How to Talk to Your Doctor About End-of-Life Wishes

Most people assume their doctor will bring up end-of-life wishes, but research shows that's rarely the case, especially for patients who appear healthy. As a result, it's up to you to initiate this crucial conversation. By doing so, you'll ensure your medical team understands your preferences and can honor them when the time comes.

Advance Directive vs. POLST: The Difference Matters

An advance directive is a document that outlines your general wishes regarding end-of-life care, created by you, and governs only if you're unable to speak for yourself. On the other hand, a POLST (Physician Orders for Life-Sustaining Treatment) or MOLST (Medical Orders for Life-Sustaining Treatment) is a physician order that you and your doctor sign together, governing active care. Both serve different purposes and are essential for ensuring your wishes are respected. The advance directive provides a broad outline of your preferences, while the POLST/MOLST form translates those wishes into actionable medical orders.

When to Have This Conversation

You don't have to be seriously ill to discuss end-of-life wishes with your doctor. Ideally, you should have this conversation when you're 60 or older and still healthy. The annual wellness visit is an excellent opportunity to bring it up. You should also consider discussing end-of-life wishes before surgery, after a new diagnosis, or when a parent is aging and may soon need decisions made on their behalf. By having this conversation early, you'll ensure your wishes are documented and respected, even if your health status changes.

How to Start the Conversation With Your Doctor

Starting the conversation with your doctor can be as simple as saying, "I'd like to talk about my end-of-life preferences today" or "I want to make sure my wishes are documented before they're ever needed." Doctors respond well to directness, so be clear and straightforward about your intentions. If your doctor seems dismissive or uncomfortable, it may be a sign that you need to find a different doctor who is more willing to have this important conversation. Remember, this discussion is a normal part of healthcare, and your doctor should be supportive and non-judgmental.

Key Questions to Answer Before the Appointment

Before meeting with your doctor, take some time to reflect on what matters most to you. Consider the following questions: What does a "good death" look like to you? What would you want if you couldn't communicate your wishes? Who do you trust to make decisions for you if you're unable to do so? What medical interventions would you want or refuse, such as CPR, ventilator, feeding tube, or aggressive treatment versus comfort care? Thinking critically about these questions will help you clarify your wishes and ensure you're prepared for the conversation with your doctor.

What Happens After the Conversation

After discussing your end-of-life wishes with your doctor, they will document your preferences in your medical chart. You'll also receive a POLST form, which you should keep in an accessible location, such as with your other important documents or in a visible spot at home. Do not store it in a safety deposit box, as it may be difficult to access when needed. Share copies of the POLST form with your healthcare proxy, family members, and keep one at home. It's essential to revisit this conversation annually or after any significant health changes to ensure your wishes remain up-to-date and respected.

What If Your Family Disagrees With Your Wishes

If your family disagrees with your end-of-life wishes, it's essential to remember that your documented preferences take precedence. The law prioritizes patient autonomy, and your wishes should be respected, even if they differ from your family's preferences. To minimize potential conflicts, consider having an open and honest conversation with your family about your wishes. This will help them understand and honor your decisions without feeling guilty or uncertain. By discussing your preferences with your loved ones, you can ensure they're prepared to support your wishes when the time comes.

Final Thoughts

Having a conversation with your doctor about end-of-life wishes is one of the most important discussions you'll ever have, and it's also one of the most loving things you can do for your family. By taking the initiative to discuss your preferences, you'll ensure your wishes are respected, and your loved ones will be spared the burden of making difficult decisions without your input. Approach this conversation with confidence and clarity, knowing that it's a crucial step in taking control of your healthcare and ensuring your values are honored.

Disclaimer: This article is for informational purposes only and does not constitute legal, financial, or medical advice. Always consult a qualified professional for guidance specific to your situation.