How to Start a Conversation About End-of-Life Care

Issues to address

This list is a starting point; there may be other issues to think and talk about. Your health care team may be able to suggest additional questions.

Keep in mind that you don't have to steer the conversation — just let it happen. You don't have to cover everyone and everything right off the bat. Be patient and give others time to think about what's being said.

If there are disagreements, try not to judge: A “good death” means different things to different people.

And remember, as circumstances change, you and your loved ones can revisit issues.

1. What do you want the last phase of your life to be like?
2. Are there important milestones you'd like to be there for (the birth of a grandchild, your 80th birthday)?
3. How do you want to handle medical decisions? As a patient, how much do you want to know about your condition? If you have a terminal illness, do you want to know how quickly it is progressing?
4. How much information do you want doctors to share with your loved ones?
5. Do you want to be actively involved in care decisions?
6. If you prefer to have a loved one make decision, who do you want involved in those decision? Which family member will be the primary decision maker?
7. What do you want your medical care to look like? Are there treatments you would want (or not want), such as a feeding tube or resuscitation if your heart stops?
8. Do you want to continue treatment, no matter how uncomfortable it gets, or is quality of life more important than quantity?
9. Is there a point you think you might want to move from curing an illness to comfort care alone?
10. Do you want to spend your last days at home, or are you OK being in a hospice, hospital or nursing facility?
11. When the time comes, who would you like to be with you?

Additional topics to raise now or at a later date:

Are there financial affairs you want to get in order?

Are there family tensions you're concerned about?

Setting up for the talk

Once you feel ready to share your end-of-life wishes, or to solicit them from a loved one, think about the basics: who, what, where and when.

Who should I invite? The list could include not just particular family members but also friends, doctors, caregivers, members of the clergy or others.

When should we talk? Do you want to broach the subject at a family gathering — around the holidays, for example? Ahead of major life events like the birth of a child or grandchild, or a kid leaving for college? At the first sign of a significant health problem?

Where should we talk? Around the kitchen table? At a favorite restaurant or park? On a hike or at your place of worship? Choose a setting you think will be conducive to an intimate, open conversation.

After you’ve talked

Congratulate yourself! You've broken the barrier. This initial conversation will hopefully be the first of many. Think about how it went, and how you'd like future talks to go. For example:

How did it make you feel? What do you want to remember about it?

What do you want your loved ones to remember about it?

Is there anything you need to clarify? Something you think was misinterpreted or misunderstood?

What do you want to make sure to talk about, or ask about, next time?

Next steps

Another important follow-up to the conversation is putting what you talked about in writing, in legal documents that will ensure those wishes are respected when the time comes.

Create a power of attorney for health care in which you appoint an agent (commonly called a health care proxy) to make medical decisions for you, based on your expressed wishes, if you can no longer speak for yourself.

Create an advance directive that lays out your wishes regarding end-of-life medical care, including what kinds of treatment you do or don't want.

More resources

The Conversation Project has a downloadable guide developed to give people a jumping-off point for this all-important talk and to help them keep it going over time.

Editor's note: This story has been updated with new information.