By Toni L. Eaton, RN, BSN, MS, President & CEO of Old Colony Hospice & Palliative Care

The holidays are here, the perfect time for family dinners, group gatherings, and present giving. This year, consider giving a different kind of gift—a courageous conversation about your wishes for the end of life.

“It’s a gift to yourself and to your loved ones. You can make sure things are done the way you want, and your loved ones will know what it is that you want,” said Kathleen D., Old Colony & Palliative Care’s Vice President of Clinical Care. “You can lift that burden for them during what is already a very stressful time. They will know they’re following your wishes.”

Without having these courageous conversations, families run into ambiguity and difficult and sometimes heart-breaking decision-making situations.

She recalled a case where the mother had a devastating stroke and was taken to the hospital, where the doctors were able to stabilize her. Sadly, her condition was dire, and she could no longer verbalize, swallow, or make decisions for herself. The medical team asked the family what they wanted to do. Without the mother’s guidance, the adult children made the agonizing choice to keep her alive with a feeding tube. She lived for a long time in this state, and her quality of life became something that was truly difficult to watch. The children felt horrible at how she was staying alive but deciding to take her off life support also felt wrong.

“You don’t want your loved ones to be the ones making these decisions without your input. They are the ones who have to live with it,” Kathy D. said.

Although it may sound counter-intuitive, the holidays can be the perfect time for these talks, and to help raise awareness, hospice organizations throughout the country are promoting National Hospice and Palliative Care this November with a Courageous Conversations theme.

Asking or telling loved ones about end-of-life care wishes isn’t easy. Almost everyone says having these conversations is important, but no one wants to have it. The best time to start these conversations is early, when we are still healthy, and before a medical crisis occurs. 

The holidays bring families together, which may not happen often with busy schedules and people living in different parts of the country. This time provides an opportunity for families to have face-to-face conversations and begin giving the subject some thought. It’s often not an issue that is resolved all at once but takes time.

Here are some conversation starters and ways to broach the subject:

  • If you are trying to state your wishes, consider asking a family member for help. “I need your help with something,” can be a good way to get the dialogue started. Explain that you don’t want to burden them with difficult decisions later.
  • Start out by sharing a story about someone else. Discussing someone other than yourself at first may make the conversation less scary and may encourage family members to open up. You might start with, “The family of a friend of mine found themselves in a complicated situation, and it made me realize we haven’t had any of these important conversations either.”
  • If you are trying to get a loved one to tell you their wishes, explain that you want to respect their decisions. “I want to make sure that you have what you want when the time comes. It would be good for you to tell us so we can make sure it happens,” is a good opening.

If you’d like to download forms for assigning a health care proxy or filling out a MOLST you can do so at the Massachusetts Medical Orders for Life-Sustaining Treatment website.

Remember, this is a process, so you will probably need to have several discussions about end-of-life care. What kind of medical interventions do you want and when? Who should be your healthcare proxy? Do you want to die at home? If not, what kind of setting do you want for this time of life? What do you want your family and friends to do after you pass? Starting these conversations is the first step. This kind of planning doesn’t happen overnight. It will take thoughtfulness and readiness.

“Don’t leave it until too late,” Kathy D said. “During the holidays, we appreciate family, and this is another way to take care of each other—by talking about this.”

Toni L. Eaton, RN, BSN, MS, is the President & CEO of Old Colony Hospice & Palliative Care

of West Bridgewater, a dynamic non-profit hospice serving more than 55 communities south of

Boston. OCH also runs the Dr. Ruth McLain Hospice Home in Braintree. A native and resident

of the South Shore, Toni brings her compassion and experience as a nurse, veteran, and

community leader to her insightful columns for South Shore Senior News. She is also the founder

of Sunny Paws Dog Rescue. Several groups have honored her leadership, including the South

Shore Women’s Business Network. She currently sits on the board of the Hospice & Palliative

Care Federation of Massachusetts. For more information, call (781) 341-4145 or visit Old

Colony Hospice & Palliative Care at