When parents, grandparents, aunts, uncles, cousins, and other family members gather around the holiday dinner table, conversations are typically sprinkled with small talk about the weather, football scores, and the latest gift-giving trends.
Rarely, though, do families address perhaps the most important subject for any adult – especially older adults with a serious health condition such as cancer, lung disease, or heart failure. What matters most to them in the time they have left on earth? How do they feel about invasive life-sustaining measures such as life support that might only prolong the inevitable? What kind of medical care would they want if they are no longer able to speak for themselves?
Discussing these healthcare decisions and the values that guide them is called advance care planning – and the best time to do it is now, experts say.
While such talk may seem at odds with the festive spirit of the season, the holidays are actually the perfect time for end-of-life discussions, said Sharon Hamill, PhD, a professor of Psychology at Cal State University San Marcos who has done significant work in the area of advance care planning. Hamill is the former and founding director of the CSU Shiley Institute for Palliative Care at Cal State San Marcos, a campus partner of the CSU Shiley Institute for Palliative Care.
How to Start the Conversation
Dr. Hamill said talking about personal values, quality of life, and the importance of documenting one’s own healthcare decisions can help destigmatize death and appreciate the now. Getting together for the holidays often presents several openings for those important conversations, she said.
“If adult children are visiting from out of town, they may not have seen their mom or dad all year, and they might notice that their parent is not moving so quickly anymore,” Dr. Hamill said. “That could be an opening for such a conversation.”
Aging parents could also initiate the conversation by talking about the joys of past holidays, what gives their lives meaning, and how they’d want to spend their final days. Would they want to pass away peacefully at home surrounded by family and friends, or in a hospital room knowing that all available medical interventions are being attempted, regardless of the likely outcome?
Avoiding these discussions can lead to deeper anxiety, guilt, and suffering if a medical crisis occurs and families are called on to make healthcare decisions not knowing what their loved one might want. “You want to have (these) conversation when you don’t need it,” Dr. Hamill said. “The very worst time is in the ER when there is so much stress and pressure.”
Advance Directives and Other Documents
Surveys have shown that about 80 percent of adults believe it’s important to have advance care planning conversations, and yet only about 30 percent have actually done so and documented their wishes in an advanced directive. There are two main types of advance directive —a living will and a durable power of attorney for healthcare.
A living will is a legal document that specifies the type of medical care that an individual does or does not want if they are unable to communicate their wishes.
A durable power of attorney for healthcare is an official form that lets you name someone else to make decisions about your care in case you are not able to make those decisions yourself. It gives that person (called your agent) instructions about the kinds of medical treatment you want.
“In the state of California getting an advance directive is as easy as Googling,” said Dr. Hamill. “Although many people take care of this directive with an attorney while doing their estate planning, you don’t [really] need a lawyer or a notary.”
She added that it’s best to choose three persons for the advance directive—one primary person and two others who know you and can serve as witnesses to the document. “Your primary person (or agent) should give the form to your doctor, but your doctor should not be one of the three people (the primary person or witnesses.)”
Conversations Bring Families Closer
Many healthcare professionals pursue training in advance care planning and can help provide you with forms or facilitate conversations. Primary care providers are often a great resource, as are palliative care and hospice providers.
Robert Sawicki, MD, Vice President Clinical Services for OSF HealthCare in Peoria, Illinois, talked about the importance of advance care planning during the holidays in a recent article on the OSF website.
In the article, Dr. Sawicki said, “The most important thing is not to be afraid of (advance care planning). Talking about these things doesn’t make them happen; it does not create fear and anxiety so much…”
“When it’s done it’s actually a relief,” Sawicki said. “Thank goodness we were able to talk about this—and it actually brings families closer together and isn’t that what the holidays are all about?”