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Fourth Quarter of Life:
Crucial Conversations

Nancy Fisher | 24th Street

With a higher percentage than the national average of residents over the age of sixty-five, Del Mar is lucky to have many resources for our seniors. Non-profits host educational programs, social events, and provide financial assistance. Community volunteers drive seniors to appointments and to grocery stores. Neighbors check up on neighbors.

But even in a city with a heart as big as ours, there are topics so sensitive that they’re just plain hard to talk about, so the Sandpiper has decided to screw up its courage and present a series of articles that will unflinchingly look at end-of-life issues. This one addresses how to talk, in detail, with family or friends about specific wishes, and next month we’ll tackle assisted living/skilled nursing and when and how to find the safest facility for you or a loved one. We intend to continue the series, so suggestions for topics are welcome.

If you have your estate plan in order, with a will or trust, a Health Care Proxy, a Power of Attorney and an Advance Directive stating your wishes, you’re way ahead of the game. 82% of people say it’s important to put their wishes in writing, but only 23% have actually done it (California Health Care Foundation 2012). If you’ve gone through the estate planning process, you’ve probably also made a decision about under what circumstances you’d want, or not want, to be resuscitated in the event of heart failure.

So anyone this far along is in good shape legally, but the questions that aren’t normally asked are trickier. For example, as a patient, how much would you want to know about your condition? This answer can range from “ignorance is bliss” to “I want a say in every decision.”

Another important issue is how much medical attention you want. Some want to live as long as possible “no matter what,” and others value quality of life over quantity. Some worry that they won’t get enough care and others that they’ll be treated too aggressively. Some are fine with being cared for in a nursing home and others prioritize living independently. When would it be okay to shift from curative to palliative care?

These are questions that are very hard to broach with loved ones. And speaking of loved ones, how involved do you want the family to be? Do you want them to follow your wishes even if it makes them uncomfortable or do you want them to do what brings them peace although it goes against what you’ve said? When the time comes do you want to be alone or surrounded by loved ones?

These are all wishes that can be discussed with family, doctors, and attorneys if you can find a way to start the conversation. The Conversation Project and the Institute for Healthcare Improvement, sources for much of this article, recommend identifying who, when, and where you want to begin. Do you want to talk with your mom, dad, sibling, child, partner, friend, or doctor? Do you want to do it before your next big trip, before you get sick again, at Sunday dinner? And where? At the kitchen table, on a long drive, on a beach walk?

For more information and a “starter kit” on how to address end-of-life care, please visit www.theconversationproject.org.


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