10 Questions to Help You Plan for the End of Life
Talking about death doesn't have to be morbid. If you approach the conversation the right way, 'it makes us more awake to our lives,' says Dr. Shoshana Ungerleider, founder of End Well, a nonprofit that aims to change the way people talk about and plan for the end of life. 'When we avoid this discussion, we rob ourselves of one of life's most clarifying forces—and that's the awareness that our time is finite.'
There are other benefits to planning ahead. Research suggests that the majority of people don't get the end-of-life care they want: While 80% would like to die at home, for example, only 30% do. Ungerleider has found that those who experience the most peaceful deaths tend to be the ones who have had ongoing conversations with themselves and their families about their wishes, including their values, fears, and hopes for how they want to be remembered. These discussions 'should be as common as financial literacy,' Ungerleider says (another topic people too seldom discuss). 'Embracing mortality is one of the most life-affirming things you can do.'
Ideally, these conversations should start in early adulthood, around age 18, and continue as the years progress and life evolves. We asked experts to share 10 essential questions to ask yourself—and your loved ones—to plan for the end of life.
'Who is your decision maker?'
If you're no longer able to make your own health-care decisions, someone else needs to do it for you. Every adult has the right to designate who they want that person to be—and if you don't do it, your state will. 'That's the most practical and tangible question and decision that everybody needs to think about,' says Paul Malley, president of Aging with Dignity, a nonprofit that created the Five Wishes advance directive, a simplified legal document that helps people express their preferences. Choose someone who knows you well, cares about you, and is adept at making difficult decisions, he advises.
'What's your guidance for life support?'
If you were approaching the end of life, what kind of medical treatment would you want—or prefer to be spared from? Your answers will likely vary depending on the circumstances, Malley points out, so think through some of the most common ones: when you're close to death; in a coma and not expected to wake up or recover; or suffering from permanent and severe brain damage. You should specify exactly what kind of procedures, devices, and medications you want, and which you don't want.
Read More: 10 Questions to Ask Your Parents While You Still Can
The way you answer this question will likely be different at age 45 compared to age 85. Malley suggests revisiting your plan at least every five years, as well as any time there's a big change in your health.
'What makes you physically comfortable?'
Everyone wants to be treated with dignity at the end of life. To help ensure that happens, share your guidance for what family members, doctors, and nurses can do for you. 'Things like, 'I want a cool, moist cloth put on my head if I have a fever,'' Malley says. ''I want my hands massaged with warm oils as often as they can be.''
When Malley talked about his mom's end-of-life wishes with her, she said she didn't want to be massaged all over her body, because it would make her ticklish. He asked if she might enjoy hand massages, because she always loved manicures. 'She said, 'Oh, that would be wonderful,'' he recalls. 'So when my mom was nearing the end of her life with cancer, we were able to take very good care of her hands.''
Making these wishes clear is like 'giving an instruction book to the people who love you about how to take good care of you,' he adds, instead of leaving them to hope they're doing right by you.
'Where are the important documents?'
Always ask your family members if they have a will or trust—and if they don't, it's time to change that. It's also a good idea to talk through bank accounts, investments, and passwords, says Rebecca Feinglos, a certified grief support specialist and founder of Grieve Leave, a community that provides grief support. Make sure you know who their lawyer is, too. 'It's better to ask on the front end, even if it's uncomfortable, because if it reveals that something isn't done, you can get it done,' she says.
'What would a good day look like for you?'
Ask this question over and over again—of both yourself and your loved ones. You might be surprised at the answer. Feinglos' grandmother, for example, said it was going shopping, or sitting at home and watching the birds out the window. When she couldn't physically shop anymore, Feinglos brought the impromptu fashion shows to her.
Read More: 8 Things to Say When Someone Lies to You
Understanding what contentment looks like allows you to make your loved ones' days as happy and fulfilling as possible. Keep in mind that 'a good day looks different over time,' Feinglos says, especially with age and illness progression.
'What possessions matter the most to you, and what do you want to happen with them?'
Feinglos' late father was a world-renowned mineral collector, and leading up to his death, the two discussed his wishes for his collection. 'We knew what he wanted,' she says, which enabled the family to donate their dad's most prized possessions to a Harvard museum.
Read More: What to Know About 'Death Cleaning'
Your loved ones might not have a museum-worthy collection, but chances are they're holding onto something else that matters to them dearly.
Feinglos' grandmother, for example, cherished a special silver pocketbook. 'I only knew it mattered because we had those conversations, and she was like, 'I really want you to have this,'' she says. ''Go get it and let me tell you about it.'' In Feinglos' own will, she specifies that two of her best friends are responsible for going through all her clothes and purses. 'I know they'll understand how much they matter to me, and that they'll appreciate them,' she says.
'What do you want your funeral or memorial to be like?'
This can feel particularly tough to talk about—but it's 'critical' to ask your family members for their wishes, and to share your own, Feinglos says. You should also discuss what you want to happen with your physical remains. 'If you don't have those conversations, you're trying to guess what that person would have wanted, and it feels really uncomfortable," she says.
'When you think about the future, what worries you the most?'
Maybe the answer is becoming a burden to family members, dying in pain, or being forgotten. 'Our fears show us our values,' Ungerleider says. Naming them offers your loved ones the opportunity to figure out how to alleviate what you're worried about—while providing you with a sense of comfort and security. Aim to be as vulnerable as possible, even if it's hard: 'If you can let yourself go there—even tiptoeing into some of these discussions—it can allow you to know the people in your life even better, which can be inherently meaningful,' she says.
'What kind of interactions do you want to have?'
If death seems imminent, do you want people with you? 'Do you want them to play music? Do you want pictures of your grandkids? What name do you want to be called?' Malley asks. 'Do you want to be visited by a chaplain or your priest or your rabbi or your faith leader?'
Read More: The Race to Explain Why More Young Adults Are Getting Cancer
Malley recalls one woman who described her dad as the most outgoing person she had ever met. She assumed he would want to be surrounded by all his friends in his final days—but he said he wanted only immediate family. 'We all do the best we can to guess what our loved ones would want,' Malley says. 'But if we ask them, we might actually get different information, and then we're happy to do it.'
'What do you want your loved ones to know?'
It might feel important for you to express love or forgiveness to family members—or to ask for forgiveness for times you hurt them. Maybe you want them to know you don't fear death, or you'd like to see your estranged kids make peace with each other.
Share these wishes with your family members while you still can, Malley advises, perhaps during a quiet conversation in a coffee shop or around the dinner table. 'Anything will be more comfortable than an emergency room or a lawyer's office,' he says.
Remember: By having the tough conversations early, you're eliminating 'the chaos that can exist when there's no plan,' Malley says. 'Chaos is the last thing families need in a time of crisis.'
Contact us at letters@time.com.
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Food & health TikTok Cancer Mental healthFacebookTweetLink Follow Chia seeds, goji berries, strawberries and raspberries: A TikTok user going by the name 'impamibaby' is filling her pretty wooden breakfast bowl with fiber-rich foods and filming it, inspiring her audience to eat more of the nutrient she says has made her bloating disappear. She's '#fibermaxxing' — the practice of eating meals that help people meet or exceed their daily fiber intake recommendations in the name of improving their gut health, losing weight and more. Videos with the tag have garnered tens of millions of views and likes. They generally feature people making and eating meals chock-full of fiber-rich foods, and are sometimes overlaid with text detailing the amount of the nutrient in their dish and the health benefits. 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'Whether it's adding chia seeds to everything, sneaking veggies into your meals, or finding new ways to love whole grains, fibermaxxing might just be the trend we didn't know we needed,' Manaker said — especially as rates of colon cancer, to which low fiber intake has been linked, she added, have been rising among people ages 20 to 54. Gastroenterologist Dr. Kyle Staller agreed, adding that adequate fiber intake has 'been a recommendation that has not changed for years.' 'Despite lots of science that comes and goes and trends that come and go, fiber is an oldie but goodie,' said Staller, director of the Gastrointestinal Motility Laboratory at Massachusetts General Hospital and associate professor of medicine at Harvard Medical School in Boston. But like anything else — and especially TikTok trends — fibermaxxing can definitely have drawbacks if you make substantial changes too quickly, Staller said. There are two types of dietary fiber: soluble and insoluble, experts said. Soluble fiber dissolves in water and absorbs it to form a gel-like substance, and is more associated with some of the digestive benefits of fiber, experts said. Insoluble fiber, on the other hand, doesn't dissolve in water and helps people have more frequent and heavier bowel movements. 'A balance of both is key for overall health,' Manaker said. 'If you get too much of one type and not enough of the other, you might experience digestive issues like bloating or constipation.' Most fibrous foods contain both types. Foods richer in soluble fiber include apples, bananas, citrus fruits, barley, carrots, oats, beans and psyllium, which derives from the husks of seeds of the Plantago ovata plant, according to the Mayo Clinic. Those with mostly insoluble fiber include vegetables such as green beans, cauliflower and potatoes; whole-wheat flour or wheat bran; nuts; and beans. Many TikTok videos on fibermaxxing feature meals made from a variety of these foods, such as colorful salads mixing different leafy greens and vegetables. Versions of TikTok user impamibaby's breakfast are common among fibermaxxers, and they're rich in insoluble fiber. Within those two types of fiber, there are other forms and characteristics of fiber also critical for gut health, Staller said. The viscosity of the fiber, for one, affects how well it flows through your digestive tract, while fiber fermentability influences how much your gut microbiome can actually ferment the fiber into helpful compounds to use as an energy source, he said. 'Then finally, how is the fiber packaged?' Staller added. Foods that are more processed, cut up, raw or cooked — all those forms have different effects on your digestive health, even if the foods contain the same type of fiber. However, you don't need to worry about doggedly tracking all these things in your efforts to increase your fiber intake. Eating a variety of whole or minimally processed foods will give you enough of what you need, Staller said. The link between higher fiber intake and decreased rates of colon and rectal cancers may be explained by a couple of factors, according to Jennifer House, a registered dietitian nutritionist and founder of First Step Nutrition in Alberta. When fiber increases stool bulk, it decreases the amount of time waste is in contact with the intestinal tract. 'Also, our gut bacteria ferments fiber, and it creates something called short-chain fatty acids,' such as butyrate, she added, which can nourish critical cells in the colon and inhibit cancer cells and inflammation. Recent research also suggests people with colon cancer may have greater odds of surviving if they increase their fiber consumption, Staller said. Fiber can also reduce your risk of other chronic illnesses and health conditions, experts said — including type 2 diabetes, high cholesterol, cardiovascular disease and premature death. And by improving your digestion, you're also reducing your risk of constipation-induced issues such as hemorrhoids and pelvic floor problems. Part of why fiber can help prevent or manage those conditions is because it aids in blood sugar regulation by slowing digestion — to a healthy degree — and the absorption of sugar into the bloodstream, reducing blood sugar spikes after meals, Manaker said. Fiber helps maintain a healthy weight, which is possible due to that blood sugar regulation and to fiber keeping you fuller longer, likely reducing overall calorie intake, Manaker added. Some TikTokers claim fibermaxxing can also help 'detoxify' your gut. Some of the experts don't love that word, given all the pseudoscience it's associated with in diet culture. But since fiber helps you poop, it 'literally does help remove toxins from your body,' House said. Additionally, some fibrous foods, such as leafy vegetables and nuts, support liver health, which plays an important role in detoxification, Manaker said. Experts are also increasingly learning more about the connections between our gut health and mental health, House said — finding that diets high or low in fiber-rich foods do affect your mood. If you want to start fibermaxxing, first know that 'going from zero to 60 when you don't consume any fiber at all is probably not going to go well,' Staller said. That's because when fiber pulls water into the digestive tract, the tract expands, causing discomfort and bloating in people who aren't accustomed to a normal fiber intake. Start low and slow by maybe adding some berries to your usual cereal breakfast or swapping one of your meals for one higher in fiber, House suggested. See how you feel after doing that for a week or two before you increase your intake. Some types of fiber don't work for everyone, Staller said, so listen to your body and adjust accordingly. Working with a dietitian, if possible, is best when navigating significant dietary changes. Fiber supplements — particularly those solely or predominantly made of psyllium husk — can be helpful if you have problems eating enough fiber or medical problems that need to be addressed more aggressively, such as high cholesterol, sources said. But they shouldn't replace fibrous foods as you'd be missing out on all the nutrients, minerals and vitamins they have to offer. There are several ways you can start incorporating more fiber into meals you already eat, such as swapping white rice, bread or pasta for whole-grain versions, Manaker said. The Dietary Guidelines for Americans site has a list of hundreds of commonly available foods and how much fiber they contain per standard serving size. Be sure to drink plenty of water, too — if fiber doesn't have any water to bring with it into your digestive tract, that can cause more bloating, gas and constipation due to dry stools, sources said. Sign up for CNN's Eat, But Better: Mediterranean Style. Our eight-part guide shows you a delicious expert-backed eating lifestyle that will boost your health for life.