Americans are a people who plan. We plan everything: our schedules, our careers and work projects, our weddings and vacations, our retirements.
Many of us plan for the disposition of our estates after we die.
The one area that most of us avoid planning is the end of our life.
Yet, if we don’t plan, if we don’t at least think about it and share our ideas with those we love, others take over at the very time when we are most vulnerable, most in need of understanding and comfort, and most longing for dignity.
Big issues confront us when we think about our own death or that of someone we love. Our attitudes and beliefs about religion, pain, suffering, loss of consciousness, and leaving behind those we love come into play. We can let things unfold as they may. For others, it is good to plan.
Start the conversation
Talk openly with family and friends about any fears you might have, such as pain and loss of dignity. Ask your doctor about end-of-life treatment, medical decisions and advance directives. If you are already ill, find out what could happen if your condition gets worse. Talk the proper people about legal, financial and spiritual concerns.
Among the specific issues related to the end of one’s life are what medical treatments and care are acceptable, and where you want to be if you are seriously ill.
It’s easier to take control of planning in estate and finances because the content is more concrete. Make sure you have an up-to-date will, and keep insurance information, medical and long-term care and special needs policies in an accessible place. Either give copies to a trusted relative or friend, or tell them where to find the information when needed.
You have the right to decisions about your health care. You can appoint an agent to be your proxy or surrogate should you become incapacitated. For most people, the final days are spent in a hospital, nursing home or in their own house. This is where advance directives come into play.
Prepare advance directives
Advance directives are written instructions about the care and treatment you want if you reach the point where you can no longer speak for yourself. The most common form is the durable power of attorney for health care. A living will is a more limited type of advance directive.
Without an advance directive, your doctors, hospital staff, friends and family members will do the best they can, or a guardian could be appointed by a court. Having a guardian provides a higher degree of protection, but there is a cost for the legal proceedings and the process becomes part of public record.
Most advance directives cover life-sustaining treatment such as artificial feeding, resuscitation, antibiotics or other invasive procedures. Some ask for only palliative or comfort care, designed to manage terminal symptoms.
Choose someone to speak for you
When deciding a proxy or surrogate, choose a responsible person who shares your values and beliefs about medical care or dying. It will be up to them, when the time comes, to decide where you will die, and arrange for an autopsy, organ donation and funeral plans.
A health care provider may refuse your stated wishes or the decisions of your proxy because of conscience or the institution’s policies or standards. The provider must inform you or your surrogate immediately and transfer to another provider should be arranged.
Federal and state laws are in place if a person who’s incapacitated had a mental illness or developmental disability.
There is much that we can plan in advance of our own death, such as where we want to be, how medical costs are covered and funeral arrangements. Advance directives must be made knowing that some day other people will follow our wishes and live with the results. For that reason our plans should, when possible, allow for flexibility and trust in the discretion of our surrogates.
National Hospice and Palliative Care Organization: Advance planning guide
Hospice Foundation of America: End-of-Life guide
US Living Will Registry
Honoring Choices (Twin Cities Public Television)
Based on the Family Caregiver Alliance fact sheet “End of Life Decision-Making.”
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