speak and I want to be cremated, not buried." Whatever the issues are that are the top ones. Once you do have an audience, you can say, "While we're at it, I would really like to know what your feelings are about your end-of-life wishes.

The discrepancies come in all pairings of family members. Sometimes it's the parents who either because of an illness or advancing age will want to talk to their grown children. Sometimes it's the grown children who see their elderly parents starting to decline, they can see the writing on the wall and they need more information. Usually the most difficult are the spouses. For example, the husband does not want to talk about these things, so the wife has to get a support team. Maybe she needs to start with her children, her sister or parents, but she needs to get a support system.

When these conversations have not taken place and the dying process begins, especially if the dying person cannot speak, it becomes much more difficult. Problems will ensue, as if it isn't difficult enough to lose somebody that you love.

MEMBER QUESTION:
Recently my mother passed away and I was shocked to discover she and my dad never discussed DNR situations. They discussed everything else including her funeral. How can I start that conversation with my Dad?