Before They Leave For College: One More Awkward Conversation

When most people hear “advance care planning,” they picture retirees, hospital rooms, and stacks of legal paperwork. They do not picture a 19-year-old college student carrying a laundry basket across campus while surviving on cold pizza and caffeine. But as an end-of-life doula, one of the most important conversations I encourage families to have often happens long before old age enters the picture.

Because once a child turns 18, parents lose the automatic legal right to make medical decisions for them — even if that “adult” still calls home asking how long chicken can stay in the fridge.

College is often the first time young adults live independently. They’re driving farther, traveling, making healthcare decisions alone, and sometimes living in entirely different states. It’s exciting, but it’s also the perfect time to talk about advance care plans.

Not because we expect tragedy.

Because we prepare for life.

Remember, planning for death doesn't make it happen sooner.

What Is Advance Care Planning?

Advance care planning is simply making sure someone’s wishes are known if they become unable to communicate for themselves. For college students, this often includes:

• A healthcare power of attorney

• HIPAA authorization forms

• Advance directives

• Emergency contact information

• Discussions about medical preferences

This isn’t about being morbid. It’s about clarity, preparedness, and reducing chaos during emergencies.

Because if your college student is unconscious after a car accident, the hospital may not legally be allowed to share information with you without proper documentation. And yes, that realization tends to hit parents somewhere between “we’re paying tuition” and “they still can’t remember to bring home their water bottle.”

Why These Conversations Matter

As a former hospice nurse, I’ve seen firsthand what happens when families are forced into critical decisions without guidance. In moments of crisis, uncertainty can create enormous emotional strain.

Advance care planning gives families:

• A sense of direction during emergencies

• Reduced conflict among loved ones

• Confidence that wishes are being honored

• Less stress during already overwhelming moments

And for young adults, it can actually feel empowering. Many college students have never been asked:

• “What matters most to you medically?”

• “Who would you trust to speak for you?”

• “What kind of care would you want if something serious happened?”

These are deeply human conversations — not just legal ones.

How to Approach the Conversation

The key is avoiding the “sit down, we need to talk” energy that makes everyone immediately suspicious.

Instead, keep it casual and practical:

• “Hey, while we’re updating your insurance and emergency contacts…”

• “This is something all adults should have.”

• “I hope we never need it, but I’d rather have it done.”

Treat it like any other milestone of adulthood — because it is one. You’re not planning for death.You’re planning for dignity, communication, and peace of mind.

The Role of an End-of-Life Doula

People are often surprised to learn that end-of-life doulas don’t only support people at the very end of life. We also help families have proactive conversations before crises happen.

A doula can help:

• Facilitate family discussions

• Explain advance directives in plain language

• Reduce fear around the topic

• Encourage values-based decision-making

• Create a calm space for honest conversation

Sometimes families just need someone neutral to say, “This conversation is uncomfortable, but it’s also loving.”

Final Thoughts

Sending a child to college comes with a thousand emotions. Pride. Anxiety. Excitement. The sudden realization that your grocery bill might finally decrease slightly.

Advance care planning probably isn’t on most dorm shopping lists, somewhere between extra-long twin sheets and LED lights. But it should be part of preparing young adults for real-world independence.

Because adulthood is not just learning how to register for classes or survive finals week.

It’s learning how to advocate for yourself, communicate your wishes, and make thoughtful decisions about your care — no matter your age.

And honestly, if they’re old enough to choose their own major, they’re old enough to fill out a healthcare power of attorney.