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Understanding Your Health Choices: Conversations Before the Crisis

Talking across generations

We are products of history as well as our personal experience. Attitudes about dying, and about talking, often differ depending on our date of birth. For example, social historian Mary Pipher writes about the "greatest generation," the group now in their 80's and 90's, as people who survived the Depression and World War II, experienced enormous changes in society, and may have known substantial poverty as children.

While there can be wide variation by individuals, in general terms members of this generation tend to be very self-reliant, have a strong sense of privacy, and do not like to ask for help. These characteristics must be respected.

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Siblings work together-Vanessa and her brothers and sisters

Vanessa Brown and her five brothers and sisters are part of an African-American family. They are well established in careers, live in the same area, and stay in close touch with each other and their parents. In talking with their peers about the end of life, they felt that attitudes across cultures were fairly similar. But when their father suddenly became ill, they were reminded that their parents' experience represented a different history and different attitudes.

"My father died without a will, and so did my mother, even though he died first and she saw what problems it created," says Vanessa. "And they absolutely refused to talk about death. With that generation in our community, certain things were just never mentioned in polite company, and one of them was death. My father's view was, 'Don't you try to hurry me along.' And both my parents had a distrust of authority, plus they expected the family to do all the caregiving. My brothers and I tried to get my father to see other doctors, but he did not trust the white medical establishment. He had no reason to."

Vanessa and her siblings were not able to convince their parents to act differently, but the brothers and sisters grew closer through coping with the deaths of their parents. Eventually they helped one another prepare wills, designated responsibility for raising the nieces and nephews should a parent die young, and talked about end-of-life interventions and wishes. Through the loss of their parents, they were strengthened as a family.

When Siblings Disagree-Elizabeth's Family

Elizabeth's parents, now in their mid-70's, are reluctant to talk about the end of life. She has tried to engage them more than once, using her own plans as an example, but is making no progress. A keen observer, Elizabeth is aware that through her parents are living independently and doing well, change has begun. They tire easily, have increasing difficulty with stairs, and her mother seems to be acting strangely in social settings.

Elizabeth and her brother and sister do not live in the same area, each has problems and difficulties, and they are not close. Elizabeth knows that there will be conflicts over caring for the parents, making decisions, and about finances. With some dread, she decides that it's better to talk about the future than pretend it's not coming. She arranges a three way phone call.

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WebMD Medical Reference from the National Hospice and Palliative Care Organization