Many people dread having an Advance Care Planning conversation because they don’t want to think about themselves or their loved one being too ill or injured to speak for themselves or about eventually losing that person.  But, Advance Care Planning discussions aren’t just about end-of-life.  Anyone, at any time, at any age could find themselves temporarily incapable of making health care decisions.  Accidents, illnesses and injuries don’t just happen to the elderly. 

So, how do you start those all important conversations? 

People sometimes think it needs to be about a checklist of interventions.  Will you ever want to be put on a ventilator?  Will you ever want to have a feeding tube?  Will you ever want to be resuscitated with CPR…and the list goes on. 

And that’s part of the problem – the list goes on and on and potential interventions are continually added, some of which you may not even know about or fully understand.  As well, your desire for interventions may change as you journey through different stages of your life. 

  • You never want CPR?  
  • Not even if you just choke on a peanut and are otherwise healthy?
  • Never want to be put on life support? 
  • Not even if it’s temporary and you could eventually return to being your ‘old self’? 
  • You don’t want any heroic measures?  What does that even mean?  Your idea of heroic and mine and the doctor’s could be very different. 

Additionally, your family may be very uncomfortable and resistant to talking about these kinds of medical situations. They don’t want to think about it!  But, are the answers those questions even  what they really need to know?  Or do they really need to know who you are, what is important to you, what ‘quality of life’ means to you and where your line in the sand is in terms of what limitations you are willing to accept.  If your SDM knows these things, they will be able to make healthcare decisions for you in the moment because they will know what you would want, even if you haven’t talked about explicit interventions.

Remember, Advance Care Planning isn’t about having ONE conversation.  It is about having MANY conversations.  Talk about it over family dinners. Talk about it while you’re driving back and forth to work or school.  Talk about it over a glass or wine or a cup of tea.  Talk about what is important to you in your life.  Talk about what a good day looks like and what an unacceptable quality of life looks like.  Help your family to become an expert in YOU and they will know how to ensure that you receive the care that you would want.

And finally, be sure that you have conversations with more than just your Substitute Decision Maker (SDM).  All your loved ones need to know what your wishes are so that they can support your SDM and understand that your chosen SDM is expressing your wishes and not their own.

The time to buy fire insurance is not when the house is on fire and the time to have Advance Care Planning conversations is not in the midst of a health crisis. 

Talk about it now, while you are healthy and give the gift of peace of mind to your family and to yourself. 

Written by: Dale Gellatly, Hospice Wellington

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