One Conversation Every Family Should Have This Thanksgiving.

A family Thanksgiving table in Stamford, Connecticut (2024).

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This Thanksgiving, roughly three-quarters of Americans will gather with family and friends. While many crave meaningful conversation, most don’t want to discuss politics at Thanksgiving, according to Quinipiac pollsters.

If you’re looking for something real to talk about at your Thanksgiving gathering, start a conversation that can actually make a difference: ask your family members about what they want their final years to look like.

That simple conversation can not only increase the odds that your family members (you included) will spend their final days as they would want. It may also avoid future family disagreements and anxiety. Researchers at Massachusetts General Hospital and the University of Tennessee found that family members asked to make healthcare decisions for patients experience greater distress if they do not know patients’ wishes.

Get the Conversation Started

Ask your family members about their preferences and goals for future healthcare. Would they want to live as long as possible no matter what? What if it meant being kept alive by artificial means? Or if they were in serious pain? Or couldn’t recognize or communicate with people they love? And how would they want decisions made if they couldn’t make them for themselves?

To make the conversation easier, avoid focusing exclusively on doom-and-gloom scenarios. Ask about best-case scenarios and values too. For example, ask questions like: What would matter to you most at the end of your life? What are your most important goals for your final years? Who would you want to support you in making healthcare decisions? How would you like them to do so?

Share your own thoughts too. This will help model the conversation for others. Plus, it may increase the likelihood that family members will make the choices you would want should they ever be called on to make decisions for you. If you’re not sure where to begin, one place to start is with the conversation planning guide from The Conversation Project, an initiative run by the Institute for Healthcare Improvement to encourage individuals to engage in end-of-life discussions.

While discussing end-of-life can decisions seem daunting, research suggests that older adults may be far more receptive to such conversations than their younger relatives expect. For example, AARP’s data indicates that the vast majority (85%) of older adults report that they are “comfortable discussing death and dying.”

Encourage Your Family to Create Advance Directives

Discussing treatment preferences and goals is just the first step. Encourage all adults at the table, regardless of age, to make an advance directive. Advance directives are documents that say how people want healthcare decisions made if they cannot make them for themselves.

If your loved ones are like most Americans, they probably don’t have an advance directive. According to the Pew Research Center, only 31% of U.S. adults have an advance healthcare directive. That number climbs with age, but many older adults still lack one. The Pew Research Center found that over one-third of adults in their 70s had no advance directive in place.

That’s a problem because patients without advance directives are less likely to get the care they want and are more likely to be treated in ways that are inconsistent with their values and wishes. In addition, failure to create an advance directive risks avoidable anguish for patient’s families, who face the prospect of making unnecessarily hard decisions without the guidance an advance directive could provide. A randomized trial of older hospitalized patients found that relatives of patients who had engaged in advanced planning had lower levels of stress, anxiety, and depression compared to relatives of patients who did not.

Types of Advance Directives

An advance directive can do several things. First, it can appoint an agent to make health care decisions for you if you can’t make them for yourself. This kind of advance directive is typically called a “power of attorney for healthcare” or a “healthcare proxy.” Second, it can provide instructions for future care, letting care providers and family members know about what types of care someone does or does not want. This type of advance directive, especially if it is focused on providing instructions for end-of-life care, is sometimes called a “living will.” Third, an advance directive can be used to share information about a patient’s goals and values. All three of these functions are often combined in a single document.

Fortunately, creating an advance directive is not difficult. The specific requirements to make a valid one vary from state to state, with states commonly requiring a signed document that is witnessed by one or two disinterested witnesses. AARP’s website features a useful resource for individuals which gives them information about what it takes to make an advance directive in their state.

And contrary to some people’s fears, creating an advance directive does not mean giving up the right to make decisions for yourself. An agent appointed under an advance directive can generally only make healthcare decisions for a patient when a qualified healthcare provider has determined that the patient is unable to make those decisions.

Seek professional guidance if you have questions or would like assistance with advance care planning. Elder law attorneys, and those practicing in the area of trusts and estates, routinely work with their clients to create effective advance directives that reflect client wishes.

Why Thanksgiving is the Perfect Time for Hard Conversations

Thanksgiving is the perfect opportunity to have a meaningful conversation with family about the care they want, and don’t want, at the end-of-life. It’s a time when families are gathered together, often without any agenda other than to share a meal and conversation. It’s also a time when people are invited to reflect on those things for which they are grateful. And so it naturally lends itself to conversation about what we value, and the tools that we can use to ensure that our preferences and values are respected should we ever become unable to make decisions for ourselves.

If everyone used this Thanksgiving to finally have the important conversations that are so often put off, we could create better futures for ourselves and our loved ones. And ultimately that might be much more satisfying than even a well-cooked turkey.