A how-to guide to have the most important conversation of your life

Photo: Corbis

Photo: Corbis

Even in this age of hyper-communication, where people are willingly sharing all kinds of things with each other on social networks, there is one area of our lives where we quiet down completely. On the one hand, it’s not surprising. The topic is uncomfortable and the potential for misunderstanding is large. On the other hand, it’s shocking, because this is one of the areas that almost everyone agrees that more conversation is absolutely necessary. The topic is end of life care.

If we honestly assess ourselves, I’m guessing your reaction to the topic was to immediately think about other ways to spend the next few minutes. But hang in there, stay with me: I’m going to give you the tools to make this as easy as discussing any other important issue.

First, some context. If you haven’t yet had to deal with a serious illness– yours or someone you love– it may be hard to understand why this issue is so important. If you have, then you’re likely among the 60% of people who think it’s “extremely important” that their family members aren’t burdened by tough decisions (yet 60% have not communicated their end of life wishes.) Or consider this: 80% of people say that if seriously ill, they would want to talk to their doctor about end-of-life care, but only 7% report having had an end-of-life conversation with their doctor. Finally, 82% of people say it’s important to put their wishes in writing, yet only 23% have done it. In other words, you too have probably avoided this tough issue and you’re definitely not alone.

Most people, it seems, have trouble knowing where to start. We’re concerned that our loved ones won’t agree or even understand how we could feel a certain way. The key, says Ellen Goodman, co-Founder of The Conversation Project, is simply talking about it. And the best place to begin is at your kitchen table– not an intensive care unit– with people you love, before it’s too late.

Why is this important?

Imagine, for a moment, being seriously injured or ill, unable to speak for yourself, or facing the end of your life. Who do you want standing at your bedside, speaking for you, making tough decisions about your care– perhaps even disagreeing with other family members or medical professionals about how you should be treated? Now that you have that person in mind, do they know how you feel? Do they know what’s important to you, how you want to be treated?

Or maybe you’re in a position to make these decisions for someone else… do you know their wishes?

In either case, The Conversation Project believes that the key is communication. They’ve put together a ‘starter kit’ with a list of questions to first ask yourself to be sure that you understand your own feelings on the issue. The starter kit is available online and as a downloadable file. The questions are simple but thought-provoking.

Once you’ve completed the preparation, the next step can be the hardest: you have to talk with someone, tell them what you think, how you feel, and ensure that they are brave enough to adhere to your wishes in the midst of a challenging, emotionally-charged situation. Starting this conversation will be the most difficult step. It’s hard to bring these issues up (I’ve found that it’s tough writing about it, even in an abstract sense.) But having this conversation can be liberating for you both. It will give you the peace of mind that someone will be prepared to make your wishes known, and you will have the information you need to reciprocate. What could be better than having full confidence that you’re doing exactly what your loved one would prefer at that crucial juncture?

The starter kit is really the crux of The Conversation Project. This 10-page document will equip you to have this conversation with all of the important people in your life and will prepare each of you for the acceptance necessary to make it work. Following the conversation, the starter kit provides some valuable next steps: documents you should have on hand, further clarifying questions to deal with specific cases, and more.

If you’re still on the fence about whether this is important, consider one more item: 70% of people would prefer to die in their homes. The reality is the exact opposite: 70% die in a hospital, nursing home, or long-term care facility. Wherever you are on the spectrum, whatever your wishes for your own care, however you’d like to be treated, make your wishes known. The Conversation Project can help you do just that.

[Note: I realize this isn’t something that rises to the top of your mind when you think of things that need to be done, especially if you’re ranking them by magnitude of enjoyment. It’s tough; I get it. But it truly is important. If you still need convincing, spend a few minutes with Judy MacDonald Johnson as she tells her story.]

This is about truth. This is about choice. This is about life before death…This is Water.

In a commencement address in 2005, David Foster Wallace told the graduates of Kenyon College that they were about to face a life of boredom, routine, and petty frustration. He said, “The plain fact is that you graduating seniors do not yet have any clue what ‘day in day out’ really means. There happen to be whole, large parts of adult American life that nobody talks about in commencement speeches. [One of these is that] the most obvious, important realities are often the ones that are hardest to see and talk about.”

David Foster Wallace

David Foster Wallace (Photo credit: Steve Rhodes)

He then explains that the real value of their education is not in teaching them to think,
but in teaching them how to think, by providing them the ability to make a choice about what they think, and when they think it. He continues:

But please don’t just dismiss it as just some finger-wagging Dr. Laura sermon. None of this stuff is really about morality or religion or dogma or big fancy questions of life after death.

The capital-T Truth is about life BEFORE death.

It is about the real value of a real education, which has almost nothing to do with knowledge, and everything to do with simple awareness; awareness of what is so real and essential, so hidden in plain sight all around us, all the time, that we have to keep reminding ourselves over and over:

“This is water.”

I could go on about this, but I could never do it the justice that the author did, so I will merely provide the following and encourage you– as strongly as possible– to watch it and then read the transcript. I’m telling you, truer words may have never been spoken and few commencement addresses provide as much real world advice to graduates. This should be required reading in colleges throughout the country.

Video: This is Water

A note about the author: David Foster Wallace was an award-winning American novelist, short story writer and essayist (as demonstrated with applomb by “This is Water.” His second novel, Infinite Jest, was cited as one of the 100 best novels from 1923-2005 by Time magazine. 

Sadly, he suffered greatly from depression and hung himself in 2008, at the age of 46.