How to Start the Conversation

Bringing it up is an important first step. 
Once the subject is brought out into the open, families commonly report that it comes as a relief. 
If a parent reassures you that “everything is taken care of,” it’s a good idea to press for specifics.

Consider using the following opportunities to bring up the subject:
Illness or death of a relative, friend or celebrity  -  A movie, book or TV program
Estate planning  -  Annual physicals  -  Change in health status
Family gatherings

Use direct statements or questions:
"If you ever got really sick I would be afraid of not knowing the kind of care you would want.”
“It worries me that we’ve never talked about it. I’d feel better if we did."
“If you could choose, how would you want the time to be spent at the end of your life?”
“How can I best care for you at the end of your life?”
“What would you consider a good death?”
“What type of care would you want and not want at the end of your life?”

If parents live in a different state:
They need to have an advance directive that is valid for their state.

one for their state and your own state so you can be familiar with both before a crisis or emergency. 

Frequently Asked Questions

#1 What if there is conflict among siblings?

When dealing with a parent(s), optimally all siblings and extended family should be a part of the discussion process. Conflicts among family members can often begin to overshadow discussions. Do not let power struggles regarding "whose way is the right way" distract from what is really at stake. The focus needs to be on the parent(s). The time and effort spent gaining family consensus before a death is a good investment in helping everyone constructively process events after a loved one has died. Bringing in a chaplain, social worker, trusted faith leader or other professional can help allow everyone to feel heard and guide the family through decisions that are informed and acceptable.

#2 How do I talk with my adult children?

No one understands your family dynamic better than you. You may want to take advantage of a time when the family is together. Holiday gatherings are a great opportunity for conversation. You may be more comfortable writing a letter to family members first, which could make subsequent conversations easier. Families commonly report that it comes as a relief to everyone once the subject is brought out into the open. Make clear that you would like to share something that is important to you. Reassure them that it is not your intention to make anyone uncomfortable. Explain that you want peace of mind for yourself and for them should decisions need to be made on your behalf. Resistance is common. Be persistent. Your family may initially try to change the subject, but remember talking about it will ultimately make their lives easier. Try to push through resistance by describing what you are afraid of if you don’t talk about it. Let them know they might need to make some tough decisions on your behalf in the future and you don’t want to make it worse than it needs to be by their not having the benefit of knowing what you want. And talk about it again from time to time, especially if there is a change in your personal health.

#3 My physician has never discussed advance planning. Should I bring it up?

It's important for your doctor to know your perspective about quality of life and types of medical interventions you do and do not want. If you are being treated for advanced illness, discuss goals of treatment. It is important to have enough information to make an informed decision about treatment options. Decisions should be based on a full awareness of the risks, benefits and expected outcomes. If at any time, you do not understand options or terms being discussed, ask questions. When weighing the benefit and burden of treatment options, ask your physician if the treatment will make a difference, what the expected side effects are and how it will affect your quality of life. Before a crisis, discuss with your doctor your desire to complete an advance directive. Information throughout this website can help prepare you to know what to ask. Once you have completed your directive, provide a copy for your physician. Make certain your physician’s office records include the contact information of your health care agent and designated alternate. With advanced illnesses you most likely will have several treating physicians. Do not assume each physician automatically understands your goals for treatment. Ask about treatment side effects and how pain and other symptoms can be managed.