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January 17, 2021

Francis Koster: Time for a different version of ‘the talk’ with family

By Francis Koster

When I was a kid, there is a little ritual that happened in private.

I later learned my parents referred to it as “the talk.” At some age-appropriate point, my dad would invite “just the two of us” out for a fishing trip. After we dropped an anchor and threw our baited hooks into the water, I was trapped.  After we caught a fish or two, he would bring up changes he was seeing underway in my body and how I was probably beginning to face new biological urges. He explained that these changes carried with them moral and ethical responsibilities.  The discussion was uncomfortable, but necessary. He was a good parent.

As you contemplate your future and think about how your survivors will manage after you leave them, talking with them about your inevitable death is potentially a similarly stressful conversation. But because your parent can no longer trap you in a boat, you can avoid it. Most of us do. We stop behaving like responsible adults and shirk our responsibility as parents.

In America two out of three of us do not create plans for how we wish to be treated as we approach death. Then, when it is too late because we are unconscious, sedated or mentally unsound, we make our final gift to our family. They learn they have to make the decision whether to put us on life support, heavy duty drugs, undergo major surgery, go to hospice or be allowed to pass peacefully at home. Your loved ones are likely to have great difficulty coming to agreement without great stress and permanent damage to their relationships with other family members.

In our society, as we adults approach the end of our life, two out of three of us act like kids.

COVID-19 is bringing this home to around 3,000 American families every day now.

Astonishingly, these numbers are not much higher if the dying person has been sick for some time and they and everyone around them knew the end was coming.   

The research shows even in these circumstances those who know they are approaching their end of life do not make their wishes known in writing.

Study after study shows that the people who are happiest with your taking responsibility are your surviving loved ones.   They rest easy knowing that their last loving act was to give you what you said you wanted.

There are several different lenses to view this decision through. The first is where you want to die. When interviewed, seven of every 10 patients approaching death said they wanted to die at home, but because they did not put their preferences in writing, only a quarter of them do.

Another lens is how much pain and suffering you are willing to endure or have to endure because you failed to put your wishes in writing.

You can put in writing that you want nature to be allowed to take its course — no more surgery, ventilators, kidney machines — just pain killers,and professional care.  You can do this at home, or in healthcare settings designed to take good care of you.

If you failed to make your wishes known in writing, the health care professionals are legally and morally bound to try to prolong your life — so you can wind up semi-conscious for weeks, going the toilet through a tube inserted in your body, praying for the pain to stop.  This can significantly impact the amount of resources you leave behind for your spouse or children. The average cost of one month in the hospital before death is around $35,000 per month. If your insurance does not pay it, it will likely reduce the size of your estate you say you want to pass on to your loved ones.

You can get a lot of useful information on how to put your wishes in writing by entering “The Conversation Project” into your internet search engine.  Both area health care systems offer free assistance to help you put your wishes in writing.

You can connect to Novant’s resources by calling 1-844-677-5134 or visit their website at Atrium offers similar services. You can call them at 704-631-1152 or visit their website

Do I need to take you fishing?

Koster, who lives in Kannapolis, spent most of his career as chief innovation officer in one of the nation’s largest pediatric health care systems.



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