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Later-life decisions not as easy as pie

We make a lot of tough decisions in life. Those that present themselves in our final decades include, "Should I take that new medication — adding it to the other five prescription meds I already take?" "Should I should move to an assisted-living facility — which facility and when?"

One we tend to ignore — often until it’s too late — is the conversation we have, first with ourselves and then with our loved ones, about death and dying. That one is so incredibly hard to initiate and so critically important to complete. The quality of your life, in its final days, weeks and months, depends on having this type of discussion. It involves assessing your end-of-life preferences and documenting them. Answering questions such as, “How do I want to be treated if I have Alzheimer’s disease?" “If I’m in severe pain, what do I want done?” “Do I want tube feeding?”

Maybe it starts by talking about where you’d like to be when you die. Maybe it starts with a story about the complicated hospital death of one of your parents. These are difficult conversations to launch and are seldom initiated by a health provider.

Your adult children aren’t inclined to raise the topic of a parent’s dying process other than a tenderly stated, “Don’t worry mom, we’ll take care of everything when the time comes.”

The time has come. Think about how you will launch “your” conversation. Maybe even practice what you want to say and put it in a written correspondence.

In our household, we did it over Thanksgiving dinner a few years ago. My gathered family had eaten their share of turkey and trimmings and they were eying the pies. That’s when I announced, “This year no one gets any pie until we have a discussion about end-of-life issues. Your father and I have made decisions, and we want you to be aware and supportive.”

It was a little abrupt, a bit harsh perhaps, but it got the conversation started. I recall there was an initial collective gasp and then stunned expressions — yearning looks in the direction of the pies. But I also recall the thoughtful conversation that followed. It was awkward in the beginning, but we were prepared for that. It felt cleansing when it was over.

Neither my husband nor I want to end our active lives in the critical care unit of a local hospital with tubes in every orifice or find paramedics in our living room providing resuscitation we opted never to have. We completed advance directives and signed them with a witness present as insurance that our choices would be honored.

That’s what this is about — informed choice. It’s a different process in every state, but the following websites can get you started: www.caringinfo.org and www.familydoctor.org.

In our household, some time has passed, and it might be appropriate to pull out those advance directives to review and refresh them. Now that I’ve had some practice at this, if there are topics we need to keep talking about, I’m ready. And you?

Sharon Johnson is a retired Oregon State University associate professor emeritus. Reach her at Sharon@hmj.com.