Palliative care specialist Rachel Clarke, writing in The Guardian, perhaps sums up this moment better than anyone else: “Whether we like it or not, society’s greatest taboo- death and dying- has been thrust unequivocally centre stage.” Indeed, virtually none of us will escape the reality that loved ones, friends or acquaintances will be touched by the devastation that is COVID-19. It’s an almost unimaginable moment when young and older alike, both those previously healthy and those already ill may be confronted by the possibility of death like never before. And at this moment, none of us can have the excuse of turning away and shirking our responsibilities: we all need to consider our values and preferences when it comes to serious illness, medical treatments, and end-of-life care. These are essential conversations we need to have for ourselves, our loved ones and for the greater good of society, including those professional health care workers risking their lives on the front lines of this pandemic. For an overview of how to start such conversations, and what to consider, check out The Conversation Project, The Five Wishes website and the agebuzz resource page on advance care planning.

The concept of advance care planning has been around for decades, as the advent of sophisticated medical interventions has meant the lives of patients have been prolonged in conditions that many find to be an unacceptable quality of life. While it’s challenging to have these conversations and to consider different treatment options in the abstract, the new public interest in ventilators brings it home all too clearly: Being put on a ventilator is no picnic, to say the least. The machine makes it virtually impossible to speak or eat on your own, and for those on it for longer than a couple of weeks, there comes the risk of long-term lung disease and the necessity of a tracheotomy, which means a surgically-made hole in your throat into which tubing is placed. As Drs. Jessica Gold and Shoshana Ungerleider write in Time, most older adults with serious underlying illness who are put on ventilators will not survive to leave the hospital. The question then becomes whether they should consent to being put on a ventilator in the first place. And while tough rationing questions may complicate that question, the reality is that many people would not want to end their lives that way, if only they realized they could express their wishes in advance. Now is the time to express those wishes if you feel strongly about this.

Kaiser Health News Columnist JoNel Aleccia reports that, in a bit of irony, the time we are all spending quarantining, at home, with many of our prior responsibilities vanished for the moment, gives us the breathing space to have these conversations and to clarify our wishes. And there are reports of upsurges of interest in organizations that promote this kind of advance planning, given our current situation. It’s also a good time to re-evaluate documents you’ve previously executed and signed, to make sure they continue to represent your current thinking on end-of-life care and values. And while you’re looking at documents, end-of-life doula Tamelynda Lux, writing in Thrive Global, has the suggestion for one additional “document:”  She provides the guidance and text for constructing a “just-in-case” last letter to your health care providers during this crisis, to thank them for their dedication and to express your gratitude, for their devotion to caring for you at this critical juncture. So wipe away your tears, and read her suggestions here.