As we navigate life's journey, it's natural to shy away from conversations about the end of that journey. Yet doing so can leave loved ones in a difficult place, unsure how best to honor our wishes. End-of-life planning is an empowering step that ensures our voice is heard, even when we can no longer speak for ourselves.

In a moving example shared by Stanford palliative care expert V.J. Periyakoil, MD, a patient in his 60s was dying of a brain tumor. His wife, a devoted cook, struggled with his inability to eat and requested a feeding tube against his clearly expressed wishes. She meant only to care for him, but this intervention caused him discomfort and put him at risk. Eventually, with guidance from Dr. Periyakoil, she honored his desire for a gentle, dignified passing. Sadly, such painful dilemmas often arise when individuals have not clearly documented their end-of-life preferences.

To help people express these wishes in a direct, accessible way, Dr. Periyakoil created the Stanford Letter Project. This initiative encourages everyone—regardless of age or health status—to share their values, beliefs, and treatment preferences with their physicians and loved ones. By completing a simple letter, you can guide doctors and family members in understanding your priorities. For example, you might specify whether you'd want a breathing machine, artificial feeding, or certain life-prolonging interventions that may compromise comfort.

The Letter Project's step-by-step templates and checklists break down a complex, emotionally charged topic into simple choices. They also encourage the sharing of these letters with family members, prompting meaningful conversations before a crisis occurs. The end goal is not about hastening death. Rather, it's about clarifying how you want to live the last part of your life—ensuring that your care aligns with what matters most to you, rather than defaulting to medical interventions that you may not want.

As Dr. Periyakoil notes, we often wait for doctors to start the conversation. But physicians are trained to “do” rather than to “discuss,” and they may be reluctant to raise such sensitive subjects. By taking the lead, you ensure that care decisions reflect your personal values, helping your loved ones feel more at peace with the course of action.

Consider taking advantage of this valuable resource. The Letter Project is available online, and you can even find a mobile app version. Ultimately, documenting your wishes helps prevent unnecessary suffering and confusion while giving your healthcare team and loved ones clear guidance. It is an act of kindness—to yourself and to those who care about you—ensuring that your final chapter is written in your own words.

If you'd like to learn more or begin drafting your own letter, please reach out to our office at (530) 601-3311 or visit the Stanford Letter Project website. We're here to support you and your family in creating a plan that respects your values and provides comfort and clarity when it matters most.