Advance Care Planning – when is the right time?    Well, it seems sandwiched between life, laundry and longings, just like the rest of the meaningful things we do in our lives.

This last month of holiday happenings really brought that home.  A couple in their late 50s/early 60s was invited by their primary care provider to consider advance care planning as a standard part of their routine care.  And a dear elder with a new diagnosis and pending surgery wanted to share her choices for care.  Both families found time between celebrations and surgeries to do this important work.

Each couple had selected their spouse to be their health care agent, (the person you choose to make medical decisions for you if you cannot make them for yourself.)  Although their conversations started from different places, each ended with a richer appreciation for each other.

What transpired next for these couples was profound.  There was lots of love, caring, and kindness expressed for each other.  Each had a clear and expressed desire to understand more fully the other’s choices and to truly honor those choices.  We often think we already know the choices of our loved one.  But these quiet, reflective conversations are also a time of discovery.  We remember others who have gone before us and how their living and dying shaped us, and informs our choices now.   Tears, yes there were tears, but tears of tenderness.  And there’s laughter and relief too.  Such relief they could have this conversation so openly and honestly.   Counter to what one might expect, there is less time spent talking about specific medical procedures and more time spent talking about how that person wants to interact with the world, what it means to them to live with dignity and respect, what independence means, and how they want to say goodbye when the time comes.  Another constant and touching conversation thread is always a desire to make sure the other person is okay now and will be okay later.

In a sense, as facilitators, we are truly never in the room, and certainly not part of the conversation. Rather we are a witness to their conversation.  A conversation that starts within the individual, and conversation shared between two people who deeply care about each other.  Their words are built upon experiences, feelings, and hopes.  Fear might be present before they start the conversation, in thinking about it; but seems to lessen once they are having the conversation.

There are a few surprising words that describe this incredible process of Advance Care Planning:

CONNECTION.    Amazingly in this reflective process, when a person starts to discern what is right for him, he comes to a better understanding of, or a better connection to his own belief systems; choices for what living well looks like, his values; and what dying well might look like.   There is also a stronger bond forged with their health care agent, particularly because they shared so intimately their hopes, fears, and desires.

PERMISSION.  This is so profound.  The individual gives permission to his spouse, family member, or friend to take care of himself in the process; to be the spouse or friend, and not always the caregiver.  They don’t expect them to do everything. They want them to live well long after they have died.  They don’t want them to carry guilt.    And we hear the healthcare agent tell their loved one it’s okay to be angry, tired, frustrated in the moment.  They give them permission to be themselves however that might change over time.

GRATITUDE.  The individual voices a sense of gratitude for the life they have now, no matter their health status now or later.  The healthcare agent conveys such relief and gratitude to actually know what their loved one wants for future care.  It gives them the confidence that they can speak for their loved one.

HOPE.   Hope is always foundational in these conversations.  People often believe talking about death and dying is giving up hope, but those that do so find it’s just the opposite.  It brings hope to the individual.  They now realize they’ve been heard and their choices are known.  They now have hope that whatever happens, it will better for them and for better for those they love.

TIMING.  When is it the right time to considering advance care planning?  Well, it seems sandwiched between life, laundry and longings.  When life nudges you.  Some say the 5-Ds – a decade, death, divorce, decline, or diagnosis.  If you think about it, then that’s the right time.

Friends of Hospice offers free, confidential advance care planning facilitations with Honoring Choices® certified facilitators in the community. To schedule an appointment please call (509) 332-4414 or email