How to Start End-of-Life Conversations

Lead by example. Begin by talking about your own desires and preferences for the end of life, suggests Katy Butler, author of Knocking on Heaven’s Door: The Path to a Better Way of Death. Then ask, “I was wondering if you’d thought about these things.” You can fill out your own advance directives, then ask, “Do you have a sense of who you’d like to have helping you if you can’t make decisions?”

Use the news. “I read an interesting article/heard a podcast/saw a video about end-of-life planning, and it really got me thinking about these things for myself — and for you.”

Use a medical occasion. You can always request that your loved one’s physician initiate the conversation. Counselor Howard ­Winokuer, PhD, coauthor of Principles and Practices of Grief Counseling, notes that doctors will often ask a patient whether she or he has filled out an advance directive for end-of-life care, and this relatively neutral, professional approach may work better for some people than if a family member raises the issue.

Employ the “control” Angle. “People may not like talking about death, but they generally like the concept of control,” says psychologist and grief specialist Janice Nadeau, PhD. “So you can approach the topic by saying something like, ‘If you want control over what happens at the end of your life, it’s important that we talk about this and get your wishes written down.’”

Connect with one family member. Even if there’s a “we don’t talk about things like that” rule in your family, there’s likely to be at least one member who’s more open to the idea than others, Nadeau suggests. Even a short conversation is progress. “You don’t have to set up a grand family conference. You can begin with a single conversation with that relatively open person.”

Use the movies. Many films deal with physical decline and death in a sympathetic and life-affirming way, including The Bucket List, Steel Magnolias, and Still Alice. (The Huffington Post has a list at huff.to/28NvUZD.) Nadeau suggests using these films as conversation starters.

Use The Conversation Project’s online starter kit. After her mother’s death, journalist Ellen Goodman founded The Conversation Project, whose goal is to make end-of-life discussions easier and more productive. The project’s online Conversation Starter Kit (theconversationproject.org/starter-kit/intro) provides a handy way to record wishes about the end of life, to share them with your loved ones, and to get the conversation going.