What steps should be taken to communicate a loved one's end of life wishes?

David Kessler
Hospice & Palliative Medicine

Talking about a loves ones beliefs, wishes and values is the best way if they can no longer speak for themselves. If you can express them, put them on paper via documents known as an Advanced Directives or Durable Power of Attorney for Health Care. These documents will speak for you when you cannot. They allow you to specify the level of treatment you wish to receive, anything from full code to allowing for a natural death. They also can address pain medications to keep you comfortable as in your last months to weeks. You can also designate a proxy, a person who will make decisions for you when you cannot. There is also a new form call a POLST. It stands for Physician Order for Life Sustaining Treatment. Ask your local hospital, home health agency, nursing home or Doctor about them. 

The bottom line is sit down with your loved ones doctor and tell them what your loved one would want if they could walk in and see themself today. What happens to your loved one should always be based on their wishes and no one else’s.

Katie Ortlip
Hospice Nursing

Communication is the key to making sure that a loved one's wishes are respected at the end of life. This, ideally, should be discussed early on in life, and again and again throughout life. Sometimes talking about someone else's death helps us talk about our own wishes. The next step is to discuss these wishes fully and regularly with the person's health care provider, and document these wishes by filling out an advanced directive. In this document, a health care representative is appointed to make health care decisions based on the person's wishes, if he or she can't. These wishes can also be documented in this form. If someone is near the end of life, he or she may also want the doctor to sign a Do Not Resuscitate order, which instructs emergency personnel to allow the person to die naturally, and not try to "bring her or him back" once their heart and breathing stop. I think it's important to talk about other wishes as well, such as where you want to die, who you want to be with you, and other things that might be important to you at the end of life. Home care and hospice social workers are good resources to help with these important discussions and completing the paperwork.

Anne Fabiny
Geriatric Medicine
Desires for health care and end-of-life care cannot be followed if they haven't been clearly communicated to key people. Check that the following steps are taken to communicate your loved one's end-of-life wishes:
  • If possible, let the person preparing an advance directive discuss health care wishes with a doctor before writing the directive. If a directive has already been prepared, talk with the doctor to make sure the person's wishes are understood and can be followed.
  • Provide all doctors caring for the patient with a copy of the advance directive. Keep a copy handy yourself.
  • Make sure anyone named as agent in a health care proxy has a copy of that document and knows the goals for medical care.
  • Explain the person's health care wishes to other family members. Be prepared to acknowledge that this is a difficult topic even if you have become comfortable discussing it.
  • Realize that more than one discussion with doctors and family is warranted. Revisit the advance directive annually or whenever big changes occur in your loved one's health to be sure the document still reflects his or her needs.
  • When a person is admitted to a hospital, ask the doctor primarily responsible for the care of your family member to look at a copy of the directive and put it in the medical chart.  Have a conversation with the doctor or team to make sure they understand and will comply with your family member’s wishes.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.