Questions to Discuss with Parents About Their End-of-Life Care

Introduction

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If you have aging parents, now is the time to discuss what's important to them as they near the end of their lives. Too many adult children wait to have end-of-life conversations when their parents are dying or in the midst of a crisis.

The topic may seem downright frightening, but it is important to know your parents' preferences at the end of life, particularly if they develop a serious illness or condition that leaves them unable to make decisions.

A good time to have an end-of-life talk is during the holidays when family is together.

If your parents wish to avoid such a conversation altogether, they can record their preferences in a living will, a dated letter or even in an email. None of their decisions are permanent, and they can always change their preferences at a later date as long as they can competently communicate.

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Because starting a discussion about life-and-death issues can be difficult, here are 10 questions to help guide the conversation:

• Thinking about your death, what do you value most about your life
• If you were diagnosed with a terminal illness, would you want to pursue every possible cure
• Do you imagine wanting to stop curative efforts if they were unsuccessful
• What kinds of aggressive treatments would you want (or not want)
• Do you want to die at home
• How do you feel about an extended hospitalization
• How much pain is acceptable to you
• Do you want to be with your family when you die
• What decisions regarding care do you want to entrust to others
• What do you hope for most regarding your death

There are three care options to consider if your parents are facing a diagnosis with a poor prognosis.

• They can choose to continue efforts to cure or treat an illness or condition.
• They can receive palliative care (pain and symptom management and relief) alone or in addition to curative care.
• Or they can choose hospice care.

With hospice, a fully covered Medicare benefit, futile curative measures cease and palliative care eliminates or greatly reduces pain and symptoms. The patient receives medical and social services, typically at home, and the entire family receives supportive services.

You can get a glimpse into the hospice experience in a recent special program, "Hospice: Something More. " Produced by Hospice Foundation of America and funded by a grant from the John and Wauna Harman Foundation, the program is available for viewing at hospicefoundation.org.

If having an end-of-life discussion with your parents is simply unworkable, consider asking a trusted friend, health or social service professional to facilitate and document a discussion. Again, do not wait until an illness forces you to have this conversation. One of the most common comments that hospice professionals hear from patients and families is that they wish they had started hospice care earlier.

So what are you waiting for? Now is the time to talk to your aging parents about end-of-life care.