While most everyone believes that they should talk with their loved ones about end-of-life care, only about a quarter of people have. Dr. Lynda Tang, palliative medicine physician at Vancouver Clinic, answers questions about how to get the conversation started.
Q: What is advance care planning?
Dr. Tang: Advance care planning is the process of deciding what quality of life is important to you, and what type of care you would like to receive, should you become ill—and then sharing your wishes with loved ones. Some patients would be devastated if they couldn’t fish, and a treatment that would leave them too frail to move wouldn’t be worth pursuing. Others would want to follow any path that allowed them to be around their family for as long as possible.
Q: Why is advance care planning important?
Dr. Tang: It helps you clarify how you want to live and makes it easier to weigh which treatments, medications, and interventions to pursue. It also gives loved ones the information they need to make health care decisions on your behalf if you are no longer able to speak for yourself. While documents such as health care directives and living wills are important, they can’t always be located during an emergency. Involving loved ones is what ensures that patients’ wishes are honored. Research data shows that the process of planning and talking is more effective than the actual paper.
Q: At what age do I need a plan?
Dr. Tang: Planning can benefit anyone 18 years or older. Accidents and emergencies can happen at any age. More importantly, having these talks many times over the years normalizes the conversation. If you spend time really thinking about what you want, then tough decisions aren’t nearly as tough when they are actually in front of you.
Q: How do I get started?
Dr. Tang: Before talking to your loved ones, make a list of your wishes. Think about how you want to live, if there are certain goals you want to reach (such as a wedding or anniversary), and how much support you are willing to accept. Are you okay with getting help with eating and dressing, for example? Decide what lifesaving measures you want, such as dialysis or artificial nutrition. Decide who you want as your durable power of attorney for health care—the one legally able to make decisions for you.
Q: How do I bring this up with my family?
Dr. Tang: You can ease into the conversation by talking about the time another loved one was hospitalized, how that went, and how you felt about it. You can explain that your doctor recommended that you have the conversation while your mind was clear and no one was in distress. You can frame it as something that responsible adults do. Sometimes it can be helpful to have a pastor, trusted friend, or medical provider present.
Q: What if I change my mind about what I want?
Dr. Tang: It’s normal and expected for your desires to change over time. Advance care planning is a process. Keep the conversation alive so that your loved ones know what matters to you.