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Kimberly Rex

Kimberly Rex is a freelance writer who lives in New York with her husband and two daughters. Her work has appeared in The New York Times, WIRED, The Independent, SELF, and Huffpost among others. She has had four open-heart surgeries and countless cardiac procedures but is deathly afraid of water slides.

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End-of-Life Planning 101

Making financial and medical plans for your end of life is important. Here’s how to get started.

Your Health

When Taya Dunn Johnson’s husband died suddenly at age 37, her world was completely shattered. Worse, she and her husband had never imagined they needed to plan so early for this type of life event. He didn’t have a will, sufficient life insurance or other end-of-life documents. Some of their financial accounts, including their mortgage, were linked to her husband’s bank account, but Johnson was unable to gain access right away and was locked out of the account after trying.* She struggled with this while planning a funeral for which she had no preplanned funds, trying to grieve and taking care of their 3-year-old son. “Not having things in place legally places a huge emotional and logistical burden on the surviving relative(s), especially a surviving spouse,” Johnson said. “It’s startling, overwhelming, and at times, infuriating.”

Unfortunately, most people don’t like to talk about death, let alone plan for their own. But speaking about end-of-life wishes with your loved ones is incredibly important, even for those who are currently healthy. In addition to legal matters, medical care and requests should be discussed.

Why are legal and financial end-of-life plans important?

Settling your finances and legal matters before your death only makes things easier for your grieving loved ones. Without end-of-life documents, relatives are left to untangle complicated logistics while also mourning their loss.

How do I make legal and financial end-of-life plans?

You should work with a lawyer to set up a will and a financial power of attorney. A will explains how your property should be distributed after you die and can name a guardian for your minor children. A financial power of attorney designates a person to make financial decisions and handle your affairs while you are living if you can no longer do so.

Gather important information and papers, such as your Social Security number, vital records and insurance information for your loved ones to easily access after your death. You should include online usernames and passwords, too. “My husband’s death taught me what additional information I might need to contact companies and cancel certain accounts,” Johnson said. “Having a document with online passwords, especially for all email accounts, cannot be stressed enough.”

Why are medical end-of-life directives so important?

Everyone has a different idea of how much medical intervention they want if they become ill. “For some people, staying alive no matter what state you're in is the most important thing,” said Catherine Amarante, R.N., honoring care decisions specialist at Dartmouth Health.

“For others, there’s a whole spectrum of what quality of life means. It’s a very personal thing.”

Some people want any medical intervention possible. For others, it may depend on the likelihood of recovery and quality of life.

If you don’t make end-of-life plans and an illness or accident renders you unable to make decisions, choices might be made for you that don’t necessarily reflect your viewpoint. Many states have a next-of-kin rule, which appoints your closest relative as the decision-maker. Unfortunately, this person may not agree with your way of thinking. That, combined with their emotional state, may lead to medical interventions that you wouldn’t have wanted.

Also, not having end-of-life documents in place puts an unnecessary burden on your loved ones’ shoulders. Having a clear plan for them to follow can make this difficult situation a little easier.

How do I make end-of-life plans about medical care?

Advance directives

Advance directives are legal documents that explain what medical care you want if you’re unable to make decisions for yourself. “What we try to do with these documents is figure out what matters most to you, so that doctors can make decisions if they’re unsure about your recovery,” Amarante said.

There are two important parts to advanced directives:

  • Living will — Spells out what medical care you do or don’t want used to keep you alive. It can also cover organ donation and pain management.
  • Healthcare power of attorney (HCPA) — Appoints a person to make your medical decisions should you become unable to make them yourself. (This document has other names in other states, such as medical power of attorney.)

When choosing your HCPA, the most important qualification is that you believe the person will abide by your wishes. “You should choose someone that you trust will make decisions based on what you want, not what they would want for you,” Amarante said. She also noted the ability to advocate for you, work with your medical team and understand complex situations.

Once you’ve decided on a HCPA, have a conversation with them. “You can say, ‘You may never need to, but just in case, I would like you to make decisions for me because I know you love me,'” Amarante said.

It’s also important to get their consent. No one should be given this task if they aren’t comfortable with it.

While you can use an attorney to complete these forms, it isn’t necessary. Most states have their own versions that are free to use. Keep the original copy of these forms at home and give one copy to your HCPA and one to your doctor.

End-of-life medical order forms

The following are doctor’s orders that must be signed by a physician and others, depending on your state’s laws.

DNRs and POLST forms aren’t meant for those who are currently healthy, but for people who are terminally ill or nearing the natural end of their life.

Eighteen months after Johnson’s husband died, her father was diagnosed with stage 4 lung cancer. Having learned how difficult things could be without planning, Johnson and her father made sure he named his daughter as his HCPA and set up both a will and living will. Having the ability to make her father’s medical decisions was immensely helpful to Johnson.

The financial and legal planning also eliminated a lot of stress. “Though having to deal with these matters after the death of a loved one is always difficult, my experience of settling the lives of my husband and father was like night and day,” Johnson said. “Taking the time to discuss end-of-life matters with your loved ones before you die should be seen as an act of love.”

*It’s important to seek the advice of a lawyer in the event of the death of a loved one to find out the correct way to handle bank accounts and other assets.

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