November 15, 2019

8 Paths to Tread as End of Life Nears

Conversations about end-of-life decisions are delicate, personal, unique — rarely begun and completed in one sitting. 

Given the mobility of our society, the advances in medical technology and the continuing cultural denial of death, the need for preparation never has been more profound.

Although there is no standard way to begin, family gatherings can be a good time.

It’s important to prepare for the conversation. Start by letting people know that you plan to have this discussion, how important it is to you and that you need cooperation and understanding.

Here is a list of do’s and don’ts.

1. Do your homework ahead of time.
Before you sit everyone down, designate a health care proxy. Complete, or at least review, the relevant documents that express your wishes in cases when you are unable to speak for yourself. Important documents include:

  • Your will
  • An advance medical directive that states your wishes for end-of-life care
  • Healthcare proxy, which is a legal and enduring form designating a health care agent to speak for a person if he no longer can speak for himself
  • Physician’s Order for Life-Sustaining Treatment (POLST) or Medical Order for Life-Sustaining Treatment (MOLST) forms. This is not recognized in all states, but it supersedes an advanced directive. Creation of these documents expressing your wishes has been supported by every major Jewish denomination.

2. Educate yourself.
Become familiar with the terms associated with these documents and your local laws as they relate to decision-making. Understand the possible tax implications of your estate and the potential challenges of spending down as your situations change, especially if you are in a second marriage or living with a partner. Consulting with trusted advisers is strongly recommended.

3. Don’t just fill out forms and forget about them.
Review all documents and directives at least every five years. Because we all change, and we may change our minds on certain treatments. The pace of medical technology is rapid, often outpacing society at large. Frontier medicine years ago may now be standard practice.

4. Share documents you develop with as many people as possible.
This can include your family, doctor, lawyer and anyone else you deem appropriate. If you enter an assisted-living facility or nursing home, they will need copies. Make sure that these people, especially your proxies, know your wishes. They may be called upon to make life-and-death decisions.

5. Be firm in your resolve to have these discussions.
Some family members already may have witnessed situations in which no advance planning has taken place and thus be more inclined to participate.

Differences of opinion may emerge as to your wishes and the thoughts and feelings of your loved ones.

6. Having these conversations will help your children, even if they don’t agree with everything you say.
Differences of opinion may emerge as to your wishes and the thoughts and feelings of your loved ones. Jewish tradition has the concept of stewardship, which, in the spirit of the Fifth Commandment, says that adult children should honor the wishes of their parents, assuming the wishes of the parents have been made in full knowledge and clarity. Having these conversations and documenting your wishes will help during moments of crisis and stress to alleviate guilt and give clear direction, especially in cases in which you may not be able to make your wishes known.

7. Speak in a language of love, affirmation and concern.
These conversations look at your choices and your belief in your quality of life. Avoid language that relates to being or not being a burden. These conversations raise the reality of our mortality and the evolving concern over the issue of loss and legacy.

8. Conversations may raise psychosocial — and spiritual — issues.
Our society doesn’t do a good job of embracing our aging or accepting our own mortality. Yet the conversations you will have with your loved ones are discussions about just this.

For spiritual guidance, Jewish sources, sample forms, and other related information visit 

A longer version of this story ran on