How To Tell Your Loved Ones

(This article marks the official return to my role as blog editor after an unplanned break of over two years. I am grateful to Gary Wederspahn for stepping up in my absence, and Melanie Raine for her continued technical assistance. One or more articles about the circumstances of the break will be forthcoming. – Kevin Bradley)

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One of the most common questions asked by people considering ending their suffering is how to start the conversation with family members and friends. That question is usually due to the fear that our loved ones won’t want to talk about it or will be angry that we’re bringing it up.

Exactly how you start the conversation will depend on your relationship dynamics. Maybe your family is accustomed to having difficult conversations or debating contentious issues.

“I was diagnosed with cancer today. I’m not going to go out the way my dad did, so I updated my will, wrote my obituary, and called Final Exit Network. Please pass the potatoes.”

Unless you have a family like that, something less direct may be in order. One approach that tends to be successful is to start with your own fear of how your loved ones might react. Let’s say you have a friend who may be elderly or has been struggling with a debilitating illness. Suddenly, they blurt out, “I’m tired of it all and I’m ready to die.”

Most people’s response to something like that is to push back against the idea, even while thinking we are being supportive. The underlying problem is that we aren’t emotionally prepared to have the conversation.

Now imagine instead the elderly or ailing friend says this: “I have something important to talk with you about but I’m afraid you will get upset.”

Chances are good that you didn’t have the same kind of emotional reaction. You probably don’t want to be the cause of upset, especially to anyone in a vulnerable state such as illness or advanced age. In fact, you will most likely bend over backwards to avoid that perception. “Please tell me what’s on your mind. I promise I won’t be upset.”

That may be a lie, because you may well be upset, but you will be emotionally and mentally prepared for the conversation so you will likely be considerably less upset, or at least you’ll be able to mask how upset you are.

The point is that by saying “please tell me what’s on your mind” you are inviting the conversation. If you’re the one delivering the news, the key is to find a way to prompt the invitation. The example above is just one idea.

Another approach is to leave in a conspicuous place something likely to prompt a question. The next time you update your advance directive (which should be at least once a year), leave it where a family member or friend will see it. If they know you have an advance directive (which should always be the case), seeing it shouldn’t create much drama, but it might at least start the conversation. (“I see you’re updating your advance directive. Are you changing anything?”)

By the way, it’s important to have both an advance directive and health care power of attorney. The advance directive explains what you want. A health care power of attorney gives someone the authority to ensure your advance directive is followed, which is not always the case.

I also urge everyone to write their own obituary and even plan their own funeral down to the last detail, such as who you want to serve in specific roles or what songs or flowers you want. You will be doing your loved ones a huge favor. It’s the advice I gave as a hospital and hospice chaplain that was often met with the most surprise but was also the advice for which I was most often thanked.

You might even ask your loved ones to participate in making your funeral plans. It’s always possible that someone will want nothing to do with it, but it can lead to some deeply meaningful conversations. At the very least, it will minimize arguments if they’re forced to make those plans without you and each is convinced you would want something different.

Your favorite flower may not be in bloom if you die in the winter, so you may want to avoid explicitly asking for something like “a rose from my garden”. And, even if you have a terminal illness, it’s entirely possible that you will outlive whoever you designate for a specific role. The solution to that is to list your first choice along with a backup. Update your funeral plans when you update your advance directive and healthcare power of attorney.

You should also consider having someone assigned as a co-owner of your bank accounts, not just a co-signer. I was a co-signer on my mother’s accounts and was surprised when the bank closed them when she died, which meant we couldn’t pay some of her outstanding bills right away. Being a co-owner avoids that problem. Also, be sure to have beneficiaries named on all assets. I learned about that the hard way when my brother died without any end-of-life plans in place. You can read about that nightmare here and here.

I’ve been asked if it’s a good idea to leave a copy of Final Exit where someone will see it as a way to start the conversation. I don’t recommend it as a way to prompt the very first discussion about death and dying. However, if you’ve had other family discussions about end-of-life planning and if your loved ones know you’ve been diagnosed with a potentially terminal or debilitating illness, seeing you have the book might be a way for them to learn you might be considering that option. They might not like it, but if they ask about it they are, in fact, inviting the conversation.

There are many ways to start the conversation, and many of them may be uncomfortable. As Dr. Lonny Shavelson wrote in last week’s blog article, it may fall on you to insist that your doctor is completely honest with you. Likewise, it falls on you to be completely honest with your loved ones about what you want. And the sooner the better.

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Final Exit Network (FEN) is a network of dedicated professionals and caring, trained volunteers who support mentally competent adults as they navigate their end-of-life journey. Established in 2004, FEN seeks to educate qualified individuals in practical, peaceful ways to end their lives, offer a compassionate bedside presence and defend a person’s right to choose. For more information, go to www.finalexitnetwork.org.

Payments and donations are tax deductible to the full extent allowed by law. Final Exit Network is a 501(c)3 nonprofit organization.