START THE CONVERSATION ON ADVANCE CARE PLANNING WITH NON-INTIMIDATING STATEMENTS AND PROFOUND QUESTIONS

A conversation on advance care planning requires an ample forethought. We must plan what to say and consider using approaches to open the discussion.  The American Bar Association has suggested some conversation starters:[1]

“I know this makes you feel uncomfortable, but I need you to listen, to hear what I have to say. It’s very important to me.”

 “Yes, death is in God’s hands, but how we live until that moment is in our hands, and that’s what I need to talk to you about.”

 “If it is too overwhelming for you right now, I understand. But let’s make an appointment for a specific time to sit down together to discuss this. All right?”

 “If we don’t talk about this now, we could both end up in a situation that is even more uncomfortable. I’d really like to avoid that if I could.”

 “Do you remember what happened to so-and-so and what his family went through? I don’t want you to have to go through that with me. That’s why I want to talk about this now, while we can.”

You may want to follow an outline for the discussion by asking important questions. Questions are important tools to open a conversation and to clarify misconceptions. The following are some of the suggested guide questions in advance care planning:  

  • Are you aware of your diagnosis and the prognosis of your illness? Do you understand their implications?
  • What are the tests and medical procedures being suggested by your doctor? Do you understand why they are important?
  • Is there any alternative approach to medical care?
  • Do you understand the side effects of the recommended treatment? Are you determined to pursue it?
  • What is the implication of the treatment to your family? Will it imperil their financial security?
  • Will the treatment allow you to spend quality time with your family and friends?
  • Are you able to discontinue the treatment at any time and for any reason?
  • If you pursue treatment or procedure and would not work, what will be the next step you would take?
  • What are the consequences if you do not pursue a recommended treatment/
  • What are your wishes and preferences at the end of life? What experiences do you value most about your life?
  • Have you found time to talk to a spiritual counselor or a member of the clergy to learn the teachings of your faith about end-of-life care?
  • If you were diagnosed with a terminal illness, or become incapacitated, would you want to pursue life-sustaining treatments?
  • Do you want to be resuscitated when your heart stops?
  • How do you feel about extended hospitalization?
  • Do you consider hospice care?
  • What is your opinion about pain (some patients equate suffering as a spiritual journey)? Are you aware of the side effects of pain medication, particularly morphine?
  • Do you consider to be on pain medicine even with its known side effects?
  • What area about your care do you want to entrust to your loved ones or caretakers?
  • What do you hope for most regarding your death or the death of a loved one?

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References:

[1] Conversation Scripts, Getting Past the Resistance,  American Bar Association, https://www.americanbar.org/content/dam/aba/administrative/law_aging/tool6.pdf

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