Dad," he says. "I've been thinking about the end of life lately, the end of my life. I know it sounds weird. Nothing is wrong. But a friend of mine at work had a terminal illness and his family didn't know what he wanted. The family disagreed about what to do, if he should be put on a ventilator and other stuff, and it made the whole thing so much harder. I don't want that to happen if I should suddenly be in that situation."
"Let's not talk about this now," his father says. "You're healthy and young, and nothing bad is going to happen to you. Besides, if we talk about it, it could come true."
"Talking about difficult things does not make them happen. Since Deborah is my wife she'd have the legal responsibility to decide, but I would want you and Mom to understand and help her. And to be able to explain to the kids that this is the way I wanted it."
"So tell Deborah, but don't tell me. I don't want to know."
The conversation has begun. Steven and Deborah begin their own conversation and complete their advance medical directives. A few months after the first conversation, Steven gives his father a copy of his plans.
"Dad, I know that you don't want to talk about this, but Deborah and I have agreed on what we each want, and have written it down. My doctor has a copy. I want you to know that I plan to be conscious and able to communicate as long as possible, while Deborah is worried about pain and would prefer to be sedated, even if it means being out of touch. Which do you think you would want?"
"I don't want to choose. I want to die in my sleep."
"Well, that may happen, but you can't be sure of that."
This may be as far as Steven can go right now. But it is a good bet that at some point, one of his parents will raise it with the other. Over time, Steven can use current events and family happenings to restate his concern. And Steven and Deborah are clear about their choices, and have informed their doctor.
There is another benefit. Steven purposely had these discussions in the hearing of his teenage children. He did not ask them to participate, but later, when his daughter asked why he insisted on bringing this up, he said, "I love my parents and I want to care for them, just as I want to take care of you. Dad and I don't agree on much, and what I would choose may not be what he would want. But this is part of what we need to do as a family. If you have any questions about these things, I hope you will ask your mother or me."
WebMD Medical Reference from the National Hospice and Palliative Care Organization