Chicago Ideas Week, an annual city-wide programming series of speakers and hands-on experiences, dubs itself a “community of curiosity.” The audience gathered on a dreary, rain-drenched night this week at Northwestern University’s Thorne Auditorium for “Death: An Unexpected Take On Life” is evidence of many Chicagoans’ curiosity about death and the dying process.

“Your life will be better, longer and more fulfilled if you take some time to talk about your death,” said Dr. Jennifer Brokaw, a San Francisco-based physician and founder of Good Medicine, a consult, planning and care coordination service; she is also the daughter of former NBC News anchor and current special correspondent, Tom Brokaw. Her talk aimed to help the mostly “Millennial” crowd navigate conversations with family members and doctors about health care goals.

Brokaw told tales of almost a decade and a half spent in emergency medicine, during which she saw patients with each passing year becoming frailer and more troubled by growing numbers of chronic conditions. Resuscitation happened too frequently, she said, often leading to stints in intensive care units and ultimately, death. The Dartmouth Atlas on Health Care reports that 30 percent of patients spend one week or more in ICUs in the week prior to death. “In this country, we load you with tubes and electrodes and send you off in a haze of beeping machines,” Brokaw said. “Even though I may have saved their life today, the bigger picture still was not good.”

“It’s not a matter of if your healthcare agent will act on your behalf, it’s a matter of when”

That “big picture” prompted her career shift into advance care planning, helping patients to spell out the health care they want at the end of their lives. “We will be able to extend life a lot, but how do you want to live and at what cost to your family, emotionally and financially?” Brokaw asked.

Creating a “quality care plan,” she said, involves three steps: 1) naming a healthcare agent, 2) communicating goals and 3) infusion of values.

Health care agents are essential not only for ill or older people, but for anyone 18 or older- especially those inclined to risky endeavors like skiing, rock climbing, biking- or even driving fast cars. This health care agent is able to make decisions on a patient’s behalf if he or she is unable to communicate. An agent may be legally recognized by downloading and competing state Health Care Power of Attorney forms, on a website like Everplans.

“It’s not a matter of if your health care agent will act on your behalf, it’s a matter of when,” she said, citing data from the Journal of the American Medical Association that 50 percent of those 65 and older needed health care decisions to be made by another person within 48 hours of hospital admission.

With a health care agent in place, goals of care should be conveyed to that agent at regular intervals, as goals of care often change over time. What medical treatment the 20-something audience may desire in the case of an emergency could differ if they were diagnosed with a terminal illness, were living with multiple chronic conditions, or when they grow older. Another way to think of goals of care, Brokaw said, is by asking the question “What do I want to do until the day that I die?” For her, that goal was to have the ability to communicate with her family. If her health condition rendered that impossible, Brokaw said she would want to opt out of high-intensity medical treatment.

The third step, infusion of values, is something that likely only needs to be done once, as Brokaw said these personal beliefs do not vary much over time. Values that should be communicated to one’s agent include any religious convictions regarding certain medical treatment- like blood transfusions- beliefs about organ donation, and wishes for the disposition of one’s body- burial, for example, or cremation. With personal reflection about goals and values and the appointment of a healthcare agent, patients are more assured of receiving the care they desire in a health crisis, Brokaw said.

In situations of non-emergent crisis, patients should be able to start an informed discussion with a physician about any particular treatment that may be offered. Three questions should be asked before undergoing any therapy: 1) what are the benefits of a treatment? 2) what are the risks of this treatment? and 3) are there any alternatives?

“Everything in life is incentivized,” Brokaw said, but possible financial or professional incentives of a physician or health institution should not preclude a patient from receiving the care that aligns with their personal goals and values.

“What your physician’s goals are at any given time may be different from your own,” she said. “You have to give your physician the opportunity to get on the same page as you.”