For the person whose own death is coming.

Palliative care is comfort-focused care that can run alongside active treatment. You can have palliative care for a serious illness while still doing chemotherapy, surgery, or other curative treatment. Goal: manage symptoms (pain, nausea, fatigue, anxiety, shortness of breath) so the treatment is bearable and your quality of life is as high as it can be. Available at any stage of illness, including very early. Most major hospitals have a palliative-care team you can request a consult with.

Hospiceis also comfort-focused care, but it’s for the final phase — when continued treatment isn’t working or you’ve decided to stop. Hospice eligibility under Medicare requires a physician to certify a life expectancy of 6 months or less. To enter hospice you stop active curative treatment for the terminal illness (you can still be treated for unrelated conditions). Hospice covers all medications, equipment, nurse and aide visits, social workers, chaplains, and 13 months of bereavement support for your family after death.

The transition between them is usually a single conversation: “treatment isn’t working / isn’t worth the side effects / isn’t what I want to keep doing.” Many patients find that switching from active treatment to hospice produces an immediate quality-of-life gain — the side effects stop, the appointments drop to one or two a week, the focus changes from fighting to living.

The median length of US hospice care is about 18 days, but the benefit is designed for 6 months. Earlier hospice = more relief for you and more support for your family. Almost no one regrets going in early; many regret waiting.

Medical systems are oriented toward action. Every new treatment is presented as something to be done. Choosing comfort-only care — stopping or declining treatment that has poor odds, severe side effects, or low quality-of-life gains — is a legitimate medical choice, and one that doctors do not always present clearly.

Questions worth asking before any treatment:

• How likely is this to extend my life, by how long, and at what quality of life?
• What are the most common side effects, how severe, how long do they last?
• What does the next 6 months look like if I do this vs. if I don’t?
• Is this curative, or is it slowing the disease?
• At what point do most patients in my situation decide to stop this treatment?
• Would you, the doctor, take this treatment if you were me? (Surveys of oncologists show that doctors routinely decline aggressive end-of-life treatments for themselves that they recommend for patients.)

None of this is morbid. It’s how you find out what you’re actually being offered.

1. Advance directive / healthcare proxy. States what you want medically if you can’t communicate, and names the person who decides for you. If you don’t have one, sign it this week. Free forms from your state’s attorney-general office or AARP.
2. POLST. Physician Orders for Life-Sustaining Treatment. This is an actual medical order, signed by you and your doctor, that paramedics and ER staff must follow. Particularly important if you don’t want CPR, intubation, or hospitalization in a crisis. Initiated by your treating physician.
3. Will + beneficiary designations. This isn’t for you, it’s for your family — but it’s for them to not be ambushed by paperwork while they’re grieving. Update beneficiary forms on retirement accounts, life insurance, and bank accounts (they override the will). Full pre-need planning guide.

If any one of these feels overwhelming, do them in order. Advance directive first — it’s the shortest and matters in the next medical crisis. POLST when you have a doctor visit anyway. Will whenever there’s an afternoon.

About 70% of Americans say they would prefer to die at home. About 30% actually do. The biggest reason for the gap is unanticipated 911 calls in the final hours and lack of in-home support.

• At home— possible with hospice in place. Requires at least one capable caregiver or rotating family help. Hospice provides medications, equipment, and a 24-hour line. Most peaceful option for most people.
• Hospice inpatient facility — some hospice agencies have residential facilities for people without home support, or for short stays during difficult symptom management. Quiet, low-medical-intensity environment. Often feels more like a guest house than a hospital.
• Hospital — the default if no plan is made and you aren’t on hospice. Highest-intensity environment, often the least peaceful, sometimes with last-day interventions you didn’t want.

Pick one and write it down. Tell your family. Tell your doctor. Put it in the advance directive. The decision becomes much harder to override if you’ve stated it in writing in advance.

You don’t have to be the strong one. Most families describe being grateful when the dying person stopped trying to protect them and started being honest about what they were feeling. The pretending is exhausting for both sides.

Useful sentences:

• “I’m scared and I’d like company.”
• “Some days I’m fine. Today is not one.”
• “I want to talk about this. Most people are too uncomfortable. Can you be the person I talk to?”
• “I don’t want to talk about it right now. I want to watch a movie.”
• “I’ve decided to stop treatment. I need you to support this even if you wouldn’t make the same choice.”

If family disagrees with your choices — about stopping treatment, about MAID, about where to die, about anything — you don’t owe them agreement. Their grief is real but their grief is theirs. The hospice social worker or a family therapist can help mediate. Asking for that help is not a weakness.

If you have young children or grandchildren, the children’s book The Goodbye Book by Todd Parr is a gentle opener. More on age-appropriate conversations in our talking-to-kids guide — written for parents, but useful for you to read so you can guide whoever talks to them.

Whatever your relationship to religion, the period between diagnosis and death often raises questions that aren’t medical: what was this life for, what happens next, what do I want to be remembered for, what unfinished business matters. These questions are real even for people who don’t hold religious beliefs.

• Hospice chaplains are available to every hospice patient and family. They’re explicitly trained to support people of any faith, mixed faith, or no faith. They do not evangelize. They sit with whatever you bring. Visits are included in the hospice benefit; ask.
• Death cafes — informal community gatherings where people discuss death and dying over coffee and cake. No agenda, no religion. Started in 2011, now in dozens of countries. Find one at deathcafe.com.
• Conversations Project — theconversationproject.org. Free conversation guides for talking with family about end-of-life wishes.
• Books often loaned to dying patients: “Being Mortal” by Atul Gawande, “When Breath Becomes Air” by Paul Kalanithi, “On Living” by Kerry Egan (a hospice chaplain’s observations).