Rev. Candace McKibben answers your questions about advance care planning

April 16 is National Healthcare Decisions Day, which begins a weeklong focus on understanding the value of planning for care at the end of life.

At Big Bend Hospice, we know that advance care decisions are best made when individuals have time to consider their options in a non-crisis situation. We see patients and families every day who experience peace of mind by communicating their wishes to their loved ones. That’s why we’re so passionate about what we do.

Talking about care at the end of life can be uncomfortable, but often, the conversation isn’t as difficult as we fear, says the Rev. Candace McKibben, director of Faith Outreach. In the Q&A below, she addresses some common questions and misconceptions people can have about advance care planning.

Why is talking about the care we want at the end of life difficult for most of us? 

It involves acknowledging that we are mortal and that the end is coming. That can be sad because we’re thinking about people we love and have lost, or we don’t want to consider our own mortality. It’s a topic we’re not accustomed to talking about.

What can be gained from talking about death?

It would certainly be morbid to think about death all the time. The wisest among us say that if you think about it some of the time, you appreciate life more. You realize how beautiful and fragile life is, and you have a greater appreciation for life.

Many of us, understandably, would rather avoid the topic. Why should we be intentional about having these conversations?

Death is the natural outcome of life. That’s how things are designed, and acknowledging that gives us opportunity. If you leave it to chance and you don’t discuss it, there will less opportunity for you to do the things you want to do or say the things you want to say before you die.

Advance care directives can also be a gift to your family. People who have struggled with uncertainty in making decisions for their loved ones can have more difficult grief than individuals who had clear guidance and felt like they were honoring a loved one’s wishes.

How have advances in technology affected advance care planning?

Technology can generate some very complex decisions to make. We are only advancing technologically, and there will only be more sophisticated ways of extending people’s lives.

There are, of course, tragedies where things happen instantly and there’s no time for planning, but in the majority of situations, people will die a rather protracted death so it’s important to think through these issues.

What are some of the common misconceptions about advance directives?

Most people think of an advance directive as a way to limit treatment, but it’s not necessarily that. It’s about clarifying treatment, and it may be that you want every measure taken to sustain your life. Advance directives are about making your wishes known, whatever they may be.

Another misconception is that this isn’t a conversation for younger people. If you’re 18, you can have an advance directive.

What tools and services does Big Bend Hospice offer to help?

We distribute Five Wishes, a document published by Aging with Dignity, and written with the help of The American Bar Association. It’s a holistic and beautiful document that considers your personal, emotional, spiritual and medical wishes. 

We also offer the PEACE (Planning Early About Care at the End) program to help people complete their advance directives. If anyone wants to bring in what they have to review it, or if they want to come in and work on a Five Wishes, I do that with them here.

What advice do you have for getting the conversation started?

Having a tool like Five Wishes will help. Another great tool is the Conversation Project, which offers videos and starter kits online.

Then it’s a matter of saying, “You know, I think we need to try to talk about our wishes for the end of life and know from each other what we want and expect.” If you’re using Five Wishes, Wish Three, which talks about how comfortable you want to be at the end of life, is a good place to start

I like to say, “If someone were taking care of you, what would you want them to know about what makes you comfortable?”

An important part of advance care planning is choosing someone to make decisions for you when you can’t speak for yourself. What considerations should go into that decision?

You want it to be somebody who doesn’t get overly emotional. Somebody who is available and somebody who is willing to advocate for what you want and will not see this as an opportunity to do what they think is best for you. 

What opportunities does Big Bend Hospice offer to learn more?

We host “Death Cafes,” a concept that started in England, from 6 to 7:30 p.m. on the last Thursday of every other month at Hopkins’ Eatery (1208 Capital Circle SE). It’s an opportunity for people to come and talk about death in a supportive, nonjudgmental environment, and it’s an educational opportunity.

On the months when we do not have a Death Café, we offer a presentation on a relevant topic at Big Bend Hospice (1723 Mahan Center Blvd.)  Odd months are Death Cafes and even months are Living, Loving, Leaving this Life Presentations.

We also do presentations on advance care planning in faith communities, civic groups and businesses and offer community events during National Healthcare Decisions Week


If you have questions about Five Wishes, the PEACE program or advance care planning in general, contact McKibben at (850) 878-5310 or Candace@bigbendhospice.org. To request a copy of Five Wishes, email virginiaf@bigbendhospice.org.