Managing Treatments

Having an Advance Directive Discussion With Your Loved Ones

If your family members don't agree with your end-of-life choices, reapproach the subject again at a later time.

While many otherwise healthy adults consider end-of-life preferences and care, this difficult subject can become even more important during cancer treatments. If you have attempted an advance directive discussion with your loved ones, you already know that it can be a conversation full of charged emotions and opinions.

However, what can you do if your preferences are in stark contrast with those of caring family members and friends? Here are a few ways to make sure your wishes are honored, while being gentle with the people who love you in the midst of disagreement.

Provide Insight Into Your Point of View

For many family members or friends, hearing your wishes for a Do Not Resuscitate (DNR) order can be shocking or upsetting. If you are met with disagreement or denial when you talk about your end-of-life decisions, you can use something called substituted judgment.

This tactic, according to the National Institutes of Health, encourages family members to look at the situation from your point of view. If you want to try this approach as a way to help family members see your side of the decision, use phrases that express your daily trials or challenges. Don’t be overly dramatic, but use concrete examples instead.

For example, you could tell your loved ones, “The last time I had CPR, I was sore for three months and in the hospital for two months. I missed my daughter’s recital and quality time at home while I was in critical care in the hospital. My quality of life was not good, and still is not good. These are just a few reasons that I believe a DNR order would best suit me and my situation.”

Don’t Have a Conversation While Depressed or Angry

Choosing your advance directives is a serious decision that you should do with counsel from your doctor, psychologist, spiritual advisor, trusted friends and close family. However, once you’ve made your decision and discover that your loved ones do not agree, do not attempt to have another conversation while you’re feeling depressed or angry.

Reapproaching the conversation is an excellent idea, and you may have to have the talk a few times together, but it will not be productive if you come into the discussion feeling angry or upset. Of course, you are certainly entitled to your emotions, and it may seem strange to not be able to share those with your loved ones during this difficult conversation, but you can always debrief these emotions later, after the discussion has taken place. You’ll feel more objective and able to express your point of view if you do so from a less emotional place.

Write It Down

If you find that you’re having problems having a conversation with your family about their differing opinions and reapproaching the subject only falls on deaf ears, try writing to them instead. Many times, writing down your reasons can give your loved ones the space and time they need to read (and reread) your thoughts, so they can truly see your point of view.

Find Other Support

Sometimes, having someone in your corner can make your advance directive discussion go better. Ask your oncologist, social worker, counselor or spiritual advisor to come to the meeting with you. This professional has experience working in these exact situations and can often bring a fresh perspective as you try to communicate with your loved ones.

Remember Your Decision

No matter who agrees or doesn’t agree with you, your advance directives and end-of-life wishes are solely your own. Certainly, it would be wonderful if your trusted friends and close family members could agree with your decision, but if that doesn’t happen, you can rest assured that your decision is yours alone.

This is an emotionally charged time, and you may find yourself playing caregiver to your loved ones as they come around to your end-of-life choices. However, with a gentle hand and loving explanation (and a lot of patience), your loved ones should rally to support you and your decisions.

Palliative Services at UVA Cancer Center can help you through these difficult decisions and conversations.

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Haley Burress
Haley Burress