Close to Home: End-of-life discussions are hard — but have them anyway

An elderly friend of our family recently died. After a slow year-long decline, our friend experienced a rapid and dramatic downturn over his last two weeks. A day before his death, his son confided to me that his father's ability to manage his affairs had deteriorated over the last year and he would be confronting a chaotic mass of papers scattered over several rooms with his father's death.

Our friend's death inspired me to think about my own aging parents and the conversations I have not yet had with them. I am in the sandwich generation, a middle-aged adult raising children while at the same time bearing witness to aging parents. So far, I have only had brief conversations with my parents about their end-of-life wishes. I could not tell you if either one of them had begun to think about their own deaths. In reflecting upon this, two questions stood out to me: What sort of advanced care planning have they made and how do they want to be remembered?

Many people have not discussed this subject with their parents, let alone contemplated their own end-of-life issues. A study published in the American Journal of Preventive Medicine in 2014 looked at adults who did and did not have an advance directive. Of the more than 7,900 respondents, only 26.3 percent had an advance directive. Lack of awareness was cited as the most common reason a person did not have a specific end-of-life plan.

This led to my first question to my parents: What sort of advanced care planning have you made?

Sometimes referred to as end-of-life planning, this comes down to three important documents: a will, a financial power of attorney and healthcare power of attorney. There are endless online resources and legal experts available to fill these out and ensure that they both fulfill wishes and are legally sound. Details include everything from financial planning to cover extensive costs to what type of memorial service someone desires.

The second question is more emotionally charged: How do you want to be remembered? The answers from my parents for this question were more elusive. I should have anticipated their answers to this question would be more complex since this is the question that keeps many of us awake at night. I challenged them with specifics. Are there certain important items you want to leave for certain people? Are there things you would like said or done at your final service?

An excellent resource for these issues is a book by Sally Balch Hurme, “ABA/AARP Checklist for My Family: A Guide to My History, Financial Plans and Final Wishes.” She offers a few more specific suggestions including sorting through, dating and identifying family photos before those in the picture are forgotten and photographing or videotaping special possessions and noting who should get special items.

These two questions have resulted in two important conversations between my parents and myself. It turns out, my mother has most of this already figured out, my father not so much, but at least now he is thinking about it. These discussions are just the beginning, but it was good to get started. End-of-life discussions are hard; anticipate some charged feelings, break it up over several sessions and consider getting other family members involved. Regardless, if you haven't started the conversation, do it. If you have started, do it some more. Whatever you do, just make sure you do it.

Dr. Douglas Jimenez is a family physician who teaches in the Santa Rosa Family Medicine Residency. He lives in Santa Rosa.