Being Present with the Dying: Arrangements

neardeathIt is profoundly difficult to be with those who are dying.  We feel at a loss for words or we’re so reminded of our own mortality that we have trouble empathizing and bonding. The more this uncomfortable situation persists, the more we find ourselves lost in platitudes or long silences.  If this discomfort is great enough, we may even find ourselves cut off from the dying and hence miss out on much of the richness that this experience can provide for both those involved.

​Three years ago I left a job where I had spent 20 years visiting the ill and dying in their homes.  Each person died in his or her own way; I learned that very little about the process is predictable. What might be a “good death” to some might be a bad death to someone else.

​Because the subject of death is so uncomfortable and painful, it has become taboo in our culture to discuss it. This leads to avoiding many important decisions that should ideally be made before confronting illness or when death is imminent.  By putting off the subject until being in the midst of serious illness, otherwise clear-headed decisions may become embroiled with emotion and fear, a combination that can lead to traumatic conflict and turmoil.

​Here are a number of concrete decisions that should be done around illness and death:

HEALTH CARE PROXY:  This document names someone and an alternate to act as your voice if you can’t make your wishes known.  This often intimidates people because of the heavy responsibility of deciding someone else’s fate.  In actuality, for a health care proxy to work the way it is meant, the person named the proxy had been told by the one ill what he or she wants.  The person and alternative who will act as proxies are not making decisions but are simply being the voice of the ill person who cannot make his/her wishes known. This document does not need to be notarized (a notary republic) but needs to be witnessed.  Keep copies at home and when in the hospital, a copy should be put in the front of the hospital chart.

LIVING WILL:  This document can accompany a Health Care Proxy.  A living will provides more detail about wishes and decisions the ill person wants made in his or her behalf and can be a written guide for the proxy. Detailed wishes can also be stated in the heath care proxy without having a living will.  This document needs to be notarized.

(DURABLE) POWER OF ATTORNEY (POA):  This is a legal document that allows the person named as the POA to act on the behalf of the incapacitated.  It can be limited to certain powers (such as banking) or be something more general.  This document needs to be notarized.  A copy is given to any entity (such as a bank) that requires proof that the person acting as the POA has such legal status.  The POA is void upon a person’s death.

WILL:  This is a legal document that states what a person wants to have happen with his or her estate (possessions, monies, financial holdings, property) after death.  A trusted person is named to act as an executor whose job it is to manage the estate.  Many people mistakenly think they have no need for a will because they have nothing of value, but a will can help clear up issues concerning possessions with sentimental value and dispel ambiguity about who gets what.  This is a notarized document and is best kept in a secure place at home and possibly with a lawyer.  Even a simple notarized paper stating one’s wishes can go a long way toward preventing ambiguity and conflict after death.

CREMATION AND BURIAL:  Arrangements for burial or cremation can be included in a will.  If cremation is desired and there is no will, it is best insurance to have a cremation document stating that desire.  A document appointing an agent who controls the disposition of remains can be done so that there is no ambiguity or conflict confronting loved ones after death occurs.  Although cremation laws vary from state to state, a document stating one’s wishes will take precedence over the wishes of any survivors. Without family and in absence of documentation, cremation may be legally blocked.  A stand-alone cremation document needs to be notarized.

(DNR) DO NOT RESUSCITATE:  Usually this document is not completed until illness is present.  There is a DNR put in the hospital chart as well as an at home DNR posted in an easily seen place at home.  A DNR states that a person doesn’t want to be resuscitated if the heart stops.  Without a DNR, in most situations a person is legally required to be resuscitated.  An at-home DNR states that no resuscitation is wished if a person’s heart stops at home and medical personnel are called and present.  Once resuscitated and put on a machine such as a ventilator to breath, it is legally very difficult to be taken off the machine and be allowed to die, regardless of the length of time or the futility of survival.  A DNR does not usually need to be notarized but must be signed by a physician and witnessed.

In following posts I will discuss other difficult decisions that are best to consider as well as emotional issues confronted around this frightening time.