Know the Ropes

As mentioned earlier, if you are just getting acquainted with the dying person or if you have few or no plans on file, the situation can be a bit tense and stressful.  First, deal with any immediate trauma and assess how comfortable the dying person is in the situation.  Then, discuss arrangements for the end.

Start with the immediate needs of the dying person: find out if he or she has a living will or advance directive.  Often people have written these, but the family and the medical staff have no idea that they exist.  Find out.  Get the information to the medical staff as quickly as possible and acquaint the family with the wishes.

If need be, hospitals have these papers available and they can be filled out quickly.

Ask: does someone besides the dying person have Power of Attorney (POA)?  If not, who should undertake the roll when the dying person is no longer able to fulfill that role.  This is not an “if” question–it is a when question.

After ascertaining Power of Attorney, the next crucial question is how much medical intervention the dying person wishes to have.  Some of this information will be in the living will.  The best policy is to discuss it again anyway.  Discuss intubation, often used as a last resort, and a procedure that the dying person or the person with Power of Attorney will have to sign a release form for.  Be clear: intubation can be useful in getting a person through a few tough hours.  It can also prolong life long after the quality of that life is gone.  Intubation is a crucial discussion.

Next, discuss CPR and advanced cardiac life support (ACLS).  These procedures can prolong a life but sometimes the resulting trauma is not worth it.  If the person is frail, bones can be broken.

After answering the questions, the Celebrant may offer a Do Not Resuscitate (DNR) order, sometimes also call a No Code (hospital jargon that says “do not call in a Code Blue).  In some states, the DNR is turned into a positive statement, AND, meaning “allow natural death.”

Where are other important papers, identification cards, and credit cards?  The family will need to know.

How many death certificates should the family order?  It depends.  If the loved one had such things as a house, a car, and the “average” number of bank accounts and certificates of deposit, fifteen to twenty death certificates should be enough.  For investors or automobile collectors, the number could be far higher.

Does the dying person wish to be cremated?  Know the creation options in your area.  Or does the dying person wish to have his or her body donated to science (this requires paperwork that is available at the hospital).  If the dying person desires a “casket funeral,” know what the options are.

Does the person have a place in mind for the memorial service?  Does the dying person have a burial site in mind, perhaps even purchased?  How about the ashes after cremation?  Spreading ashes looks dramatic in the movies, but often there are local regulations concerning where and how ashes can be spread or buried.

What might be a fitting memorial or marker for the person?  The list can vary, from trees to benches to witty sayings carved in stone.

NOTE: Some humanists choose to exit life in the face of debilitating diseases.  It is imperative for the Celebrant to know the laws of the state.  These vary widely.  For more information, the best resource is Final Exit Network.

What Are Advanced Directives

A living will allows one to document wishes concerning medical treatments at the end of life.

Before a living will can guide medical decision-making two physicians must certify:

The person is unable to make medical decisions, they are in the medical condition specified in the state’s living will law (such as “terminal illness or “permanent unconsciousness”), and other requirements also may apply, depending on the state.

A medical power of attorney (or healthcare proxy) allows one to appoint a trusted person as healthcare agent (or surrogate decision maker), who is authorized to make medical decision on the persons behalf.

Before a medical power of attorney goes into effect a person’s physician must conclude that they are unable to make their own medical decisions. In addition:

If a person regains the ability to make decisions, the agent cannot continue to act on the person’s behalf. Many states have additional requirements that apply only to decision about life-sustaining medical treatments. For example, before your agent can refuse a life-sustaining treatment on a person’s behalf, a second physician may have to confirm the doctor’s assessment that they are incapable of making treatment decisions.

What Else Does One Need to Know?

Advance directives are legally valid throughout the United States. While one does not need a lawyer to fill out an advance directive, an advance directive becomes legally valid as soon as you sign it in front the required witness.

Emergency medical technicians cannot honor living wills or medical powers of attorney. Once emergency personnel have been called, they must do what is necessary to stabilize a person for transfer to a hospital.

One state’s advance directive does not always work in another state. Some states do honor advance directives from another state; others will honor out-of-state advance directives as long as they are similar to the states own law; and some states do not have an answer to this question.

Advance directives do not expire.

One should review advance directive periodically to ensure that they still reflect one’s wishes.

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