Caring Currents

Sasha and Malia Obama's Parents Have Living Wills, How About Yours?

Last updated: Aug 04, 2009

Image by dbking used under the creative commons attribution license.

President Obama just revealed during a healthcare forum that he and the First Lady have [living wills] ( -- turning a white-hot White-House spotlight on one of those subjects every family should talk about, though most would rather ignore. Do you have one? Do your parents? Do you have any idea how to bring up the topic?

At least young Sasha and Malia Obama won't be left guessing decades from now. For those who aren't sure where their parents' critical-illness and end-of-life wishes stand, I asked geriatric psychiatrist Ken Robbins, a senior medical editor, how to tackle this often charged conversation.

First, just to clarify: A living will, also called an advance healthcare directive, is a document that specifies one's healthcare preferences in the event you can't speak for yourself because of some kind of incapacity, from a brief temporary condition to a long terminal illness. Who do you want to make decisions for you? Do you want artificial life-prolonging measures? Which: Nutrition and hydration? CPR? Under what conditions? Where do you prefer to recuperate? Do you wish to donate your organs?

Before You Say a Word

To ensure a positive outcome "“ getting that living will in order "“ take a minute to visualize how the talk might go.

  • Check in with how you're feeling about the conversation.

I remember being nervous about broaching the subject of death with my parents when they were perfectly healthy because I didn't want to "jinx" anything. Robbins says that some people simply aren't yet at the point of accepting their parents' (or their own) mortality. If you're feeling awkward or too emotional "“ or in any way incapable of having a matter-of-fact chat, you may not be the best person to broach the subject.

Possible alternate candidates: Your parents' physician (a natural starting place), a trusted friend who's already prepared a living will, a family member (the wise uncle, a parent's favorite sibling), or an adult child who may be perceived as having some authority on the subject (e.g. a doctor, a lawyer.) In my own family's case, the sister who worked for an insurance company seemed to carry more clout than the rest of us.

  • Think about past conversations with your parents in which you've tried to give advice.

How were your suggestions received? Were you viewed as intrusive or helpful? If you're confident of a positive discussion, that's great. Your parents might find it a relief to have assistance tackling an issue they've been putting off or never gotten around to. But if you're concerned that you'll make them angry or defensive, then again, there may be a better person to introduce the idea. "As smart as you may be, you're still your parents' child," Robbins says.

To involve your parents' doctor, place a call with your request ahead of a check-up. You can ask that it not be mentioned that the suggestion came from you, to give it more weight.

The brilliance of having a third party communicate how important the subject is: Your position shifts. You're no longer the nagging child, you're the helper, the supporter there to help carry out the suggestion.

Good Opening Lines

Wondering how to plunge in?

  • Make it about you.

"Mom, I met with my doctor (or lawyer) yesterday and she suggested I do a living will. Now that I've started the process, I think it's a smart idea. Is it something you've ever done or considered?"

  • Reference someone else's story.

"Did you see that article in the paper about the woman who has been in a coma for 10 years? Her parents don't want to withdraw life support but her ex-husband insists that's what she would have wanted, and now nobody's speaking to anybody else. What do you think should happen?"

  • Acknowledge the difficulty, but stay matter of fact.

"As hard as this discussion is to have, it's better that we do because one day someone is going to have to make certain decisions, and I'd rather that they were yours. Not doing anything is making a choice, too. By doing something about it now, you have a chance to have input."

  • Depending on the person, appeal to his or her sense of being helpful.

"Someday I might have to guess about what you want me to do about these decisions. You'd be making it easier for everyone if we knew we were following the wishes that you'd expressed for yourself."

Pitfalls to Avoid

  • Dragging too much emotion into it.

The awkward underbelly of discussing living wills is that the actual subject is mortality: illness, dying, death. "You want to be compassionate and clear about how much you care about your parent, but on the other hand not so emotional that your parent has to comfort you and can't fully attend to the decisions at hand," Robbins explains.

  • Laying out what you think.

The goal is for the person to make up his or her own mind without pressure. Some of us have such strong opinions about incapacity or dying that we can't discuss them without sharing our own views. If you can't squelch that impulse, better to let someone else carry the ball. This talk shouldn't be a debate.

  • Being unnecessarily blunt, even in a crisis.

Avoid framing the focus as, "You might be dying, so this is something we have to take care of." If an illness or accident has happened, get the treating physician involved in raising the matter of healthcare directives (along with the person designated as [power of attorney for healthcare] (, if there is one). Then be supportive: "The doctor's right. Look, I know you're sick. But I hope you live forever. But if things take a turn for the worse, we all want to make sure you get what you want."

  • Implying this is a heavy, now-or-never conversation.

Many people are more willing to make progress when reminded that a living will can be changed. "It's not a permanent decision," Robbins says. "When someone is first diagnosed, they may think they want no extraordinary measures to be kept alive. But as they get sicker, sometimes they change their minds." Discussing end-of-life wishes should, ideally, be an ongoing process.

Say: "Remember this is just a starting point. How do you feel about these things today?" Let the person know, too, that to get the job done, you can walk them through [a step-by-step guide to advance healthcare directives and living wills] (

No word on whether the President's live-in mother-in-law, Marian Robinson (who just turned 72 on July 11), has a living will. (He's said his grandmother, who died right before the election, did.) Which might make another good opener for you: "Hey Dad, I just read the President and First Lady have living wills. Which is surprising because people in their 40s are supposed to be less likely than people in their 60s to have them. [So found a 2008 study by LegalZoom.] What do you think the odds are that Michelle's mother has one, too?"

Good luck!