There has been a push in recent years for adults 18 and over to create an advance directive to tell their loved ones what type of care they would like to receive at the end of life. This advance planning is especially important for those who want to avoid unwanted and costly care when they reach their final days.
The conversation about end-of-life wishes is meant to inform friends and family so that they can make sure the patient receives the care they want. But what happens if you and your loved ones don’t share the same feelings and preferences for the last days of life? What if you have been asked to serve as a healthcare proxy for someone in your family but you find out that you don’t agree with that person’s choices?
As an example, Theresa had consented to serve as a proxy for her elderly aunt who had never married and had no children. But when she received a copy of her aunt’s advance directive Theresa was surprised to see that she indicated she wanted to be resuscitated if her heart stopped beating. Theresa didn’t feel that she could support that decision because of her aunt’s frailty and underlying health issues.
This can be a tricky situation as it was for Theresa, because we want to help our loved ones as much as possible when they reach the end of their lives, but we also have our own strongly-held beliefs and opinions. Here are some steps to take to help you negotiate this challenging situation:
Have a face-to-face conversation
In Theresa’s case she had received a copy of her aunt’s paperwork but had not talked about her wishes with her. It’s important to understand the deeper reasoning and emotions behind your loved one’s choices so take time to sit together and discuss these issues thoroughly. Invite other family members to be present as well so that you can all share the same information.
Utilize discussion tools
To facilitate your conversation you might want to bring along copies of the Starter Kit from The Conversation Project. This booklet asks pertinent questions about end-of-life issues and allows you to express your answers on a scale from 1 to 10. The nuances and complexities of choices become more apparent when the possible responses are more than just yes or no.
The Go Wish Game is another excellent tool for guiding conversations about these challenging issues. As you each discuss your own feelings about the questions in the game or starter kit you will begin to see where you share common ground and where you differ in your understanding.
Get more information
During your conversation you may discover that you and/or your loved one are lacking some of the factual information needed to make the best possible choices. In Theresa’s case her aunt didn’t really understand what resuscitation entails and based her decision on something she had once seen on television. You might arrange to watch a film together like Being Mortal on PBS, take a class in your community, or engage in an online presentation about advance care planning so that you can base your discussion on a shared fund of knowledge.
Express your concerns
Once you have a full understanding of your loved one’s preferences and the reasons behind them take time to explain your own concerns. Be honest if you still cannot support their choices and explore together the possibility that another person might be a better fit for healthcare proxy.
Revisit the discussion at a later date
Don’t try to reach consensus in a single conversation. Agree to meet again after taking time to process the ideas that were discussed. Over time you or your loved one may begin to see things differently and might find it easier to compromise than seemed to be true initially.
Know what love means to you
Throughout life there are many times when we disagree with a loved one, yet we manage to show love and support for them anyway. Examine whether or not you would ultimately be able to advocate for your loved one’s wishes even if you don’t share those wishes. Could you temporarily set aside your personal preferences in order to represent someone you love?
The answer to this question might make all the difference in the outcome of your discussion. Consider carefully what it means to love another person and how best to show that love. This is one of the most important issues that arises at the end of life—is it more loving to hold on to every moment of life or to let go peacefully when the time comes?
Ultimately each of us will say goodbye to those we love and hopefully we can find ways to offer our caring and support even when we don’t agree. The best hope for a peaceful farewell is to begin these very important conversations now and continue them over time.
Dr. Karen Wyatt is a hospice and family physician who writes extensively on spirituality and medicine, especially at the end-of-life. She is the author of “The Tao of Death” and the award-winning book “What Really Matters: 7 Lessons for Living from the Stories of the Dying”. She is a frequent keynote speaker and radio show guest whose profound teachings have helped many find their way through the difficult times of life. Learn more about her work at www.karenwyattmd.com. Connect with Karen Wyatt at karenwyattmd.com, on Facebook and on Twitter .