The Time to Discuss End-of-Life Decisions is Now

Life as Drama, Drama as Life

When Shakespeare wrote “All’s well that ends well” about 400 years ago, he was referring to the end of a play, not the end of a life. In the play of that name, Helen says, “Our remedies oft in ourselves do lie/Which we ascribe to heaven.” Shakespeare knew that we can, with guidance and support, often have a greater bearing on our lives – and on our deaths – than we might imagine.

Shakespeare also knew that life’s greatest truths can often best be examined and understood through drama. I’d like to invite you to a live virtual performance of my play, “Honoring Choices,” followed by a discussion and Q&A moderated by Bonnie Bizzell, MBA, MeD, Community Engagement Liaison and Program Manager at our partner for this presentation, Honoring Choices PNW.

There may be no time as fraught with pain and sorrow as when a loved one is close to death. Along with the emotional trauma of facing a loss is the stress of trying to determine how to provide the loved one with an end to life that fulfills his or her desires. But by then, the individual may not be able to express his or her wishes. Or by then, emotions may cause conversations to be less than fruitful.

It’s important for families to initiate a discussion – or a series of discussions – that have the potential to empower loved ones and mitigate the grief after death. My play, “Honoring Choices,” dramatizes what can happen in families when they’re faced with making end-of-life decisions under pressure. The discussion following the dramatization will focus on helping families understand the value of opening the lines of communication early to one of life’s most challenging set of decisions – the final ones – and giving them the tools to get started.

Starting a Difficult Conversation

The key to mitigating the trauma of making decisions under the pressure of an impending death is to start the conversation early. How can a family open the door to communicating about such a delicate and weighty subject?

As a family and patient advocate for fifteen years, Bizzell says that with a positive outlook, families can have a conversation that can be surprisingly uplifting. “One way to start is by asking each other, ‘In your daily lives, what brings you joy?’” she said. “If I’m talking to a very young person, I ask him or her to draw a picture of what brings them joy. Once an adult starts thinking about and sharing what brings them joy, it becomes clear what their day-to-day life might include. Thinking about and sharing their priorities is empowering for people throughout their lives.”

The key to mitigating the trauma of making decisions under the pressure of an impending death is to start the conversation early.


It’s okay if the conversation starts slowly and takes a while to develop. Bizzell suggests finding a way to bring up the subject naturally, and to allow yourselves a grace period to get used to the idea and get comfortable with it. The path to this conversation can be a winding one. It can start with a casual conversation about others who are facing or faced end-of-life decisions and a question about how loved ones reacted. It can start with a book, a movie, a TV show, or a play. The important thing is to look for opportunities to bring up the topic and test the waters.

Bizzell observes that if people don’t plan, there’s likely to be more prolonged grief. “If an individual puts off making end-of-life decisions and, ideally, putting them into writing, the resulting decisions made with uncertainty during stress could lead to PTSD and prolonged grief for the loved ones. Documents are voluntary, so the important part is talking about what’s important to you and what you would prefer. You won’t take away grief, but you can change the experience of that grief,” she said. 

It can start with a casual conversation about others who are facing or faced end-of-life decisions and a question about how loved ones reacted.

Empowering Those Left Behind

Participating in planning for end-of-life is a gift for those left behind. When loved ones know what an individual valued and what they wanted, “they were doing something with the individual, not to him or her.” 

For Bizzell, being outdoors and around nature is what brings her joy. “I want my loved ones to understand what’s important to me, to open windows and bring in plants to bring the outdoors in,” she said. “Knowing this also helps me make lifelong decisions by setting priorities. These are discussions to have continually throughout life. It’s not just end-of-life, it’s important to know one’s values throughout life to make decisions. Having and sharing this self-awareness is also important in situations in which incapacitation is temporary.” 

“The important part is talking about what’s important to you and what you would prefer. You won’t take away grief, but you can change the experience of that grief.”

Bonnie bizzell

Letting Drama Spark the Discussion

Drama is an effective way to get to the heart of a subject. When I was commissioned to write “Honoring Choices” by Honoring Choices PNW, I saw it as a way to use the love, conflict, despair, anger, frustration and fear inherent in such a situation to spark productive family discussions. In the play, Bob receives a terminal cancer diagnosis. Despite the pleas of his adult children and the encouragement of his doctor, he wants nothing to do with preparing an end-of-life plan. The situation comes to a dramatic head when Bob is hospitalized and a variety of family dynamics comes into play. I hope the situation that plays out in the drama will encourage discussion afterwards to leads to loved ones finding ways to have a more satisfying outcome than this family does.

What better time than right before we gather safely, either in person or remotely, for Thanksgiving, to reflect on what matters most to us and to our loved one? What better time than when the world is engulfed in a pandemic that seems like it will continue to get worse before it gets better? Especially now as we head into this unusual holiday season, the play is a great way to explore, both intellectually and viscerally, what advance planning can be: what do I want it to look like and what do I want it to be? I hope that the play and discussion, taken together, will help initiate action and bring peace of mind for families. It’s so important for the voices of loved ones to be encouraged and heard, and for their wishes to still be present when others are making decisions for them. 

Over 2000 years ago, the Greek philosopher Epicurus said, “The art of living well and the art of dying well are one.” By taking the initiative to plan early, we can make the end of life as satisfying, dignified, and comforting as a life well-lived.

“The art of living well and the art of dying well are one.”

Epicurus

Join Us

It’s understandable to put off end-of-life decisions, thinking they need to be morbid, sad and uncomfortable. But many have found that they don’t have to be that way at all.

I hope you will join us live on November 24th at 5 p.m. Pacific Time to watch the play with your loved ones and participate in the discussion. Register here.

“Honoring Choices” is presented as a partnership between Honoring Choices Pacific Northwest, a joint initiative of Washington State Hospital Association and Washington State Medical Association

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