How to Broach End-of-Life Discussions

Question: I know it’s really important to have end-of-life discussions sooner rather than later, but I’m a procrastinator by nature and that’s not exactly something I want to have to think about. Where do I even start? Do you have any ideas on how I should approach this?

Response from Stephanie T. Machell, PsyD: As no lesser authority than Hank Williams observed, we’ll never get out of this world alive. Most of us would prefer to live longer and die more gently than he did. Had he been given a choice it’s likely he would have, too.

We don’t get a choice. Few of us know when or how we will die. It would make sense for everyone to have end-of-life plans in place at an early age, especially if we have dependents and/or beliefs and wishes we want respected. Yet most people don’t. We procrastinate and avoid. Our families collude with us because they don’t want to think about our death, let alone their own. Our culture encourages us to speak in euphemisms, as if the “d-word” is somehow obscene.

Whether we say the word or not, talking about death makes just about everyone uncomfortable. Even for those who have unquestioning faith about what does (or doesn’t) happen, death is the ultimate unknown. We may be afraid it will involve suffering, be frightened of the loss of control it represents, or of no longer existing. And thinking about death brings up other deaths, those losses we’ve failed to fully grieve.

A surprising number of us procrastinate out of superstition. I’m not proud to admit that this is part of my own procrastination. It’s irrational, yet some part of me fears that getting things settled will hasten my own death, in spite of knowing people who died never having completed a will or advance directives, and many more who lived for years after putting them in place.

I share this to let you know that while our reasons may not be the same, I understand your resistance. How are you (and by “you,” I really mean “we”) going to get past this? By dealing with what is in your way. Identifying the reasons you’re procrastinating may mean acknowledging that thinking about your eventual demise makes you afraid or sad or otherwise uncomfortable. Or recognizing that it’s “just” one more thing you procrastinate over.

Procrastination doesn’t really make you feel better. It keeps whatever you’re procrastinating over present in your thoughts. Set a date and use Dr. Olkin’s excellent checklist to get it done. If you’re not sure what your wishes are, take the time to clarify them. If you’re afraid of having an uncomfortable discussion with those who will carry them out, remember that doing so models the importance of having such conversations.

Your significant others have likely thought about what you will want and may be relieved that you brought it up first. And because you’ve taken the time to decide what you want, all you will need to do is make sure the person(s) you name are comfortable carrying out your wishes as you want them carried out.

I wish you success in completing this necessary task. And now that I’ve written this column, I’m out of excuses for not calling the attorney I was going to call last year!

Post-Polio Health (Vol. 37, No. 4, Winter 2021)