THE ADVANCE CARE DIRECTIVE
We encourage everyone, whether old, middle-aged, or young, to fill out an advance healthcare directive communicating your wishes before a health crisis occurs. Life-threatening accidents and illnesses can happen at any age. If you become incapacitated and unable to communicate your wishes, your advance directive will guide your family, friends, and healthcare practitioners to provide the end-of-life care you would want.
At least as important as completing an advance directive is to discuss your wishes with your health care agent, your physician, and your loved ones. For resources to support this challenging conversation, see The Letter below and the Minnesota Threshold Network Resources page.
For an excellent advance directive, with the option of authorizing your health care agent to make decisions about the care of your body after death (p. 3) and with space to express your funeral wishes (p.7) visit Honoring Choices Minnesota.
ADVANCE FUNERAL PLANNING
Also see Choices, a free downloadable booklet from Minnesota Department of Health with legal and practical information on the final disposition of a body.
At least as important as completing an advance directive is to discuss your wishes for end-of-life with your physician and your loved ones. For resources to support these challenging conversations, see Ellen Goodman’s Conversation Project starter kit, the Minnesota Threshold Network Resources page, and The Letter (below).
THE SHORT LIST: Practical Tasks to Prepare for End of Life – by Linda Bergh, September 2014
Make End-of-Life Plans and Share Them
- Check websites for an advance directive that works for you, such as Honoring Choices Minnesota, where a standard form and a short form are available free for download. While most advanced directives do not specify options for after-death care, you can include your wishes. Also, the PSAT Personal Self-Assessment Scale form is VERY helpful in determining end of life procedures. See www.oktodie.com/resources under Resources/P
- To strengthen your advance directive, write a letter to your health care agent, family, and friends. The letter can explain your trust in your health care agent as well as your philosophy and feelings about death, preparing you and your loved ones for a meaningful conversation. Examples of letters can be found at https://mnthresholdnetwork.wordpress.com/final-letter/.
- Talk with your health care agent, family, and friends about what you or they want for end-of-life care. Ellen Goodman’s Conversation Project, http://theconversationproject.org/starter-kit/ is an excellent starting point. “This goes beyond filling out advance directives or other medical forms.
Consider Going Green
- Research ecological options to standard funeral industry body care. Learn about the environmental costs of embalming, traditional casketing, and cremation. Discover lower cost possibilities.
- Learn how to care for someone after they have died, as our grandparents did. Read a book, watch a movie, or take a class on family-directed after-death care. For resources and offerings, see the Minnesota Threshold Network website: https://mnthresholdnetwork.wordpress.com/resources/
- Add your wishes for a home vigil, and/or green cremation/burial to your advance directive,
- Think about your memorial or perhaps life celebration at a special birthday to allow those you love to honor your life.
- Gather information. Attend a Minnesota Threshold Network meeting. Start a study group or work together to prepare documents.
- Get on the Minnesota Threshold Network list, firstname.lastname@example.org, and go to monthly meetings, especially those that focus on ecological funerals.
Complete Your Own Legacy
- Give friends and family the gift of completing your legacy projects, such as writing a memoir, making a picture album, or doing or creating something special to give to the next generation.
- Make a life review. Think about your life and what you have given to the world.
- Take a legacy class, where you can share this process with other people.
- Express your gratitude and let go of regrets. Think about people you wish to thank and go ahead and do it now. Release any regrets about your life or relationships to bring more peace to your life.
- Try the experiment of seeing your life as if you had six months to live. How does that awareness change your perception of what you choose to do today?
Make Help a Friend Who Is Ill or Dying
- Spend quality time with someone who is ill or dying. Think about what would give them sustenance and peace and completion.
- Help a friend review their life and see their thread of legacy and gifts for others. Help them prepare and complete a project if there is something they wish to do.
The Letter is a personal expression of thoughts regarding our dying process to share with those we love. The letter is not only for someone who is old or actively dying. It can be written (and re-written) at any age. The Letter can give a more personal and heartfelt meaning to an Advance Care Directive and lead to deeper life-and-death-changing conversations with family members.
Sample 1: Letter to My Health Care Agents
I am leaving this Health Care Directive to give you some guidelines when I am unable to make decisions due to my health condition. This is just a guideline and not rules. I understand that situations may come up that are not anticipated or covered in the directive. Know that whatever decisions you will ultimately make about my health care and after- death care, I trust your good intentions. I would like you to make decisions out of love and with a sense of freedom, not out of fear and sense of burden. Death is not the worst that can happen to a person, nor is it the end of our journey. There will be no perfect decisions. Let your heart guide you. I know deep in my heart that you will do the best you can. I would like you to completely receive this trust that I have in you. Have courage.
I would like you –those who are named in this Directive as agent and the support for the agent—to review my wishes, the specifics in the document, and understand the spirit of my wishes.
I am naming _______________ as my health care agent. ________________ will be a “point person” in the medical care system because of her own medical knowledge.
As I wrote, death is not the end. It is not the worst. You will continue to love me, and my love for you will only be more boundless and eternal when I leave my body. You will continue to know me in ways you could never imagine.
It is the quality of life that matters not how long I live. I would not want my life to be artificially prolonged when there is no hope for recovery. I wish to be allowed to die naturally when possible.
I would like to be comfortable and my pain to be managed without excess. I would like to remain conscious as much as possible. If I am able to withstand the pain reasonably well in order to remain conscious, pain medication should be moderated. If I am unable to communicate, however, I trust my agent and her consultants to work with medical providers to determine use of pain medication even it causes loss or diminishment of consciousness.
_______________________________________________________________________ Name Date
Sample 2: Letter to My Family and Friends
Dear family and friends,
Thank you for loving me so much and being the light in my beautiful life. I really have had a wonderful life even if I didn’t always think so. Life has been a struggle for me in many ways, but through that struggle, I found unspeakable joy. I will die with so much love in my heart that heaven will surely see me coming! I can’t wait.
I love you all so much. I have been so blessed to have such generous and loving parents, grandparents, sister, brother and awesome children in my life. It is rare to have family that likes each other as much as we do and cares in such deep and kind ways. And, my friends are precious to me and give me that added touch of joy that has made my life complete.
I thank Spirit for the joys of my career and the opportunities I have had to spread peace and love into the world. I have witnessed many miracles from angels because I “BELIEVED.” Always believe and keep letting go. All you need will find you. You are so loved!
I thank the grand Spirit for my good health and all I learned from my various years of dis-ease. What a blessing on my soul to have a body that, through its discomfort, healed my mind and heart. I transformed my inner life because of my illness. Thank you, thank you, thank you Spirit.
I see beautiful plans for the earth and all living beings. It’s all good and it’s all God. Just remember to love, look for the light in the darkness and hold one another. Then, all will be well.
Be the Love!
Sample 3: My Dying Wishes and Health Care Directive
Letter of My Wishes
My Health Care Agent: _________________________________
Second Alternate ________________________
Others who wish to support the process: _________________________
Others may be added later.
Dear Health Care Agent,
Attached is my health directive, finalized on ___________________. Before you implement my wishes, I would like you to have an understanding of why I have made the choices I have and the spirit and values that drive those choices. I realize that writing wishes and expectations down is only a guideline for real life. Situations may come up that are not anticipated. I trust the decisions you make as my agents if I am not able to make those decisions.
My Value Statement
I have a belief in a spiritual world, and that the soul continues after the life of the body has ended. I see dying as a part of a larger spiritual process. I will follow my individual spiritual journey as long as I am conscious. When I lose physical and/or mental consciousness, I would appreciate your respecting my journey and to help facilitate it as best you can.
My health care directive states that in the event of terminal illness, I do not want treatment to prolong dying, but I am open to interventions that would add comfort to the dying process. I wish to be allowed to die naturally and not be kept alive by medications, procedures and/or heroic measures such as CPR, artificial nutrition or hydration, mechanical respiration, etc.
I request that pain medication be given to alleviate excessive amounts of pain, but not sufficient to keep me from communicating with my loved ones. I wish to be as conscious as possible throughout the dying process. However, should I be unable to withstand the pain without it, I trust my agents to work with medical personnel to determine use of pain medication even it causes less consciousness.
Name ____________________________________ Date ________________
Contact Information for My Health Care Agents:
Primary Health Care Agent:
Heath Care Directive
If I am unable to decide or speak for myself, I automatically give the powers listed here. If I have not given specific instructions, I trust my agent to act in my best interest.
- Make any health care decision for me, including the power to give, refuse, or withdraw consent to any care, treatment, service or procedures. This includes deciding whether to stop or not start health care that is keeping me or might keep me alive, including intrusive mental health treatment
- Choose my health care providers
- Choose where I live and receive care and support when those choices relate to my health care needs
- Review my medical records and have the same rights that I would have to give my medical records to other people.
If I have a reasonable chance of recovery but am temporarily unable to decide or speak for myself, I would want my health care directive to take measures that seem appropriate as long as that situation maintains. If my condition worsens and becomes terminal, move the steps stated below so as not to prolong life.
SPECIFIC INSTRUCTIONS FOR DYING AND DEATH CARE
Comfort Care When Dying
- If I were dying and unable to decide or speak for myself or permanently unconscious, I would want my health care agent to choose alternatives that give me the best way to die naturally. I would want to be cared for naturally and lovingly without any interventions. I trust any decisions that my health care agent would make.
- I do not want to be kept alive by means of medication or life support if there is no reasonable expectation of my recovery from extreme mental/ physical disability
- Specifically, if I do not have a chance of recovery, then I wish:
- No intubation
- No artificial nutrition or hydration
- No dialysis
- No invasive testing
- No intervention by 911
- No resuscitation
If possible, I would like to die at home; my health care agent can determine if a home death is possible. When I am dying I would like to be able to have friends and family come and to create a loving environment for my departure.
- If death occurs in Hospice or Hospital, there is no need to call the coroner. Hospice or the hospital will take care what is needed.
- If death occurs at home and has been anticipated or expected call my physician Dr. _____________________ at _______________________.
- If death has not been anticipated, still call Dr. _______________. She may ask you to call the coroner. In this case, call the police (911 AFTER DEATH), and ask them to send a coroner.
- If I die while in Hospice, the Hospice doctor will provide the death certificate.
- If I die at home, my personal doctor or a coroner will activate the death certificate.
- The Cremation Society (see below) can have multiple copies of the death certificate made.
- Sometime in the hours after death, call the Cremation Society of Minnesota at 612-825-2435 to inform them that my body will be available for cremation in 72 hours. They are located at 4343 Nicollet Ave. S, Minneapolis, MN 55409.
- The Cremation Society can be the transporting agent of my body to my home for a vigil if I die away from home, and to the cremation site for final disposition, unless my Health Care Agents make other arrangements.
AFTER DEATH BODY CARE
- I wish to NOT be embalmed.
- I wish to have my body washed and cared for by close friends to be determined by my health care agent. These people would include ________________________________.
- I wish for no body donations.
I wish to have a three day vigil in my home or as determined by my health care agent open to all friends and family I welcome music, readings, rituals or ceremonies important to friends to accompany my soul over the 72 hours. Team members include: _______________________ ______________________________, the Health Care Agents and others named by them.
My health care agent can determine the casket, cardboard box, shroud, or nothing. A community casket is available through the Minnesota Threshold Network.
If possible, at the end of the three days, I would like a small private ceremony with the funeral rites of the Christian Community where the three day vigil was held. All who would wish to be present would be welcome.
I wish to be cremated. I have a file with the Cremation Society of Minnesota, which means I have done the paperwork, and they can activate my file when I die. I have not paid anything toward services in advance. I wish the Cremation Society to be the agency contacted by my health care agent at the time of my death, unless I die elsewhere. The nature of the cremation ceremony and who is present is up to the community led by my Health Care Agents.
I entrust my ashes to ________, who will determine if they are split in any way. I wish my ashes to be scattered _____________, unless someone wishes to have some for sentimental value.
If possible, I would like my memorial service to be held at _____________________. The service could be at any time after my death and would be determined by my Health Care Agents and the following friends: ______________________________.
Preparers of the service: ____________________________________
Other Music: _____________________
I have no attachment to any event at the memorial service. My wish for the group preparing any service is to be comfortable and under no pressure.
I am thinking clearly, I agree with everything that is written in this document and I have made this document willingly.
Name (Printed) __________________________________________
Name (Signature) ___________________________________
Date of Birth:
In my presence on ___________________ (date), I, ______________________________
acknowledged the signing of this document. I am a legal notary.
Signature of Notary __________________________________________