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Dear Iris: I Don’t Want to Think About the End

Dear Iris,

My spouse and doctor keep asking me to complete my advance directive. Honestly, I worry that the more I think about it, the more real it becomes. I know they aren’t wrong to bring it up, but the topic makes me want to run and hide. Help!!


Dear F,

You’re right — talking about an advance directive is tricky.

As humans, it’s natural to avoid thinking about our own death. Advance care planning conversations can feel hard because they bring up the end of life, the exact situation we’re hoping — and actively working — to avoid by going through cancer treatment.

One way to interpret your spouse and doctor’s requests may be to see it as a reflection of their care for you and a desire to support your specific choices.

An advance directive asks what types of life support treatments you would and would not want in specific scenarios when you cannot communicate your wishes. These decisions include the use of CPR, placing a feeding tube, and other medical devices that can help you breathe when returning to breathing on your own is unlikely.

Quality of life and wishes for end-of-life care can look different for each person, so it’s important to consider and share what matters to you.

I want to acknowledge how difficult this topic is, while also providing an opportunity to have meaningful conversations about what matters most to you. Discussing and communicating our wishes ahead of time is a gift to our loved ones, as it takes the burden off of them to make these tough choices.

But know that you don’t have to do this alone. Some couples find it helpful to complete their advance directives together — not because they’re coping with illness, but because we’re all human.

Your Iris Care Team is also here to support you in completing Five Wishes, which is a digital advance directive document. Consider scheduling time with an Iris Care Team member to get started on completing your digital Five Wishes document at no cost to you. Your Iris nurse or mental health therapist can walk you through each wish, offer support, and answer questions as you complete your document.

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Phoebe Souza, MSW, LCSW, MPH, OSW-C, APHSW-C

Clinical Lead – Mental Health

Iris Oncology

Phoebe Souza is an oncology social worker with a passion for supporting individuals and families coping with illness. She has a decade of oncology experience bringing curiosity, creativity, and compassion to her clinical work. She has her Oncology Social Work Certification (OSW-C) and Advanced Palliative and Hospice Social Work – Certification (APHSW-C) and has worked for cancer centers in Boston, MA and Portland, OR. 

This article meets Iris standards for medical accuracy. It has been fact-checked by the Iris Clinical Editorial Board, our team of oncology experts who ensure that the content is evidence based and up to date. The Iris Clinical Editorial Board includes board-certified oncologists and pharmacists, psychologists, advanced practice providers, licensed clinical social workers, oncology-certified nurses, and dietitians.