Encouraging Discussions About End-of-Life Health Care

By Brenda Flanagan

On a lovely spring day — people enjoying sunshine and flowers — we sit with Shelly Hawk and talk about death. She says families rarely discuss end-of-life decisions, even when her mom was dying of cancer.

“At that point, it’s very hard to bring it up. You feel you’re pushing her out the door, you feel like you want to know what’s gonna happen to the money, what’s gonna happen to her things. She didn’t want to talk about it, we didn’t want to push her to talk about it,” she said.

“It’s like anything else. You know it’s important. You know you have to pay your taxes,” said NJ Health Care Quality Institute Vice President Linda Schwimmer. “Which is why National Health Decision Making Day is after tax day.”

But how do you get people to talk about end-of-life choices? A recent Monmouth University poll notes 62 percent of New Jerseyans say they’ve discussed it, but less than half (45 percent) actually put it in writing — and that’s a problem, according to the New Jersey Health Commissioner.

“Because these preferences are not know, the health care system doesn’t know how to deal with an individual in those final stages of life, and they often spend those final months in a hospital or clinical setting that they’d prefer not to be in,” said Commissioner Mary O’Dowd.

Expensive final months, she says — New Jersey leads the nation in spending in the last two years of life. So today Princeton joined Gloucester and Tenafly in a long-term pilot program called, “Conversation of a Lifetime.”

“For difficult conversations, and for difficult issues, when we can do it together as a community and provide the resources for one another — that’s what it’s all about,” said Mayor Liz Lempert.

Princeton started with an information booth at the public library featuring materials designed by New Jersey’s Health Care Quality Institute. They walk residents through a landscape that some say can be scary.

“I think people are frightened to talk about end-of-life decisions. I don’t really understand why,” said Kim Dorman.

One way to start: make the Five Wishes. Who would you wish to make decisions for you when you can’t? What kind of medical treatment do you wish — and not — wish for? How comfortable do you wish to be? How do you wish people would treat you? And what do you wish your loved ones to know? The materials explain your options.

Hawk’s committed to this project, especially after losing her 42-year-old brother recently.

“And he died of a brain aneurysm, which was quite a different death than my mother. When my younger brother found him and it came time to make decisions about Steve, we didn’t know what to do. We weren’t sure,” she said.

So Princeton will hold a book club because — as one book says — Talking About Death Won’t Kill You. But as one organizer also said, if you love someone, give them the gift of clarity.