How to get the discussion started

by Kelly O'Shea, McClatchy-Tribune

Published Jan. 17, 2014, 2:02 p.m. ET

HOW TO GET THE DISCUSSION STARTED

Here are some tips from Harriet Warshaw, the executive director of the Conversation Project, www.theconversationconservation.org. Its website offers a starter kit with many tips. "It enables people to prepare their thoughts and gives the confidence to initiate the conversation," said Warshaw. "What we have learned is that once people begin the conversation, it turns out to be one of the more intimate and rewarding conversations they have ever had with their loved ones.

1. Bring up the topic before there is a crisis. The kitchen table is a good place to gather. We also recommend that the discussion take place with parents and all the adult children at the same time. This way everyone hears directly from each other what matters most to them. Since many families live apart we suggest thinking about having the conversation when families gather for holidays, during a family vacation or when people are celebrating milestones.

2. Opening lines. Use this article to broach the subject. "There was a Detroit Free Press story about end-of-life care and the importance of having the conversation with our loved ones on what matters to me at the end of my life."

"I was talking with a friend about the way her mom died recently, it was so wonderful that everyone knew what she wanted at the end of her life."

"I want to give you the gift of knowing what is important to me at the end of my life."

"As a family, I want everyone to know how I want to live at the end of my life."

3. What if family members don't want to talk about it? Parents always want to be parents no matter how old their children are, says Warshaw. Ask parents for their help in understanding what they want at the end of their lives so that the adult child can honor these last wishes, she advises.

If grown children are reluctant, parents can stress how a discussion ensures offspring won't be second-guessing choices they make on their parents' behalf. That kind of doubt, says Warshaw, can lead to unnecessary grief and depression.

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TOPICS TO EXPLORE ONCE YOU GET TALKING

—Where do I want to die? At home, or in a hospital or medical facility? Surrounded by people who love me, or privately with as little fuss as possible?

—What kind of medical treatment do I want?

—Who do I want to take care of me? Do I have a preference in terms of male or female, or anything else?

—What kind of funeral services do I want? Do I care about an open or closed casket, cremation or donating my body to science?

—Where do I want to be buried? Do I have a burial plot? Do I want to use it or be buried somewhere else?

Then, use their answers to help them assemble advance directives, which are legal documents that explicitly describe their wishes for care near the end. Prepare the two most important directives:

1. A Living Will: This document specifies their wishes regarding medical treatment, and particularly the refusal of life-prolonging medication when death is imminent.

2. A Health Care Power of Attorney: This document allows your parents to appoint someone they trust to act on their behalf and make decisions regarding their medical treatment if they are unable to do so.

Give copies of the directives to the key people involved in your loved one's life, with his or her permission.

Source: AARP'S caregiving resource center

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