Why we have to talk to our families about death

By Liliya Jones

Originally published on onmogul.com

The holiday season means pie for breakfast, lunch, and dinner (just me?) and, for a lot of people, spending the most time they get with their families all year. This year, once the carbs and turkey get everybody appropriately sedated, I propose that you try something a little unexpected: starting a conversation with your family about aging and end of life.

Discomfort now, no resentment later (thanks, Brene Brown!)

These conversations are difficult. Aging and loss of capacity is scary enough; the specter of death lurking at the corners of these conversations, even more so. However, until the Silicon Valley finally disrupts mortality, we all have to face this reality sooner or later. It’s tempting to put off these conversations until they are unavoidable, but the problem is that’s often too late.

In reality, avoidance and inaction ends up putting all of the responsibility on caretakers to make difficult decisions later on. The reality of modern-day aging and dying is that there’s almost never a time when doctors can do nothing, but, as disease and aging progress, the treatments carry smaller and smaller chance of “curing” the condition, while side effects keep mounting. This means many very difficult choices along the way. By clarifying what is important to you, and helping your loved ones do the same, you can simplify the decision-making process for the caretakers.

How to do it (a.k.a. ice cream is important)

This conversation revolves around individual definitions of well-being in old age and at the end of life. Some questions that elder-care experts suggest discussing (excerpted from Atul Gawande’s Being Mortal) are below:

What are your concerns about what lies ahead?

What kind of trade-offs are you willing to make?

How do you want to spend your time if your health worsens?

Who do you want to make decisions if you can’t?

If you can clarify the answers to these, you will make end of life decisions much less daunting. For example, palliative care expert Susan Block, asked her father how much he was willing to go through to have a shot at being alive and what level of being alive was acceptable to him. He responded: “If I’m able to eat chocolate ice cream and watch football on TV, then I’m willing to stay alive. I’m willing to go through a lot of pain if I have a shot at that.” Later, when she had to direct medical professionals on whether to proceed with risky surgery for him, all she had to do was ask them about the likelihood of his ability to eat ice cream and watch football afterward. She didn’t have to bear the responsibility of potentially letting him go too early or condemning him to a life of discomfort he didn’t want. She just had to ask the right questions.

Getting started (sharing is caring)

Last year, a client shared concerns about his aging parents with us and asked for advice. He came from a family with 3 kids and parents who were on and off welfare during his childhood. He is now a highly sought-after music producer, and most financially successful of his siblings. He also lives farthest away, so while he would be able to contribute financially to his parents’ care, it would be his siblings who would most likely have to give their time. He could see all this adding up to a lot of difficult decisions down the line.

We suggested that before jumping into having these sensitive conversations with his family, it would be really helpful to answer those questions for himself. So he and his wife got busy figuring out what was important to them. Rather than just using the basic questions listed above, they used the more robust tools provided by The Conversation Project. Once they were clear and had their estate planning documents in place (wills, powers of attorney, and advance directives), they brought his siblings into the conversation.

They talked about their own elderhood as well as their parents’ and shared their priorities and concerns. It was much easier to approach them from a place of “I’d like to share what I’ve done” than “here’s what you should do.” With all the kids on the same page, they finally started the conversation with the parents. Our client felt much more prepared having done the work himself and recruited his siblings to the cause as well. They decided to gift their parents the services of an estate planning attorney for Christmas that year. They also discussed which of the kids would be responsible for contributing their time/money/other resources to the care of their parents when it becomes necessary.

In our most recent meeting, the client shared how much relief he felt at having this issue finally in the open. The whole family is now aligned around each other’s wishes and concerns. They are prepared for when difficult decisions inevitably start to arise in relation to their parents and their own aging.

Conclusion

Before modern medicine, it used to be that the period between getting sick and dying was brief and most people didn’t live too far past what’s now considered “retirement age.” Things have changed. We can live for years and decades after retirement and after formerly-terminal diagnoses. This has meant that there are many choices to be made along the way. Getting clear on what’s important to you and your loved ones early on will save you a lot of heartache later.

Bottom line: Talking about death is difficult, but you’ll be glad you did. Plus, at least it’s not as difficult as talking about money!