These are the conversations no one wants to have. Talking with your parent about death, dying, and their final wishes feels uncomfortable, scary, and sometimes even taboo. So we avoid it. We tell ourselves there's time. We wait for the "right moment."
Then a crisis happens—a sudden illness, an accident, a hospitalization—and decisions must be made immediately by family members who don't know what their loved one would have wanted.
Having these conversations now, while your parent can participate, is one of the greatest gifts you can give each other. It ensures their wishes are honored, reduces your burden of decision-making, and often brings families closer rather than driving them apart.
People who discuss end-of-life wishes with loved ones report feeling relieved, not burdened. These conversations typically bring peace, not distress. The anticipation is usually worse than the reality.
Why These Conversations Matter
Without Them
- Family members must guess what the person would have wanted
- Siblings may disagree, sometimes irreconcilably
- Decisions made in crisis are often not what the person would have chosen
- Guilt haunts survivors: "Did we do the right thing?"
- Aggressive treatment may continue when the person would have wanted comfort care
- Or comfort measures may be chosen when the person would have wanted to fight
With Them
- Wishes are known and can be honored
- Family has clarity and unity
- Healthcare providers have guidance
- Less guilt and second-guessing
- Peace of mind for everyone, including the person whose life is ending
Getting Started
Overcoming Your Own Reluctance
- Acknowledge that avoiding the topic doesn't prevent death
- Remember: discussing death won't cause it to happen
- Consider your own end-of-life wishes—this builds empathy
- Focus on honoring their autonomy, not planning for death
- Think of it as love, not morbidity
Finding an Opening
Natural conversation starters:
- After someone else's death or illness: "That made me think about what would be important to me..."
- During a medical appointment: "The doctor mentioned advance directives. Have you thought about that?"
- News story about end-of-life decisions
- A birthday or milestone: "At this stage of life, I've been thinking about what matters most..."
- Your own planning: "I've been working on my advance directive. Have you done one?"
"I want to make sure I understand what would be important to you if you got really sick. Can we talk about it?" Or: "I love you and want to honor what you want. Can you help me understand your wishes?"
Topics to Cover
Values and Goals
Start with big-picture values, not medical specifics:
- What makes life worth living for you?
- What would be worse than death?
- What are you afraid of about dying?
- What brings you comfort and peace?
- What do you hope for as you near the end of life?
- Is there anything you still want to do or say?
Medical Decisions
Specific scenarios to discuss:
- CPR if your heart stops
- Mechanical ventilation (breathing machine)
- Artificial nutrition (feeding tube)
- Dialysis
- Hospitalization vs. staying home
- When to shift from "cure" to "comfort"
- What conditions would make aggressive treatment not worthwhile?
Where and How
- Where do they want to spend their final days? (Home, hospital, hospice)
- Who do they want present?
- What would bring comfort? (Music, spiritual care, quiet)
- Are there any religious or cultural practices to honor?
After Death
- Burial or cremation?
- Type of funeral or memorial service?
- Organ donation wishes
- Any specific requests for the service?
- Are arrangements pre-planned or pre-paid?
"Do you want to be on a ventilator?" is less useful than "Under what circumstances would you want to be on a breathing machine? When would you not want that?" Context matters more than checkboxes.
Making It Official
Advance Directive
A legal document stating healthcare wishes if unable to communicate:
- Also called "living will" in some states
- Specifies what treatments are wanted or not wanted
- Becomes effective when the person can't speak for themselves
- Should be shared with doctors and healthcare proxy
Healthcare Proxy (Healthcare Power of Attorney)
Names someone to make medical decisions if unable:
- Choose someone who will honor wishes, not impose their own
- Choose someone who can be present for decisions
- Choose someone who can advocate firmly with healthcare providers
- Have a backup person named
- This person needs to understand the values and wishes
POLST or MOLST
Medical orders for those with serious illness:
- Physician Orders for Life-Sustaining Treatment (varies by state)
- A medical order, not just a statement of wishes
- More specific than advance directive
- Travels with the patient; followed by EMS
- Completed with healthcare provider
Having an advance directive in a drawer helps no one. Copies should go to: healthcare proxy, all doctors, hospital (in their system), family members, and be easily accessible at home for emergencies.
Having the Conversation Well
Do
- Listen more than you talk
- Accept their wishes even if you disagree
- Take notes (with permission)
- Have multiple conversations—this doesn't have to be one big talk
- Revisit as circumstances change
- Thank them for sharing
Don't
- Push for decisions they're not ready to make
- Argue with their choices
- Make it about your needs
- Promise things you can't deliver ("I'll never put you in a nursing home")
- Wait for the perfect moment (it doesn't exist)
If They Resist
- Acknowledge their discomfort
- Explain why it matters to you
- Start with smaller topics (who to call in emergency)
- Share your own planning as a model
- Enlist a trusted third party (doctor, clergy)
- Try again later—sometimes it takes multiple attempts
- "What do you want your doctors to know about you as a person?"
- "If you could only tell your doctors one thing about what's important to you, what would it be?"
- "What would a 'good day' look like if you were seriously ill?"
- "What are you most worried about?"
- "Who do you trust to make decisions if you couldn't speak for yourself?"
Special Situations
If They Have Dementia
- Have conversations as early as possible in the disease
- Simple, concrete questions work better
- Focus on values and goals more than specific medical decisions
- Document what you learn while they can still participate
- Eventually, the healthcare proxy will need to make decisions based on known values
If Family Disagrees
- The person's wishes matter most—not family opinions
- Document wishes clearly while the person can express them
- Written advance directive helps prevent later disputes
- Consider family meeting with neutral facilitator
- Healthcare proxy has legal authority when time comes
If Culture or Religion Has Specific Requirements
- Discuss religious or cultural practices around death
- Consult with religious leader if helpful
- Ensure healthcare team knows about specific requirements
- Document in advance directive
What Happens After the Conversation
Documentation
- Complete formal advance directive (state-specific forms)
- Designate healthcare proxy in writing
- Consider POLST if appropriate
- Distribute copies to all relevant parties
- Store accessible copies at home
Ongoing Conversations
- Wishes may change as health changes—revisit periodically
- After major health events, check if wishes are still the same
- Update documents if wishes change
- Keep healthcare proxy informed of any changes
Prepare for Important Conversations
Our Difficult Conversation Scripts and Estate Planning Workbook help you navigate these discussions and organize important documents.
Get the Complete Caregiver KitResources
- The Conversation Project: Free conversation starter kits
- Five Wishes: User-friendly advance directive
- Prepare for Your Care: Step-by-step planning resource
- Caring Info (NHPCO): State-specific advance directive forms
- Your state's bar association: For legal requirements
- Having these conversations is a gift—to your parent and yourself
- Start with values and what matters most, not medical details
- Multiple small conversations work better than one big one
- Document wishes formally in advance directive and healthcare proxy
- Share documents with everyone who needs them
- Revisit as circumstances change
- The conversation matters as much as the documents