Starting the conversation about end-of-life wishes — how to begin

This article is for informational purposes only and does not constitute medical, legal, or financial advice. Always consult with qualified professionals regarding your specific situation.

You've been meaning to have this conversation for months, maybe years. You know you should ask your mother what she wants if she gets very sick. You know it matters, especially if she becomes unable to speak for herself. But every time you think about bringing it up, something stops you. The timing doesn't feel right. You don't want to upset her. You don't even know how to start.

Death is one of the few topics we still treat as taboo in a culture that's obsessed with talking. We talk about sex, money, politics—all the things that used to be private. But death remains untouchable. Asking someone what they want if they're dying feels like tempting fate, like you're somehow wishing for it. It feels cruel, maybe. It feels like something you should never have to do.

But here's what's true: not asking is what causes real harm. Not knowing what your parent wants means that when they can't speak for themselves, you'll have to guess. You'll second-guess yourself. You might make decisions they would never have wanted. You might fight with your siblings about what your parent would have chosen. You might regret it for the rest of your life.

The conversation is hard, yes. But it's also a gift—to your parent, who gets to be heard, and to yourself, who gets to stop guessing.

Why It's So Hard

Let's start by naming what makes this so difficult. There's the obvious part: nobody wants to think about dying, least of all their parents. You don't want to imagine a future where they're not here. You don't want to see them having to imagine it either.

There's also the magical thinking that keeps the conversation away. If you don't talk about it, it won't happen. This isn't conscious, usually,it's deeper than that. It's the same logic that makes people avoid getting a will, that makes them skip mammograms, that makes them not look at medical bills. Acknowledging risk feels like inviting it in.

There's the guilt. You feel guilty for bringing up something that will upset them. You feel guilty for asking them to think about their own death. You feel guilty for needing to know these things, as if your need is a burden on them. This guilt often stops the conversation before it even starts.

And there's the fear of your own death sitting underneath. Every conversation about your parent's death-wishes is a reminder that you too will die. If you don't go there mentally, you don't have to feel that.

None of these reasons are foolish. They make complete sense. But they're also why so many people die without anyone knowing what they wanted, and why their families are left making impossible guesses about whether to pursue life support, whether to move them to hospice, whether to put a feeding tube in.

Choosing When to Begin

The best time to have this conversation is when no one is in crisis. Not when your mother has just been diagnosed with cancer. Not when your father is recovering from a stroke. Not when your parent is in the hospital. Those moments are too hot, too frightened. Later, when things calm down, you can talk.

The best time is when things are relatively stable. Maybe your parent is healthy, or maybe they're managing a chronic illness well. Maybe it's after a health scare that didn't turn into something serious, and everyone realizes how fragile things are. Maybe it's a quiet afternoon when you're both in a reflective mood.

Earlier is better than later. It's not wrong to have this conversation when someone is well. In fact, it's better. They have the clarity and stability to think about what they really want. They're not influenced by fear or pain or medication. They can imagine different scenarios and think about what matters to them.

Some people wait too long. They wait until their parent has clearly begun to decline, and by then the parent might not be willing to talk about it, might not remember the conversation, or might not have the mental clarity to engage in complicated thinking. Earlier is always better.

Opening the Door

The conversation doesn't start with a formal announcement. You don't sit down across a table and say, "I need to discuss your end-of-life wishes." That framing is too clinical, too scary. Instead, the conversation starts with permission and gentleness.

Sometimes it starts with a question. You might say something like, "I was thinking about something today, and I wanted to ask you about it. I hope that's okay." This gives them the chance to say yes or to put it off, which respects their autonomy. If they say "not now," you drop it and try again another time.

Sometimes it starts with something you read or heard. "I read an article about advance directives the other day, and it made me think about how I don't actually know what you'd want in different situations. Is that something you'd be willing to talk about?" This frames it as information you encountered, not something you've been obsessing about.

Sometimes it starts with vulnerability. "I'm worried that if something happened to you, I wouldn't know what you'd want. That scares me. Would you help me understand?" This tells the truth about your feelings, which often makes it easier for someone else to be honest too.

Some people do better with writing. "I was filling out my own advance directive, and I realized I should probably ask you the same questions. Would you be willing to think through this together?" Written prompts can make it easier,there's a structure, and you're not making it up as you go.

Giving Permission

The most important part of opening the conversation is giving your parent permission to not have all the answers. You might say, "I don't expect you to have all this figured out. Some of this stuff is hard to think about. We can talk about it a little bit, and if it gets too much, we can stop. We can come back to it anytime."

This permission matters because a lot of people think they're supposed to know what they want, supposed to have thought about it, supposed to have answers ready. They feel guilty that they haven't. Telling them it's okay to be uncertain makes space for real conversation.

You can also give permission to change their mind. "Whatever you say now, you're allowed to change your mind later. This isn't a contract. It's just us understanding how you feel right now." This matters because some people hold rigid positions partly because they think that if they say something, they're locked in forever.

When They Won't Engage

Some people really won't talk about it. You ask, and they change the subject. You ask again, and they get irritated or sad. You push, and they shut down. At some point, you have to respect their no.

But you can still do things. You can fill out your own advance directive and let them see it. You can say, "I've been thinking about this for myself, and it made me realize you might want to do it too, but I'm not going to push." You can let time pass and ask again in six months.

Some people refuse to talk because of denial. They're not ready to acknowledge that they might die, or they're terrified and avoiding the topic is how they manage fear. More conversation from you won't fix that. What might help is time, or a life event that makes mortality more real, or sometimes a trusted doctor or religious figure saying, "This is important."

Some people refuse because of cultural or religious beliefs. In some traditions, talking about death is bad luck. In some religions, the focus is on faith and God's will, not on planning. In some cultures, the children are not supposed to have these conversations with their parents. If this is your situation, you have to respect it. But you might find another way in,maybe through a religious leader, maybe through a trusted family member who has more standing in the culture, maybe by framing it differently.

What you can do, even if they won't talk, is document your understanding of their values. You can ask their doctor, "What does my mother care most about?" You can think about past decisions they've made, past things they've said. You can try to understand, even without their direct words, what would matter to them. This isn't perfect,you might be wrong,but it's better than nothing.

What Happens Next

If they do talk, you listen. You ask follow-up questions. You let silences happen. You don't judge what they say. If your mother wants everything done to extend her life, even if it means weeks of suffering, that's her wish. If your father wants no heroic measures, wants a simple death, that's his wish. Your job isn't to convince them to want what you think is right. Your job is to understand what they actually want.

You write down what they say. You might put it in an official advance directive form, or you might just keep notes. You let them know you'll remember. You might even come back and read it to them, to make sure you got it right.

And you might find, in this conversation, that you learn things about your parent you never knew. That your father is more afraid of dementia than of death. That your mother cares more about being at home than about living as long as possible. That your parent has been thinking about these things all along but never had permission to talk about it.

This conversation is hard. But it's also one of the kindest things you can do for someone you love.

How To Help Your Elders is an informational resource for families working through aging and elder care. We are not medical professionals, attorneys, or financial advisors. The information provided here is for educational purposes and should not replace professional consultation. Every family's situation is unique, and rules, costs, and availability vary by location and circumstance.