End of Life Wishes: How to Start a Difficult Conversation

October 4, 2019

This summer, I had a family member pass away unexpectedly at only 40 years old. Not only was our family shocked, saddened, and forever changed, but it also started disagreements throughout the family; to include heated discussions on the best way to remember our loved one. What was important to our loved one in life and how do we honor that in death? Would he have wanted a religious service or something small with immediate family? An already life altering occurrence led to high tensions in our family, but why?

According to the American Academy of Family Physicians (AAFP), “Most patients (90%) recognize that it is important to talk with loved ones about their end-of-life care, but fewer (27%) have actually done so.”

Death and dying is a difficult subject to broach, but many of us postpone this complex discussion until it is, or is almost, too late. And even when a family member attempts to share his or her wishes, it is often met with resistance and denial of our mortality. So how can we start these discussions so our end-of-life preferences are heard and respected?

First, you’ll want to collect your own thoughts before beginning the conversation with your loved ones. Consider asking yourself the following questions:

  • What kind of life-saving measures would you like, or not like, to be preformed? How long would you want to receive medical care?
  • Who do you want, or not want, to be involved in your care? Who would you like to make decisions on your behalf if you are unable to?
  • What are your preferences about where you want to be? Would you want to spend your last days at home or under the care of hospital staff?
  • When the time comes, do you want to be alone or with loved ones?
  • How would you prefer your loved ones treat your physical remains? Would you like to be buried or cremated? Would you like to donate your organs or body to science research?
  • What preferences do you have for your remembrance service? Do you want a memorial service at all? Do you have a song or scripture you would like to be included? Is your remembrance service somber or celebratory? Where does it take place? How would the memorial be funded?

There is a lot to reflect on, so take your time and make note of items that are especially important or questions that are more difficult to answer than the rest. Consider writing your preferences down to clarify your thoughts even more.

Once you have answered these questions for yourself, it is time to sit down with your loved ones. Try to pick a comfortable space to have a serious and heartfelt discussion. Remember, just as it was difficult to come to these answers individually, it will be just as hard for your family members to actively engage in this discussion. You have done the hard work of figuring out what is important to you. Don’t give up on sharing your wishes! It is never too early or too often to talk about your end-of-life preferences.

Vocalizing your wishes can bring clarity and comfort to you and your family during the dying process. What may start out as a careful conversation, with topics previously off-limits, could turn into a gift you and your family gives each other.

If you are looking for more resources to start an end-of-life wishes discussion or to request a free conversation starter kit to be mailed to your home, by visiting

Jennifer Miller

Jennifer, an Elder Options, Inc. Care Manager, completed her Master’s degree in Clinical Mental Health Counseling in Art Therapy at Lesley University in Cambridge Massachusetts. She has worked in a number of older adult-centric fields including as a program director in an assisted living facility and office manager for a physical and occupational therapy company.

Jennifer has experience working closely with individuals living with dementia. She is certified in an art program called Opening Minds through Art (OMA) which features the creative abilities of older adults with dementia. Whenever possible and appropriate, Jennifer tries to utilize artistic outlets to enrich the lives of the individuals she works with.


Categories: End-of-Life Issues