How to Have a Meaningful End-of-Life Conversation When You Can’t Be Together

As we continue to navigate the challenges of the COVID-19 pandemic, it has become increasingly necessary for families to have deep and difficult conversations about the end of life and individual preferences for care. Yet the isolation and social distancing that are required to prevent the spread of the virus make those conversations even more challenging to carry out.

We need to come together more than ever before, and we need to be open and honest about our wishes and goals for the last days of our lives. In the past, we could gather as a family around the kitchen table and explore this topic together, even though it might be uncomfortable at times. But how can we share meaningful conversation and find common ground when we are geographically miles apart? 

As more and more medical and mental health providers have resorted to using virtual technology to meet with patients, they are reporting that they can still have profound and meaningful discussions without being in the same room. We can learn from their success, so here are some suggestions for coming together virtually to conduct an end-of-life discussion:

Choose the best platform 

Having a visual connection with one another is essential for this type of deep communication, so consider using a video platform like Skype, Zoom, or even the video chat option on your phone. You can hold a conference call if necessary, but if you can’t see each other’s faces you will be missing some important non-verbal communication. Of course, sending emails is the least desirable method of connecting because of the loss of emotional tone and the ease of misinterpreting each other’s written words. Both Skype and Zoom are free and easy to use and allow you to have multiple participants.

Decide who to invite  

Make a list of key family members and loved ones who should be part of the discussion. You may want to have a preliminary conversation with the person who is stating their wishes to let them know what you want to talk about and give them time to think about their answers. It is helpful when all family members hear the same information at the same time in order to avoid confusion. You can also record the conversation so that anyone who can’t attend can listen later. 

Plan ahead for the conversation

Be prepared that some people on the call may have differing opinions, so decide how to divide up the time between listening and speaking. You might give each person five minutes to express their feelings after you’ve spent the majority of the time listening to your loved one whose wishes you are hoping to honor. Set a realistic goal for the discussion, and be prepared to meet again in the future to cover all of the necessary topics, if needed. For example, your initial goal might be to have your loved one complete an advance directive, so you’ll need to discuss the questions that the form requires.

Structure the discussion

Start by introducing the topic with a question, a story, or even by showing a brief video. For example, the trailer for the Netflix documentary “Extremis” is a compelling conversation starter because it portrays in just a few minutes what happens when people haven’t talked about their end-of-life wishes. You could even ask everyone to watch a film or read an article before you gather for the call, or you could play a discussion game together like Hello or The Death Deck. It can be helpful to have a theme for the conversation like “Planning Your Bucket List” that gives you something to return to if people start to wander off topic. 

Practice good etiquette for virtual calls

Ask each person involved to leave their camera on but to mute their microphone when not speaking. This will help eliminate background noise. Explain the agenda and goals for the call, and let them know when they will be invited to express their opinions. Have a plan for calling on each person when it is their turn to speak, and ask them to refrain from interrupting or talking over one another.

Utilize heart-centered listening

The most important outcome of this conversation is that your loved one feels heard and trusts that their wishes are important to you. Ask each person on the call to refrain from multi-tasking and stay focused on the discussion. Encourage everyone to make eye contact with the person who is speaking and also to place one hand over their heart while they are listening. This action helps engage the “compassion system” of the heart and brain, and can lead to greater empathy and less anxiety during the discussion.

Adjust your mindset

Remember that you can continue this conversation in the future, so don’t be attached to resolving every issue in one virtual meeting. Focus on gathering information rather than on pushing toward a certain outcome. Try not to take anything personally that is said, have compassion for the other people involved, and stay calm and centered as the discussion leader.

End on a positive note

Express gratitude to everyone for participating in this challenging discussion. Make plans for following up and gathering more information if necessary. Let your loved one know how important this conversation has been for all of you, and make sure they recognize that it has been an act of love.

Conversations about end-of-life issues are among the most important discussions we can have with our loved ones, and they are even more essential as we deal with the COVID-19 crisis. With patience and proper planning, we can overcome the current obstacles to these necessary talks and find a way to genuine heart-centered communication that will enable a better end-of-life experience for everyone involved.