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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.

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