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AARP Article

How To Write A Last Letter To Your Loved Ones

Complete your estate plan with this one last bit of paperwork

Let’s assume you’re well-organized. All your personal papers are in order, your will and living will are up to date, and you’ve named a health care proxy. You’ve readied final instructions and listed which of your heirs get which personal mementos. Are you done?

No. As helpful as all your preparations are going to be, nowhere have you mentioned love.

VJ Periyakoil, a specialist in geriatrics and palliative care at the Stanford University Medical Center, has had countless conversations with people near the end of their lives. The most common thing they talk about, she says, is regret — regret that they hadn’t spoken enough loving words to their spouse, or told their children how much they cared, or apologized for doing something hurtful, or thanked a special friend.

It’s not too late, as long as you still can put pen to paper (or hand to keyboard). Think about writing your family or best friend a “last letter,” showing what’s in your heart. Your words will make their lives a little better.

It’s often tough to get started on such a letter, especially when you’re still healthy and don’t feel an immediate need. But there’s help. The Stanford Letter Project, founded by Periyakoil, offers a friends-and-family letter template for your thoughts, as well as suggestions on what to include. You’ll find the template and sample letters at med.stanford.edu/letter.

Good letters start the way you might expect — acknowledging the important people in your life, telling them that you love them and expressing pride in their achievements. Maybe you think you don’t have to write these things down because you’ve said them already. But spoken words sometimes get lost in the family scrum. Written, they can be held in the hand, and cherished, for life. You might also mention treasured moments you spent with your child, family or friend.

Next comes a harder part — the apology section. Many patients, looking back, find themselves pained by specific actions or behaviors that hurt one of the people they love, Periyakoil says. She urges you to say you’re sorry. One letter won’t fix, say, a distant relationship with a sister. But it might make her (and you) feel a little better. If you write this letter while still healthy, it might even impel you to try healing that relationship. In this respect, these letters become what Periyakoil calls a CT scan of your soul. They can open new paths while you’re still alive.

You might also forgive anyone you love who has hurt you in the past, if you can. It’s solace for those you love, and cathartic for you. If you can’t forgive, keep mum. A last letter from you should be one of love and reconciliation, not spite. Death does not end your responsibility to those you leave behind.

Finally, remember to thank people for the love and care that you have received, and say goodbye.

Once you’re finished, put the letter (or letters) with your will or in a drawer where you store precious things. When you’re ready, consider delivering the letter yourself. For your family, it will be an abiding gift. 

 (Originally published in The AARP Monthly Bulletin.)

AARP Article

Making Sound End of Life Decisions

A living will and health care proxy can be crucial for you and your loved ones

Most of us have probably said to a relative or friend, “If I’m in a coma and living on tubes, just pull the plug.” But decision-making toward the end of life isn’t that simple. Maybe another few days might bring you around — how long should your family wait? Often, the medical issue isn’t even the “plug.” What if you have advanced Alzheimer’s and a doctor says you need triple-bypass heart surgery? Would you want your children to say yes or no?

If you’re of sound mind when difficult medical questions arise, you can deal with them yourself. You’re always in charge of your own treatment.

But if you’re in a mental haze, even if only temporarily, someone will have to make decisions on your behalf. That “someone” will be glad for all the advance guidance you can give.

Good medical planning starts with a conversation, among family or friends, to help you clarify your thinking about care. How far do you want any treatments to go, and what minimal quality of life are you willing to accept? Free workbooks are now available online to help with the process, says Charles Sabatino, head of the American Bar Association’s Commission on Law and Aging. A few to try: the Conversation Starter Kit, developed by the columnist Ellen Goodman; End-of-Life Decisions from Caring Connections, a national hospice organization; the ABA’s comprehensive Consumer’s Toolkit for Health Care Advance Planning; and AARP’s Caregiving Resource Center.

To turn your preferences into a legal document, set them down in a properly witnessed living will (a type of advance directive). Your doctors are supposed to act in accordance with what you’ve said. AARP provides state-specific forms at aarp.org/advancedirectives. Caring Connections also provides the forms, as does the American Bar Association. In many states, forms can also be found on the website of the attorney general.

Read any online forms carefully. Some deal mainly with the “easy” questions, such as whether you want treatment ended if you’re being kept alive mechanically. The better forms leave space for expressing your personal values. For example, what kinds of handicaps are you willing to live with? Would you want surgery if there’s a high risk of brain damage? Are you okay with life in a nursing home?

It’s especially helpful to say whether you’d want to be fed intravenously if your conditional is terminal. Medically, the answer may be “no.” Dying people lose their ability to process nutrients, according to the National Hospice and Palliative Care Organization. Even providing water might add to discomfort by creating bloat. Well-meaning relatives need to know these things.

If you want to try everything that might keep you alive, it’s also important to say so. Doctors generally won’t provide treatment they think is futile but will go the last mile if that is your written wish and your family insists.

A living will is just the start. You also need to appoint someone as your health care proxy, to stand up for your wishes and make medical decisions that your will doesn’t cover. If you have no close family members, choose a trustworthy friend. You also should sign what’s known as a HIPAA release, giving your advocate access to your medical records.

You need to be especially careful in your planning if you have a degenerative disease, says Martin Shenkman, an attorney in Paramus, N.J., and author of Estate Planning for People with a Chronic Condition or Disability. Living will forms should be modified to include such things as experimental treatments outside the United States, if you want them. Breathing tubes might be fine if they help you maintain an acceptable life at home.

As the disease progresses, your choices might change, which you should also indicate in your living will. Be sure that your health care advocate has a deep understanding of your disease. He or she should live nearby, in case you have an attack and quick decisions are called for.

Religious people should talk with their family about anything in the will that might contravene their beliefs, Shenkman says. For example, some faiths expect doctors to take heroic measures that you might not want, or prohibit organ donation even if it helps advance research into your disease. Warn your family if you’re taking these steps, and be sure that your health care advocate is on your side.

Most end-of-life decisions are made peaceably, without living wills being invoked, says elder-care attorney Gregory French of Cincinnati. They’re invaluable, however, if siblings fight about “what Mom would want” (and the doctors duck).

When you make a regular will for your heirs, your attorney may provide his or her own versions of a living will and health care proxy. Modify them to suit your situation, then sign. As a last act, it’s a classy one.

(Originally published in The AARP Monthly Bulletin.)