My mother won't discuss
Your widowed mother turned 80 a month ago. She is diabetic and has had a series of mild strokes over the past year. You and your brother are concerned about her failing health and would like to know her wishes about end-of-life care. She has no living will and has not named a health care proxy. Your father was never willing to discuss advance directives, which made his death much more difficult for the family than was necessary. Both you and your brother thought that experience would convince your mother of the importance of making her wishes clear. However, to your surprise, whenever the two of you bring up these topics, she adamantly refuses to discuss them.
Clarify the Problem
1. Does everyone agree a problem exists?
Although you and your brother consider it essential that your mother decide how she wants to be cared for during the final days of her life, your mother's position is, "I don't want to talk about this." While you cannot make her talk with you, it would clearly be in everyone's best interest to break through this impasse.
2. How urgent is the problem, really?
Although there is no imminent crisis, your mother's age and failing health make it unwise to postpone decisions. Moreover, her mind is sound at present, and she is fully capable of conveying her wishes to you. This may change at any time.
3. What is behind your mother's problematic behavior?
Because of your mother's experience with your father's death, you know that she is only too aware of the importance of having a living will, naming a health care proxy, and completing a durable power of attorney for health care. Why, then, is she so resistant? Her opposition most likely stems from fear. Talking about advance directives inevitably raises the specter of death. It is little wonder she resists doing it.
There is likely one other reason as well. Many seniors don't like to "jinx" themselves by talking about death, fearing that if they talk about it, it will happen.
4. What's hooking you?
It is an awesome responsibility to oversee the death of a loved one, and it is understandable that you want to know your mother's wishes. Nevertheless, insisting that she talk about end-of-life care so that you will feel more comfortable is a little like telling someone to put on a sweater because you're chilly.
In addition, you and your brother can hardly be neutral about discussing your mother's death. This is your mother, after all, and you have a very personal stake in her living. Most people have to steel themselves to talk about these matters with someone they love. Your mother could be sensing your discomfort and be trying to spare both of you emotionally by refusing to talk about the issues that are concerning you.
5. Who must be included in problem-solving discussions?
We recommend that only those people who are directly involved be included: your mother, you, and your brother. Involving well-meaning outsiders, each with their own biases, can create difficulties. The clergy, for example, might argue against advance directives, preferring to see matters of life and death left in the hands of God. Your mother's physician might argue that it is his or her duty to prolong life at all possible costs. Hearing this advice from such influential people might close the door on a meaningful discussion of the various options available to your mother, if she were inclined to discuss them.
6. What is your goal?
Your goal is to overcome your mother's resistance to talking about end-of-life issues. You also want her to express her wishes clearly by completing the appropriate formal documents. These must be properly executed and witnessed. Such written documents hold the best possibility of being respected by physicians. (See Advance Directives on next page.)
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