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
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
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.