As you journey toward your end, “dreading and hoping all,” to quote Yeats, there is a lot to ponder.
Assuming that you have fully documented your intentions for your estate and charitable giving, there is the looming and difficult subject of death planning. For most, it’s akin to doing taxes and having a root canal in the same day.
Although death planning can be emotionally vexing, it is essential for families and survivors. They may not know your true intentions without written directives. By the time the will is read or estate plan executed, it will be too late.
Yet death planning will not only allow you to plan a dignified, meaningful and even splashy exit, but will provide guidance for those attending to your last moments and beyond.
When my mother died in 2009, she had left explicit written directions. She didn’t want a religious service and chose cremation. Her ashes were to be spread in the warm waters of the Gulf of Mexico off the Southwest Florida coast. A party in a country club celebrated her life with family and friends. It was sad, but intimately reflected her intelligence, love, thoughtfulness and joie de vivre in planning parties and holidays.
Well before death, though, the issue of medical disability needs to be addressed. Who will make decisions for you if you are incapacitated? Do you want to be put on life support?
Important documents such as medical/health care or durable power of attorney need to be drafted by your lawyer to specify who will make decisions for you in the event you cannot make them yourself.
According to Howard S. Krooks, president of the National Academy of Elder Law Attorneys, you’ll also need an advance directive such as a living will that tells your family your intentions on end-of-life decisions.
You may not want to be resuscitated by artificial means if your heart stops, which was my mother’s wish. That would be specified by a “do not resuscitate” clause in your living will. Or, you may want the full complement of medical technology to keep you alive by heroic means. In any case, a health care proxy or surrogate such as a trusted friend or relative or a professional like a lawyer should be in place to make a decision.
“Most people don’t want to enter into this discussion,” Krooks said. “But you need to talk to people on opposing sides of the decision.”
Once important documents are drafted, family conflicts can be avoided, although the hospital may not observe your intentions. According to a 2011 study published in the journal Annals of Internal Medicine, state laws can make things complicated, and that is especially true now with states diverging on the issue of same-sex marriage. At the time of the study, some 40 states didn’t allow domestic partners to be surrogates in end-of-life decisions; 35 didn’t permit advance oral directives and 48 states required witness signatures.
Your written directions need to be as specific as possible and not stored with your estate planning materials; if they were, interested parties might not see them until well after your death. Let loved ones, friends or your trusted professionals know where your final intentions letter is, or hand out copies. Having them read and review it long before your death is also a good idea.
Although many get squeamish on the specifics of bodily disposition, don’t be afraid to do the necessary planning. Do you want to donate your organs? Details are critical here.
Because critical care procedures and some drugs can damage organs, “only about 3 percent of deaths would be suitable for lung or liver or heart donation after being on life support in a hospital,” said Lisa Carlson, former executive director of the nonprofit Funeral Consumers Alliance and co-author with Joshua Slocum of “Final Rights: Reclaiming the American Way of Death.”
If death occurs at home, where life-support measures are unlikely, “eyes, skin and long bones can be donated post-mortem,” Carlson added. You may need to prepare and sign documents that outline your intentions. Often this is a simple matter such as signing the back of your driver’s license. Do you want your body to be donated to a medical school or for nonacademic research? “Some will require enrollment prior to death; some will pay for transportation,” Carlson said.
Carlson also recommended appointing an “agent for your body disposition.” “This is helpful if you are estranged from your next of kin or part of an unmarried couple.” Your appointed agent would supervise the process of moving your remains, which could be complicated if it involved transfer to a medical school followed by burial or cremation.
If you choose a traditional burial, there are numerous options. “Green” funerals, for example, that don’t involve embalming, expensive caskets or vaults are becoming increasingly popular. An even “greener” and more intimate ceremony could be conducted at home, where allowed. Many states allow in-home funerals, although eight states require the involvement of funeral directors. Simple graveside services without a funeral are also possible.
Carlson said there was no limit to the variations in disposition.
“One woman chose to put the cremains of her husband in a whiskey bottle that was the base of a lamp because ‘He lit up my life’,” she said.
Even with extensive planning and specific directions, things can go awry because of family squabbles. One cudgel to employ in having your intentions honored is to have a strong surrogate or family member. Drafting a customized living will and power of attorney is also important. You will need a strong advocate for your final wishes. When granting durable power of attorney for health care, Carlson recommended choosing a strong-willed family advocate who’s “a witch on wheels or a bulldog.”
“Do your most important planning early,” said Laurie Siebert, a certified financial planner with Valley National Financial Advisors in Bethlehem, Pa. “Complete your estate planning documents, including a will, power of attorney, advance directives and a living will. There’s not a lot of control from the grave, but a trust may help, if needed. Do your planning today.”
In the written directions you provide your family, you may also want to include grave site or mortuary information, funeral directions and provisions on how you want to pay for your memorial. Do you want specific music played or pictures displayed? Are there past events or accomplishments you want your survivors to remember?
Most important, Carlson noted, is to discuss with your family what you don’t want in your final moments and beyond. Many severely disabled people do not want to be kept alive if they have experienced extensive loss of control over their bodies. Death with dignity is also a subject to be aired in family meetings.
“If I’m totally dependent upon someone else,” Carlson said, “my sense of self will evaporate. My time is up at that point. I will be looking forward to the other side – and coming back.”
Although death planning may be one of the most difficult things you will do, it is one final act of self-determination. You may not have control over your last minutes on earth or how you will be remembered, but you can certainly guide your survivors on how you want to be treated and memorialized.