Mediating End-of-Life Discussions

A recent virtual lecture by Khalid Rehman, MD given to the Association for Conflict Resolution of Greater New York, addressed the sensitive topic of mediating end-of-life discussions.

Dr. Rehman drew on his years of experience counseling patients and shared some of his wisdom with the audience. He started off offering this sage advice: “We’ve had difficult discussions all our life and end-of-life discussions should be no different.”

But that is probably easier said than done for most of us.

A mediator can calm down the temperature in these difficult discussions but any mediation should take place way before the end-of-life is upon us if it is to have any chance of being productive.

Here are some suggestions that might help people move through this difficult phase of planning:

-First, we have to know what we want: what kind of care do we want? When will I be ready to let go? When is it that enough is enough? What will it be beyond which we do not want to go on living?

-We may need more information before we make our decisions so that we are well-equipped to think about what we want.

-Each one of us has a special point beyond which life becomes meaningless.

-It is best to write down what you want in a living will. It is the clearest expression of the care we want at the end of our life even though it is not a legal document. There are many templates on the internet and it can be written and edited over and over again. It is the best parting gift we can leave our family. This is in addition to appointing a healthcare proxy for when we are no longer mentally competent to make decisions.

-There is no best time to have this discussion. Find a time when we are healthy, not threatened by a serious illness and no other pressing problems, when the point of death is not threatening.

-Family members may disagree with our choices about care and healthcare agent but it is our decision.

In thinking about what we would like to see happen when we are at the end of our lives, possible issue to consider are:

What medical care should be rendered?

What medical care should not be rendered?

Who decides how to proceed?

How many family members should be involved?

When should end of life planning take place?