How to Start a Conversation About End-of-Life Care

Thinking about end-of-life care for yourself or a loved one is never easy, but knowing how you’ll be cared for when the time comes can make things easier for everyone involved. Preparing in advance and communicating your wishes for end-of-life care to family and friends can help provide peace of mind knowing your instructions will be carried out, and loved ones can focus on quality time spent with you, rather than making difficult decisions during an emotional time.

Ensuring family and friends are aware of your plans before end-of-life measures are necessary is an important part of this journey. Being sensitive to everyone's needs while sharing your wishes can be complicated, but seeking guidance on broaching this topic is a great starting point and can help build confidence in having a thoughtful and productive conversation.

Why You Should Talk About End-of-Life Planning With Your Loved Ones

End-of-life planning often triggers anxiety about facing your own mortality and feeling you have no control over anything. Engaging in end-of-life planning and talking through your plans with loved ones can help offer a sense of control, decrease anxiety, and give you agency over your end-of-life care. Understanding your preferences in advance can also help family members effectively care and advocate for you in the event you are no longer able to do so.

Knowing the choices available to you and deciding what you are most comfortable with--such as naming your healthcare proxy and/or executor of your will, documenting advance directives about life-saving measures, and securing a safe place to store these documents—may feel overwhelming. Making decisions and providing necessary information to friends and family early can give you the time needed to make well-informed choices aligned with your values and beliefs, ensure your loved ones honor your wishes, and ease everyone’s stress and uncertainty when beginning end-of-life care.

Many families consider end-of-life discussions to be taboo, but they don’t have to be. Initiating conversation around end-of-life transitions gives loved ones permission to speak openly with you, providing opportunities to ask questions and to fully understand why you have made certain decisions. By bringing this up, families begin accepting death and dying as part of life's natural rhythm and learn what to expect when the time comes.

How to Start a Conversation About End-of-Life Care

Before gathering family, close relatives, and friends for an end-of-life discussion, consider the following.

Identify Who, What, Where, and When

Who needs to participate in the conversation? Your spouse, domestic partner, or next of kin is a good starting point because they will be responsible for communicating preferences and making medical and legal decisions on your behalf if necessary. Including adult children, siblings, parents, other relatives, and close friends can help clarify everyone’s role and responsibility while avoiding anybody feeling left out.

Determining the details you will share with everyone can help the conversation flow more naturally. This can make focusing on your loved ones while discussing end-of-life planning easier because you already know what your preferences are. Using an end-of-life checklist can help organize information and make sure everything is communicated in the event that emotions run high. Giving family members copies of necessary documents can assist visual learners in understanding your decisions and can help family and friends remember what you have discussed.

Time and place influence the quality of important end-of-life conversations. Navigating everyone’s schedule can be challenging, so explaining you have something important to talk about can help people make time. Avoid holidays, birthdays, and other important dates or anniversaries, even if everyone is together. Finding a quiet place can increase everyone’s comfort level and will help to protect your privacy.

Ease Into the Conversation

Subtlety is not everyone’s strong suit, but it can help pave the way for productive conversation, especially one that has potential for becoming emotionally charged. Gently introducing the subject matter -- "I've been thinking about my future lately and I’ve made plans I’d like you to know about" -- can act as a segue before sharing details. If you can, explain that your plans do not indicate deteriorating health or that your passing is imminent to help ensure your family remains calm throughout the conversation. It can help to remind loved ones of life’s unpredictability and to connect this to real life, such as with the COVID-19 pandemic, to help ground families in the reality of mortality while providing context for why this is coming up.

Stay Calm and Composed

The end-of-life conversation you envision having with loved ones may not always go as planned. Planning for end-of-life care is something you may have become familiar with when putting your plans together, but for most of your family and friends, talking about it may come as a shock. Family dynamics can often assert themselves in these conversations, leaving you disheartened and ready to shut down the conversation. Loved ones may question the choices you have made or even openly disagree with your decisions. Others may be avoidant of the conversation altogether and question why it is being addressed now.

Having effective coping skills -- such as deep breathing, grounding yourself, and taking a break -- can help to increase your ability to stay calm and focused during end-of-life discussions. Having a supportive ally backing you up if conflict arises can also be helpful. Your personal choices do not need justification or explanations, unless you choose to offer them. If you notice rising anxiety levels or anger creeping in, slowing the conversation down and inviting everyone to take a breath gives family and friends the space to settle before continuing.

Thinking and talking about end-of-life care is something people often avoid, but starting the planning process and having the conversation early can make things easier for everyone if and when this transition occurs. Thorough planning and being sensitive in introducing the idea of end-of-life care to loved ones can help you feel more prepared, confident, and in control of your future.

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