How to Discuss Difficult Medical Decisions with Your Family

By Bethany-Rose Daubman, MD

As a palliative care physician, part of my job is to help foster communication among family members making difficult health care decisions. This often relates to end-of-life matters, a topic I’ve grown comfortable with. In the department of psychosocial oncology and palliative care at Dana-Farber, my colleagues and I describe health care proxies and power of attorneys, discuss the differences between allowing a loved one a natural death and “pulling the plug,” and use a family’s natural rhythms of communication to guide these conversations.

You’d think my own family would have all of this figured out, but sadly, you’d be wrong.

Dr. Daubman helps families address tough topics.
Dr. Daubman helps families address tough topics.

Recently, after some health scares in my family, we decided to talk about what we would want for ourselves in life-threatening situations. The experience forced me to put my money where my mouth is as a palliative care physician, and admit how uncomfortable this topic can be.

In the beginning, it felt awkward to be celebrating a birthday one minute and talking about dying the next, but with a large family, we had to seize one of the few moments when most of us were together. When mother began the conversation, I was surprised to hear her say she wanted to donate her body to a local medical school when she died. She had loved hearing my stories about my medical school’s anatomy lab, and wanted to give another medical student a chance to study the human body.

My sister, an ICU nurse, talked about watching families try to make the “right” decisions. Her main wish for us was that regardless of our decisions, no one would feel guilty. She had seen so many families struggle with remorse.

The artists in the family drew cartoons about what they would want at the end of life, to lighten the mood.

We talked, joked, wiped away tears, and in the end, walked away with a better understanding of what our loved ones would want in the event of a tragedy or illness. We also gave ourselves some homework, such as completing health care proxies and making appointments with our primary care physicians to discuss these issues.

Instead of playing Bull (our family’s favorite card game), we were able to share our preferences for the future.  And when one of us gets ill, as we undoubtedly will, I’m sure we’ll be grateful we put off a game of Bull to talk about it.

If you’re not sure how to broach certain topics with your loved ones, try deathoverdinner.org, an interactive website that helps people make these conversations less scary and more empowering.

Whether you’re sick or well, consider taking a few minutes at your next family gathering to start the conversation.