The emotionally complex experience of End of Life (EoL) planning can be confusing and legal paperwork like DNR forms and living wills carry a morbid stigma, leaving many of us unwilling to proactively seek out information to complete the process. Preparing for the inevitable shouldn’t have to be so daunting, so what if there was an easy, digital solution to make the planning experience more comfortable, transparent, private, and informative?
This presentation addresses three major problems that exist with current options for EoL planning and will focus on the solutions provided by the project A Good Death, a unique interactive digital toolkit designed to help you easily and comfortably explore and plan for your own EoL experience.
4. “I was fantasising about my own death, I started thinking what my funeral would be
like and what music would be played, I was at that level of insanity.”
Billy Corgan
16. HEALTH CARE POWER OF ATTORNEY
NOTE: YOU SHOULD USE THIS DOCUMENT TO NAME A PERSON AS YOUR HEALTH CARE
AGENT IF YOU ARE COMFORTABLE GIVING THAT PERSON BROAD AND SWEEPING POWERS
TO MAKE HEALTH CARE DECISIONS FOR YOU. THERE IS NO LEGAL REQUIREMENT THAT
ANYONE EXECUTE A HEALTH CARE POWER OF ATTORNEY.
STATE OF NORTH CAROLINA
HEALTH CARE POWER OF
ATTORNEY
EXPLANATION: You have the right to name someone to make health care decisions for you when you
COUNTY OF __________________
NOTE: YOU SHOULD USE THIS DOCUMENT TO NAME A PERSON AS YOUR HEALTH CARE
AGENT IF YOU ARE COMFORTABLE GIVING THAT PERSON BROAD AND SWEEPING POWERS
TO MAKE HEALTH CARE DECISIONS FOR YOU. THERE IS NO LEGAL REQUIREMENT THAT
STATE OF TEXAS
ANYONE EXECUTE A HEALTH CARE POWER OF ATTORNEY.
COUNTY OF
BODY DISPOSITION
cannot make or communicate those decisions. This form may be used to create a health care power of
AUTHORIZATION attorney, and meets the requirements of North Carolina law. However, you are not required to use this
AFFIDAVIT
form, and North Carolina law allows the use of other forms that meet certain requirements. If you prepare
your own health care power of attorney, you should be very careful to make sure it is consistent with
§
North Carolina law.
KNOW ALL PERSONS BY THESE PRESENTS:
§
EXPLANATION: You have the right to name someone to make health care decisions for you when you
This document gives the person you designate as your health care agent broad powers to make health
cannot make or communicate those decisions. This form may be used to create a health care power of
care decisions for you when you cannot make the decision yourself or cannot communicate your decision
Texas Health and Safety wishes
attorney, and meets the requirements of North Carolina law. However, you are not required to use this I, ___________________________ (print name), based on the authority of the You should discuss your Code, concerning life-prolonging measures, mental health
to other people.
§711.002(g), upon my oath make the following declaration and directiveand other health care decisions with your health care agent. Except to the extent that you
form, and North Carolina law allows the use of other forms that meet certain requirements. If you prepare
treatment, concerning the disposition of my body
your own health care power of attorney, you should be very careful to make sure it is consistent with North
after my death: I declare that it is my wish and I hereby authorize and specific limitations or restrictions in thisbe
express direct that, upon my death, my remains form, your health care agent may make any health care
Carolina law.
(initial one box):
decision you could make yourself.
This document gives the person you designate as your health care agent broad powers to make health care
This form does not impose a duty on your health care agent to exercise granted powers, but when a
decisions for you when you cannot make the decision yourself or cannot communicate your decision to other Cremated
power is exercised, your health care agent will be obligated to use due care to act in your best interests
people. You should discuss your wishes concerning life-prolonging measures, mental health treatment, and Interred at a cemetery or on private property
and in accordance with this document.
other health care decisions with your health care agent. Except to the extent that you express specific
Interred at a mausoleum
limitations or restrictions in this form, your health care agent may make any health care decision you could
Donated to medical science; if this disposition is not possible because no medical or research facilityis intended to be valid in any jurisdiction in which it is presented,
make yourself.
This Health Care Power of Attorney form will
This form does not impose a duty on your health care agent to exercise granted powers, but when a power is
exercised, your health care agent will be obligated to use due care to act in your best interests and in
accordance with this document.
This Health Care Power of Attorney form is intended to be valid in any jurisdiction in which it is presented,
but places outside North Carolina may impose requirements that this form does not meet.
accept my body, I direct that my remains be (initial one box):
but places outside North Carolina may impose requirements that this form does not meet.
Cremated
If you want to use this form, you must complete it, sign it, and have your signature witnessed by two
Interred at a cemetery or on private property
qualified witnesses and proved by a notary public. Follow the instructions about which choices you can
Interred at a mausoleum
initial very carefully. Do not sign this form until two witnesses and a notary public are present to watch
you sign it. You then should give a copy to your health care agent and to any alternates you name. You
Other disposition as specified:
should consider filing it with the Advance Health Care Directive Registry maintained by the North Carolina
_________________________________________________________________________________
Secretary of State: http://www.nclifelinks.org/ahcdr/
If you want to use this form, you must complete it, sign it, and have your signature witnessed by two
_________________________________________________________________________________
qualified witnesses and proved by a notary public. Follow the instructions about which choices you can
initial very carefully. Do not sign this form until two witnesses and a notary public are present to watch
Other disposition as specified:
you sign it. You then should give a copy to your health care agent and to any alternates you name. You
1.
Designation of Health Care Agent.
should consider filing it with the Advance Health Care Directive Registry maintained by the North Carolina ________________________________________________________________________________________
Secretary of State: http://www.nclifelinks.org/ahcdr/
I, _____________________, being of sound mind, hereby appoint the following person(s) to serve as my
________________________________________________________________________________________
health care agent(s) to act for me and in my name (in any way I could act in person) to make health care
decisions for me as authorized in this document. My designated health care agent(s) shall serve alone,
Signature of Declarant: ______________________________________ Date: _____________________________
in the order named.
1. Designation of Health Care Agent.
I, _______________________________, being of sound mind, hereby appoint the following person(s) to serve as
A.
Name:
Printed name of Declarant: ____________________________________
my health care agent(s) to act for me and in my name (in any way I could act in person) to make health care
Home Address:
decisions for me as authorized in this document. My designated health care agent(s) shall serve alone, in the order
BEFORE ME, the undersigned notary public for the State of Texas, personally appeared
named.
A.
Name: _____________________________
Home Address: _____________________________
___________________________________________
B.
Name:
Home Telephone: _________________________ __________________________, the Declarant in this Body Disposition Authorization Affidavit, who upon
Home Address:
Work Telephone: _________________________ his/her oath made the foregoing declaration(s), including placing his/her initials in the boxes he/she choose on this
Cellular Telephone: _________________________
the _______________ day of _________________________, 20_____.
B.
Name: _____________________________ Home Telephone: __________________________
Home Address: _____________________________ Work Telephone: __________________________
___________________________________________ Cellular Telephone: __________________________
C.
Name: _____________________________ Home Telephone: _________________________
Home Address: _____________________________ Work Telephone: _________________________
___________________________________________ Cellular Telephone: _________________________
C.
Name:
Home Address:
____________________________________________________
Notary Public for the State of Texas
My commission expires: ________________________________
Funeral Consumers Alliance of North Texas
2875 E Parker Rd, Plano TX 75074, 972-509-5686, info@fcant.org
MAY BE REPRODUCED FOR PRIVATE USE ONLY. NO COMMERCIAL USE IS APPROVED.
Body Disposition Authorization Affidavit — Page 1 of 2
Home Telephone:
Work Telephone:
Cellular Telephone:
Home Telephone:
Work Telephone:
Cellular Telephone:
Home Telephone:
Work Telephone:
Cellular Telephone:
17. HEALTH CARE POWER OF ATTORNEY
NOTE: YOU SHOULD USE THIS DOCUMENT TO NAME A PERSON AS YOUR HEALTH CARE
AGENT IF YOU ARE COMFORTABLE GIVING THAT PERSON BROAD AND SWEEPING POWERS
TO MAKE HEALTH CARE DECISIONS FOR YOU. THERE IS NO LEGAL REQUIREMENT THAT
ANYONE EXECUTE A HEALTH CARE POWER OF ATTORNEY.
STATE OF NORTH CAROLINA
HEALTH CARE POWER OF
ATTORNEY
(6) Artificial nutrition and hydration: Artificial nutrition and hydration must be
provided, withheld or withdrawn in accordance with the choice I have made in
paragraph (5) unless I have checked and initialed
one of the boxes below:
EXPLANATION: You have the right to name someone to make health care decisions for you when you
COUNTY OF __________________
NOTE: YOU SHOULD USE THIS DOCUMENT TO NAME A PERSON AS YOUR HEALTH CARE
AGENT IF YOU ARE COMFORTABLE GIVING THAT PERSON BROAD AND SWEEPING POWERS
TO MAKE HEALTH CARE DECISIONS FOR YOU. THERE IS NO LEGAL REQUIREMENT THAT
STATE OF TEXAS
ANYONE EXECUTE A HEALTH CARE POWER OF ATTORNEY.
COUNTY OF
BODY DISPOSITION
cannot make or communicate those decisions. This form may be used to create a health care power of
AUTHORIZATION attorney, and meets the requirements of North Carolina law. However, you are not required to use this
AFFIDAVIT
form, and North Carolina law allows the use of other forms that meet certain requirements. If you prepare
your own health care power of attorney, you should be very careful to make sure it is consistent with
§
North Carolina law.
KNOW ALL PERSONS BY THESE PRESENTS:
§
EXPLANATION: You have the right to name someone to make health care decisions for you when you
This document gives the person you designate as your health care agent broad powers to make health
cannot make or communicate those decisions. This form may be used to create a health care power of
care decisions for you when you cannot make the decision yourself or cannot communicate your decision
Texas Health and Safety wishes
attorney, and meets the requirements of North Carolina law. However, you are not required to use this I, ___________________________ (print name), based on the authority of the You should discuss your Code, concerning life-prolonging measures, mental health
to other people.
§711.002(g), upon my oath make the following declaration and directiveand other health care decisions with your health care agent. Except to the extent that you
form, and North Carolina law allows the use of other forms that meet certain requirements. If you prepare
treatment, concerning the disposition of my body
your own health care power of attorney, you should be very careful to make sure it is consistent with North
after my death: I declare that it is my wish and I hereby authorize and specific limitations or restrictions in thisbe
express direct that, upon my death, my remains form, your health care agent may make any health care
Carolina law.
(initial one box):
Check
Initial
decision you could make yourself.
This document gives the person you designate as your health care agent broad powers to make health care
This form does not impose a duty on your health care agent to exercise granted powers, but when a
decisions for you when you cannot make the decision yourself or cannot communicate your decision to other Cremated
power is exercised, your health care agent will be obligated to use due care to act in your best interests
people. You should discuss your wishes concerning life-prolonging measures, mental health treatment, and Interred at a cemetery or on private property
and in accordance with this document.
other health care decisions with your health care agent. Except to the extent that you express specific
Interred at a mausoleum
limitations or restrictions in this form, your health care agent may make any health care decision you could
Donated to medical science; if this disposition is not possible because no medical or research facilityis intended to be valid in any jurisdiction in which it is presented,
make yourself.
This Health Care Power of Attorney form will
___
accept my body, I direct that my remains be (initial one box):
but places outside North Carolina may impose requirements that this form does not meet.
Cremated
If you want to use this form, you must complete it, sign it, and have your signature witnessed by two
Interred at a cemetery or on private property
qualified witnesses and proved by a notary public. Follow the instructions about which choices you can
Interred at a mausoleum
initial very carefully. Do not sign this form until two witnesses and a notary public are present to watch
you sign it. You then should give a copy to your health care agent and to any alternates you name. You
Other disposition as specified:
should consider filing it with the Advance Health Care Directive Registry maintained by the North Carolina
_________________________________________________________________________________
Secretary of State: http://www.nclifelinks.org/ahcdr/
I want artificial nutrition regardless of my condition.
This form does not impose a duty on your health care agent to exercise granted powers, but when a power is
exercised, your health care agent will be obligated to use due care to act in your best interests and in
accordance with this document.
This Health Care Power of Attorney form is intended to be valid in any jurisdiction in which it is presented,
but places outside North Carolina may impose requirements that this form does not meet.
If you want to use this form, you must complete it, sign it, and have your signature witnessed by two
_________________________________________________________________________________
qualified witnesses and proved by a notary public. Follow the instructions about which choices you can
initial very carefully. Do not sign this form until two witnesses and a notary public are present to watch
Other disposition as specified:
you sign it. You then should give a copy to your health care agent and to any alternates you name. You
1.
Designation of Health Care Agent.
should consider filing it with the Advance Health Care Directive Registry maintained by the North Carolina ________________________________________________________________________________________
Secretary of State: http://www.nclifelinks.org/ahcdr/
I, _____________________, being of sound mind, hereby appoint the following person(s) to serve as my
___
I do NOT want artificial nutrition regardl ess of my condition.
________________________________________________________________________________________
health care agent(s) to act for me and in my name (in any way I could act in person) to make health care
decisions for me as authorized in this document. My designated health care agent(s) shall serve alone,
Signature of Declarant: ______________________________________ Date: _____________________________
in the order named.
1. Designation of Health Care Agent.
___
I, _______________________________, being of sound mind, hereby appoint the following person(s) to serve as
A.
Name:
Printed name of Declarant: ____________________________________
my health care agent(s) to act for me and in my name (in any way I could act in person) to make health care
Home Address:
decisions for me as authorized in this document. My designated health care agent(s) shall serve alone, in the order
BEFORE ME, the undersigned notary public for the State of Texas, personally appeared
named.
A.
Name: _____________________________
Home Address: _____________________________
___________________________________________
I want artificial hydration regar dless of my condition.
B.
Name:
Home Telephone: _________________________ __________________________, the Declarant in this Body Disposition Authorization Affidavit, who upon
Home Address:
Work Telephone: _________________________ his/her oath made the foregoing declaration(s), including placing his/her initials in the boxes he/she choose on this
Cellular Telephone: _________________________
the _______________ day of _________________________, 20_____.
B.
Name: _____________________________ Home Telephone: __________________________
Home Address: _____________________________ Work Telephone: __________________________
___________________________________________ Cellular Telephone: __________________________
___
Home Telephone:
Work Telephone:
Cellular Telephone:
C.
Name:
Home Address:
____________________________________________________
Notary Public for the State of Texas
Home Telephone:
Work Telephone:
Cellular Telephone:
Home Telephone:
Work Telephone:
Cellular Telephone:
I do NOT want artificial hydration regardless of my condition.
C.
Name: _____________________________ Home Telephone: _________________________
Home Address: _____________________________ Work Telephone: _________________________
___________________________________________ Cellular Telephone: _________________________
My commission expires: ________________________________
Funeral Consumers Alliance of North Texas
2875 E Parker Rd, Plano TX 75074, 972-509-5686, info@fcant.org
MAY BE REPRODUCED FOR PRIVATE USE ONLY. NO COMMERCIAL USE IS APPROVED.
Body Disposition Authorization Affidavit — Page 1 of 2
19. 1. THE DENIAL OF DEATH
“...The idea of death, the fear of it, hunts the humans animal like nothing else; it is a
mainspring of human activity. Activity designed largely to avoid the fatality of
death, to overcome it by denying in some way that it is the final destiny for man.”
Ernest Becker
20. Six Out Of 10 People Say They Feel
Intimidated Talking To Their Families
About End-of-life Decisions.
Source: California Healthcare Foundation survey
21. 2. THE CURRENT FORMS
“Dying is more than a set of problems to be solved. The nature of dying is not
medical, it is experiential.”
Ira Byock
22. I,
HEREBY APPOINT
AS MY HEALTH CARE AGENT TO MAKE ANY AND ALL HEALTH
CARE DECISIONS FOR ME, EXCEPT TO THE EXTENT THAT I
STATE OTHERWISE. THE PROXY SHALL TAKE EFFECT ONLY
WHEN AND IF I BECOME UNABLE TO MAKE MY OWN HEALTH
CARE DECISIONS.
25. HIGH COST OF END OF LIFE CARE
Medicare recipients spend during the five
years before their death averaged about:
$39,000
Individuals
Source: Mount Sinai School of Medicine study
$51,000
Couples
$66,000
Long-term illnesses
31. A PDF TOOLKIT
Tool #5
After Death Decisions
to Think About Now
Name & Date_______________________________________
After the death of a loved one, family and friends are often left with some tough decisions. You
can help ease the pain and anxiety by making your wishes—about burial, autopsy, and organ
donations—clear in advance.
ORGAN AND T ISSUE DONATION
D ID YOU KNOW?
More than 68,000 patients are on the national organ transplant waiting list. Each day, 13 of
them will die because the organs they need have not been donated. Every 16 minutes, a new
name will be added to that waiting list.
Organs you can donate: Heart, Kidneys, Pancreas, Lungs, Liver, Intestines.
Tissue you can donate: Cornea, Skin, Bone Marrow, Heart Valves, Connective Tissue.
To be transplanted, organs must receive blood until they are removed from the b ody of the
donor. Therefore, it may be necessary to place the donor on a breathing machine temporarily or
provide other organ-sustaining treatment.
If you are older or seriously ill, you may or may not have organs or tissue suitable for
transplant. Doctors evaluate the options at or near the time of death.
The body of an organ donor can still be shown and buried after death.
1.
Do you want to donate viable ORGANS for transplant? (Circle one)
Yes
Not sure
No
2.
If Yes, check one:
____ I will donate any organs.
____ Just the following: _______________________________
Do you want to donate viable TISSUES for transplant? (Circle one)
Yes
Not sure
No
If Yes, check one:
____ I will donate any organs.
____ Just the following: ____________________________
32. A GOOD DEATH TOOLKIT
INFO
TITLE
tHIS IS WHERE THE QUESTION GOES
OPTION 1
OPTION2
STATISTICS
245,000
SOURCE
34. USA CREMATION TRENDS 2011
Deaths
Cremations
% of death cremated
2,464,392
1035,074
42.0%
Source: The Nebraska Coalition for Compassionate Care and the Nebraska Hospice and Palliative Care Association, (NHPCA) 2010 end-of-life survey .
35. NUMBER OF PATIENTS IN THE U.S
WHO RECEIVE TUBE FEEDING
Hospital
245,000
Home HealthCare
30,700
babies
8,100,000
Source: AHRQ Healthcare Costs and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) 2009 data.
36. ATTITUDE TOWARDS ADVANCE DIRECTIVES
Want
Have
93%
20%
Source: The Nebraska Coalition for Compassionate Care and the Nebraska Hospice and Palliative Care Association, (NHPCA) 2010 end-of-life survey .
37. 3. CONVERSATIONAL TONE
The current content lacks a humanizing aspect.
It feels cold, clinical, and not conversational.
38. WHAT IF
you are in severe discomfort most of the time
(such as nausea, diarrhea).
Want
Treatment
1
2
3
4
5
Do not
Want Treatment
39. LIVING WILL
Which of the following do you fear the most
near the end of your life?
Being in pain
OR
Losing the ability
to think
OR
Being a financial burden on
loved ones
OR
To be alone