Month: May 2018

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The Medical Power of Attorney: What Do I Need to Know?

What is a Medical Power of Attorney?

A Medical Power of Attorney is a legal instrument that allows you to select the person that you want to make healthcare decisions for you if and when you become unable to make them for yourself. The person you pick is representative for purposes of healthcare decision-making.

What Healthcare Decisions are you Talking About?

Any kind of decision that is related to your health that you allow. You could limit your representative to certain types of decisions. (For example, the decision to put you on life support when there is no hope of you getting better.) On the other hand, you could allow your representative to make any healthcare decision that might come up. This includes decisions to give, withhold or withdraw informed consent to any type of health care, including but not limited to, medical and surgical treatments. Other decisions that may be included are psychiatric treatment, nursing care, hospitalization, treatment in a nursing home, home health care and organ donation.

How is this Different from a Living Will?

A Living Will is a statement of decisions you made yourself. It tells the doctor that you do not want to be kept alive by machines, if there is no hope of getting better. A Medical Power of Attorney gives someone else the authority to make medical decisions for you if you are unable to make them for yourself. It is meant to deal with situations that you cannot predict. Because you cannot predict these situations, you cannot decide in advance what choice you would make. The Medical Power of Attorney allows you to pick the person that you trust to make to these kinds of decisions when you cannot make them yourself.

Do I Still Need a Living Will If I Have a Medical Power of Attorney?

Yes. Any decisions that you make in your Living Will must be followed by the person you name as your Medical Power of Attorney.

When Would I Need a Medical Power of Attorney?

A Medical Power of Attorney is used when you become unable to make healthcare decisions for yourself. For example, if you are unconscious after a car accident and you need a blood transfusion; if you are under anesthesia and you need to have a more extensive procedure than you initially consented to; or if you become mentally incompetent as a result of Alzheimer’s Disease and you need medical treatment.

How will I know if I am able to Make Healthcare Decisions for Myself?

A doctor or psychologist or advance practice nurse working with a doctor will make this determination. Commonly, the doctor will say that you lack the capacity to make healthcare decisions. He or she may also say that you are incapacitated. If you are conscious, you will be told that you have been found to be incapacitated and that your Medical Power of Attorney Representative will be making decisions regarding your treatment.

How Does the Doctor Decide that I am Unable to Make Medical Decisions for Myself?

The doctor, psychologist or advance nurse practitioner will evaluate your ability to:

  1. Appreciate the nature and implications of a health care decision; (Are you able understand what your doctor is telling you and understand the consequences of any choices t hat you make ?)
  2. Make an informed choice regarding the alternatives presented; (Are you able to process the information the doctor gives you and make your decision based on this process?) and
  3. Communicate that choice in an unambiguous manner. (Are you able to let your doctor know what you have decided? You may state your choice, write it down, or in some case, just nod your head. The important thing here is that there must be no doubt about what your are trying to express.)

If the doctor determines that you are unable to do these things, they must write this in your medical records. The doctor’s statement must include the reason why you were found to lack capacity.

Can the doctor say that I do not have the capacity to make Healthcare Decisions just because I am old or have a mental illness?

No. Simply being old or having a mental illness is not enough to support a finding that you do not have the capacity to make medical decisions. The doctor must complete the three part evaluation discussed above before he or she determines that you do not have the capacity to make healthcare decisions.

Does the Person I Name as Medical Power of Attorney have any Control Over My Medical Care if I can Still Make My Own Decisions?

No. The person you name as your Medical Power of Attorney has no authority until you become unable to make your own decisions.

Can I Name an Alternative or a Back-up Representative in Addition to My First Choice?

Yes. You may name one or more “successor representatives” to fill this role if your first choice is unable, unwilling or disqualified to serve.

What Kinds of Things Can the Person I Name as Medical Power of Attorney Do?

The person that you name as your Medical Power of Attorney representative can make any decisions related to your health care that you allow. These decisions could include giving, withholding or withdrawing informed consent to any type of health care, including but not limited to, medical and surgical treatments. Other decisions that may be included are life-prolonging interventions, psychiatric treatment, nursing care, hospitalization, treatment in a nursing home, home health care and organ donation. Your representative can have or control access to your medical records and decide about measures for the relief of pain.

Your Medical Power of Attorney can be as broad or as narrow as you want it to be. You can specifically write that your Medical Power Attorney Representative shall not have the power to make one of these decisions. Or, you can specifically state exactly what decision you want your Medical Power of Attorney Representative to make. For example, you might say that your representative cannot give a certain person access to your medical records.

How Can I Make Sure that the Decisions My Medical Power of Attorney Representative
Makes are Ones that I Would Agree With?

There are several things that you can do to help your representative make decisions that you would agree with.

  1. Write it down. You can include specific instructions in your Medical Power of Attorney to cover particular circumstances. You can also include a statement of your personal values to help your representative make decisions.
  2. Talk about your wishes. Discuss your wishes with the person you appoint as your Medical Power of Attorney representative. Tell them about your religious beliefs and personal values. Make sure that they know the things that you definitely would want as well as the things that you absolutely do not want.

Who should I name as my Medical Power of Attorney Representative?

You should pick someone that knows you well and that you trust to make healthcare decisions for you based on your personal wishes and values. You may or may not want to name a family member as your Medical Power of Attorney Representative. Keep in mind, that some of the decisions your representative will have to make will be very difficult. It might be difficult for some family members to overcome their own emotions and make decisions that are based on your personal values. The most important consideration in naming a Medical Power of Attorney Representative is to choose someone you trust to be able to make decisions based on the values and directions you have set out.

Can I appoint my doctor as my Medical Power of Attorney?

No, the law says that you cannot appoint your doctor as your Medical Power of Attorney. Additionally, the following people cannot serve as your Medical Power of Attorney:

  1. Any doctor, dentist, nurse, physician’s assistant, paramedic, or psychologist who is treating you, cannot serve as your Medical Power of Attorney representative;
  2. Any other person who is providing you with medical, dental, nursing, psychological services or other health services of any kind, cannot serve as your Medical Power of Attorney representative;
  3. Any employee of any doctor, dentist, nurse, physician’s assistant, paramedic, or psychologist who is treating you cannot serve as your Medical Power of Attorney representative, UNLESS the employee is your relative;
  4. Any employee of any other person who is providing you with medical, dental, nursing, psychological services or other health services of any kind cannot serve as your Medical Power of Attorney representative, UNLESS the employee is your relative;
  5. An operator of the hospital, psychiatric hospital, medical center, ambulatory health care facility, physicians’ office and clinic, extended care facility operated in connection with a hospital, nursing home, a hospital extended care facility operated in connection with a rehabilitation center, hospice, home health care, and any other facility established to administer health care that is currently serving you cannot serve as your Medical Power of Attorney representative.
  6. Any employee of an operator of a hospital, psychiatric hospital, medical center, ambulatory health care facility, physicians’ office and clinic, extended care facility operated in connection with a hospital, nursing home, a hospital extended care facility operated in connection with a rehabilitation center, hospice, home health care, and any other facility established to administer health care cannot serve as your Medical Power of Attorney representative, UNLESS the employee is your relative.

Does My Medical Power of Attorney Representative Have to Pay My Medical Bills?

No. A Medical Power of Attorney only gives the person you appoint authority to make healthcare related decisions. This does not include authority to pay your bills. For that you need a Durable Financial Power of Attorney. It is entirely possible that the same person may hold both your Medical Power of Attorney and your Financial Power of Attorney. However, if this is not the case, your Medical Power of Attorney Representative has no financial authority.

What Happens If I Appoint a Medical Power of Attorney and Then Someone Petitions to Have A Guardian Appointed for Me?

If you appoint a medical power of attorney and then someone petitions to have a guardian appointed for you, the court will give the person you appointed as medical power of attorney special consideration. In other words, the court will appoint the person you name as a medical power of attorney to be your guardian unless it finds that there is a good reason not to.

Can I Change My Mind After I Sign a Medical Power of Attorney?

Yes. As long as you have the capacity to do so, you can revoke your Medical Power of Attorney at any time by any of these methods.

  1. You can destroy the Medical Power of Attorney. Tear it up or burn it.
  2. You can tell someone else to destroy your Medical Power of Attorney. They must destroy it in your presence.
  3. You can write out a statement that you are revoking your Medical Power of Attorney. This statement must be signed and dated by you. This revocation does not become effective until you give it to your doctor.
  4. If you are not able to write, you can tell someone to write out a statement that you are revoking your Medical Power of Attorney. This person must be over 18 years old. This statement must also be signed and dated. You can tell the other person to sign your name on your be half. This revocation does not become effective until your doctor gets it. You can have the other person give it to them if you are not able to.

Is my Medical Power of Attorney Affected if I Get a Divorce?

Yes, if you named your spouse as your Medical Power of Attorney Representative or successor representative. When a final divorce decree is granted, the appointment of your spouse is automatically revoked. You will need to sign a new power of attorney. If you still want your former spouse to serve as your representative, he or she may do so, provided that you reappoint the m in a new Medical Power of Attorney.

What is Required to Make a Valid Medical Power of Attorney?

There are seven requirements:

  1. You must be an adult or have been determined to be a mature minor*;
  2. The Medical Power of Attorney must be in writing;
  3. You must sign it;
  4. You must date it;
  5. You must sign it in the presence of at least two witnesses, age 18 or older;
  6. A Notary Public must acknowledge these signatures;
  7. It should contain the following language or substantially similar language:

This Medical Power of Attorney shall become effective only upon my incapacity to give, withdraw, or withhold informed consent to my own medical care.

*Persons under 18 are presumed to lack capacity. In order to defeat this presumption, persons under 18 must undergo an examination by a doctor, or psychologist, or an advance practice nurse who is collaborating with a doctor and found to have the capacity to make health care decisions. Once this determination is made, these individuals are referred to as “mature minors.”

Who can be a Witness for my Medical Power of Attorney?

The law only requires that a witness to your Medical Power of Attorney be over eighteen years old. Additionally, the law says that the following people cannot be a witness to your Medical Power of Attorney:

  1. The person who signed your Medical Power of Attorney on your behalf and at your direction can not be a witness to your medical power of attorney;
  2. Anyone who is related to you by blood or marriage cannot be a witness to your medical power of attorney;
  3. Anyone who will inherit from you cannot be a witness to your medical power of attorney; (This can be under your will or under the laws that provide for the distribution of your property if you do not have a will.)
  4. Anyone who is legally obligated to pay for your medical c are cannot be a witness to your medical power of attorney;
  5. Your doctor cannot be a witness to your medical power of attorney;
  6. The person you have named as your Medical Power of Attorney or the person you have named as successor Medical Power of Attorney cannot be a witness to your medical power of attorney.

As part of the Medical Power of Attorney your witnesses must sign a statement that they do not fit any of these categories.

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Catholic Cemeteries to offer ‘natural burial’ option starting in fall

When Frank Schweigert dies, he doesn’t expect embalming, a burial vault or even a casket.

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[A]fter his funeral Mass, Schweigert, 67, wants to be placed directly in the ground, wrapped only in cloth, with little of the funeral trappings many people have come to expect.

And The Catholic Cemeteries plans to be ready to accommodate him.

The Mendota Heights-based organization, which oversees five Catholic cemeteries in the Twin Cities, is preparing to offer natural burial as an option as early as this fall. The trend, also called “green burial,” takes different variations, but aims to unite the body with the earth using little if any fossil fuel or non-biodegradable materials.

“It’s so much a part of our tradition,” said John Cherek, The Catholic Cemeteries director. “That’s the amazing part of it.”

The Catholic Cemeteries’ staff began exploring the option a few years ago, as they became aware of local Catholic interest in it. In many respects, the concept is as old as death itself, but the contemporary movement began in earnest about 20 years ago with the opening of the first green burial cemetery in the U.S. in South Carolina.

The California-based nonprofit Green Burial Council, established in 2005, certifies green burial practices for funeral homes and cemeteries. Its Minnesota listing includes only Mound Cemetery of Brooklyn Center as a “hybrid” green cemetery, meaning it offers both green and conventional burials, and Willwerscheid Funeral Home and Cremation Center in St. Paul as the only “green” certified funeral home. Other Minnesota cemeteries and funeral homes, however, do offer the natural burial options without formal certification.

Cherek said he isn’t certain that The Catholic Cemeteries will pursue certification, but preparations are underway in a section of Resurrection in Mendota Heights to make about 50 natural burial plots available this year, with the potential to add more in future years.

Burying the body

Natural burial begins with the preparation of the body, which is not embalmed. Because everything buried with the body needs to be biodegradable, the body is often not clothed, but rather wrapped in a shroud. In some instances, the grave is dug by hand, to avoid fuel-dependent machinery, and the body is transported to the gravesite by non-motorized means. The body may be encased in a biodegradable casket — options include those made from wood, bamboo and wicker — or simply shrouded before being lowered into the grave manually.

At Resurrection, the natural burial area is also being restored to native prairie. That means long grasses and wildflowers will eventually cover the graves. Instead of individual headstones, the plots will be identified collectively by monuments along paved paths.

As The Catholic Cemeteries’ leaders considered whether to offer natural burial, they surveyed focus groups and found more interest than anticipated. Several of those surveyed, such as Schweigert and his wife, Kathy, now feel passionate about the option.

“Since it’s our mission to bury the dead, and we offer full body and we offer cremation [burials] … this would be another option, and it may be attractive to folks who have thought they wanted cremation, but this might give them an alternative,” said Sister Fran Donnelly, director of LifeTransition Ministries at The Catholic Cemeteries.

In many respects, natural burial is a return to common burial practices before the rise of the funeral industry in the early 20th century. Although embalming dates to early Egypt, its contemporary use gained traction during the Civil War, when fallen soldiers’ bodies were transported home for burial.

Although there are common misconceptions that embalming or vaults are necessary for public health, that’s not the case, Cherek said.

Done properly, natural burial does not endanger the water supply or put bodies at risk of being dug up by animals, or spread disease, according to the GBC.

Funeral vaults — structures that surround the coffin in standard graves — are used as a way of stabilizing the ground around a grave for ease of grounds maintenance, preventing the otherwise inevitable sinking of topsoil, which displaces the coffin and bodily remains as they decay.

Embalming, meanwhile, puts chemicals into the ground, and vaults prolong or prevent natural decay, and many elements included in the burial — from suit coat buttons to casket hinges — aren’t biodegradable.

According to the Green Burial Council, American burials annually put into the ground 1.6 million tons of reinforced concrete, 20 million feet of wood, 17,000 tons of copper and bronze, and 64,500 tons of steel. Add to that 4.3 million gallons of embalming fluids, which contain toxins that could negatively impact the health of embalmers.

While some people think of cremation as a simpler option, it also requires chemicals, and toxins linger in the cremated remains.

Cremation is permitted for Catholic burial, and its use is on the rise. However, the Church prefers burial of the body. The Catholic Cemeteries’ leaders think that natural burial might appeal to Catholics not only because of theologically-rooted ecological commitments, but also because it allows them to have a full body burial in a simpler form.

“Faith-wise, I think it says something about the resurrection of the body, that the body is intact, and it’s just going to return to the earth,” Sister Donnelly said.

Dust to dust

Schweigert, an administrator at Metropolitan State University in St. Paul, remembers reading decades ago about traditional Muslim burial, in which the body is placed directly in the ground. It struck him as a very natural way to approach death and honor the deceased, and over the years, the idea germinated in his mind as something he would prefer to the standard use of embalming, a casket and a burial vault. A parishioner of St. Frances Cabrini in Minneapolis, he contacted The Catholic Cemeteries a couple years ago to see if it was possible. He found out that “green burial” was becoming a trend, and that The Catholic Cemeteries was exploring the option. The organization later asked him to participate in a focus group on the topic.

The idea of placing the body directly into the ground with nothing to impede its return to the earth reminded Schweigert of something he observed as an altar boy: that the body and blood of Christ, if not consumed, were buried or drained directly into the ground.

“The earth was the most sacred place for the body of Christ, and the parallel between that and putting a loved one in the earth just seemed to me convincing spiritually,” he said.

And although Schweigert has strong feelings about not being cremated, which he sees as too industrialized and destructive of the body, he said his decision to choose a natural burial is also not a reaction to the funeral industry, which he respects, as he noted funeral directors have treated him and others well during times of grief.

He does, however, question the long-term sustainability of common methods, and he sees natural burial as a way to honor the environment, the dead and the Catholic faith.

Green or natural burial practices complement Catholic teaching about death, Sister Donnelly said, as well as the Church’s social teaching on caring for creation, which Pope Francis articulated in his 2015 encyclical “Laudato Si’: On Care for our Common Home.” Already, several Catholic cemeteries in the U.S. offer green burial options, and a 2011 survey by U.S. Catholic Magazine found that 80 percent of respondents would prefer a green burial.

Some religious communities are adopting natural burial as part of their commitment to caring for creation. Among them is Sister Donnelly’s community, the Sisters of Charity of the Blessed Virgin Mary, which has a cemetery at its motherhouse in Dubuque, Iowa.

In “A Reflection on Changes in Burial Practice” in The Catholic Cemeteries’ summer newsletter, retired priest of the archdiocese Father James Notebaart looks to Scripture and Church tradition and what they say about the sacredness of a burial place, recalling the words spoken in the Ash Wednesday liturgy: “Remember you are dust, and to dust you shall return.”

After noting that the natural burial process is the way most people — including Catholics and their Jewish ancestors — were buried for thousands of years, he wrote, “So the core of natural burial is to acknowledge our innate closeness to the earth as a creature of God’s own making. It acknowledges that the earth itself is holy because it is an icon of the One who created it.

“Today we have begun to step back to much earlier practices, those of the preindustrial world in which there was a more organic sense of how all things are related, both the natural resources and the human use of them. This awareness is shaping a new articulation of ecological ethics, of which Pope Francis is a leading proponent.”

Practical considerations

Choosing natural burial, however, does mean eschewing other common aspects of funeral and burial beyond the casket and vault.

According to state law, a person needs to be embalmed, buried or cremated within 72 hours of death, but refrigeration of the body allows burial to take place up to six days after death, said Dan Delmore, who owns Robbinsdale-based Gearty-Delmore Funeral Chapels and sits on The Catholic Cemeteries’ board. State law also requires embalming for a public open-casket wake, but an in-home or closed-casket wake is a possibility.

Delmore has been a funeral director for 42 years, and for the first 15 years of his work, no one questioned the practice of embalming; it was an assumed part of the funeral preparation, he said.

“There’s been a lot of change of heart in people, and it goes more along the lines of chemicals in general, not necessarily at the time of death, but wanting a life free of chemicals in general,” he said, comparing it to the organic food movement. A Catholic, he also sees natural burial as an appropriate accompaniment to the Church’s funeral rites, and he said he’s excited to see it embraced at Resurrection.

As it prepares to open its natural burial section, The Catholic Cemeteries is working on logistics, including cost, which is among the aspects that The Catholic Cemeteries’ focus groups said would affect their decision whether or not to have a natural burial. While 41 percent surveyed said they were likely to consider natural burial, complicating factors included already owning plots elsewhere; wanting to be buried next to a loved one who already has been buried in a conventional grave or wants to be; and wanting an individual headstone, which The Catholic Cemeteries’ current natural burial plan precludes.

Schweigert admits the idea of not having an individual headstone has taken some getting used to, but while that alone has dissuaded others, he’s not deterred. He recalled seeing a family burial plot in France that had a collective monument, and it’s reminded him that burials have been handled differently in different times by different cultures.

He puts it in perspective with the knowledge that after three generations have passed since a person’s death, his or her grave is not likely to be frequented by loved ones, and that there are other ways to leave a final mark on the world. For him, it’s more important to remove any barriers — physical and symbolic — between the body and the earth.

“This is a sacred moment for us,” he said of death and burial. “We want to have a way to do this with dignity, [and] we want a way to do this with our Catholic religion, so I’m very happy, too, that the Catholic Church has gotten involved in it.”

Complete Article ↪HERE↩!

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Breaking the silence: are we getting better at talking about death?

As the media brings us constant news of strangers’ deaths, grief memoirs fill our shelves and dramatic meditations are performed to big crowds, we have reached a new understanding of mortality, says Edmund de Waal

A 2016 performance of An Occupation of Loss. Artist Taryn Simon gathered professional mourners from 15 countries to demonstrate how they perform grief.

[B]ereavement is ragged. The papers are full of a child’s last months, the protests outside hospitals, the press conferences, court cases, international entreaties, the noise of vituperation and outrage at the end of a life. A memorial after a violent death is put up on a suburban fence. It is torn down, then restored. This funeral in south London becomes spectacle: the cortege goes round and round the streets. The mourners throw eggs at the press. On the radio a grieving mother talks of the death of her young son, pleading for an end to violence. This is the death that will make a difference. She is speaking to her son, speaking for her son. Her words slip between the tenses.

Having spent the last nine months reading books submitted for the Wellcome book prize, celebrating writing on medicine, health and “what it is to be human”, it has become clear to me that we are living through an extraordinary moment where we are much possessed by death. Death is the most private and personal of our acts, our own solitariness is total at the moment of departure. But the ways in which we talk about death, the registers of our expressions of grief or our silences about the process of dying are part of a complex public space.

Some are explorations of the rituals of mourning, how an amplification of loss in the company of others – the connection to others’ grief – can allow a voicing of what you might not be able to voice yourself. The actor and writer Natasha Gordon’s play about her familial Jamaican extended wake, Nine Night, is coming to the end of a successful run at the National Theatre. The nine nights of the wake are a theatre of remembrance, a highly codified period of time shaped to allow the deceased to leave the family.

Theatre of remembrance … Hattie Ladbury and Franc Ashman in Nine Night, Natasha Gordon’s play about a Jamaican wake.

Julia Samuel records in Grief Works, her remarkable book of stories of bereavement, a woman who “asked friends and family to sit shiva [the Jewish mourning tradition] with me at a certain time and place”. And that there was anguish when these particular times were ignored: two friends came at times that were “convenient for them rather than when she was sitting shiva, thus ‘raising all the issues I was temporarily trying to keep contained’”.

As an academic writes in the accompanying notes to artist Taryn Simon’s performance An Occupation of Loss, recently staged in London, “communication between the living and the dead is possible only in mediated forms”. There are obligations we have to fulfil to those who have died. Simon gathered professional mourners from 15 countries (Ghana, Cambodia, Armenia and Ecuador, among others). The mourners wailed and sobbed and keened, the intensity of their expression, their sheer volume, a challenge to the idea that there has to be a silence that surrounds bereavement.

There are silences. Contemporary books on death often take as their premise that to be writing in the first place is a breaking of a taboo. “It’s time to talk about dying,” writes Kathryn Mannix in her book about her work in palliative care, With the End in Mind. “There are only two days with fewer than 24 hours in each lifetime, sitting like bookmarks astride our lives: one is celebrated every year, yet it is the other that makes us see living as precious.” These books record the silence that we in the west have created. By removing dying into a medical context, where expertise and knowledge lie so emphatically with others, we have made death unusual, a process clouded by incomprehension. And by novelty.

So one kind of language we need is that of clarity. A lucidity that allows for the involvement of family and friends alongside healthcare professionals. Clarity, writes Mannix, around the questions such as “when does a treatment that was begun to save a life become an interference that is simply prolonging death? People who are found to be dying despite the best efforts of a hospital admission can only express a choice if the hospital is clear about their outlook.” Conversations about palliative care need extraordinary skill and empathy. These are skills that can be learned.

But for someone writing about their own grief, there are no guidelines. You might have read Thomas Browne’s Urn Burial, or the poems of John Donne, the theories of John Bowlby or Donald Winnicott, Freud’s Mourning and Melancholia, but it simply doesn’t register. Being well read doesn’t help when someone who matters dies. Part of this attempt to start again, to find a form out of the formlessness of grief, is a reluctance to take on the generic language of sympathy, the homogeneous effect of cliche. Bereavement is bereavement, not a masterclass in being well read in the classics. “The death of a loved one is also the death of a private, whole, personal and unique culture, with its own special language and its own secret, and it will never be again, nor will there be another like it,” writes David Grossman in Falling Out of Time, his novel about the death of his son. A death needs a special language.

The language of loss and the framing of sympathy in everyday life is so impoverished, so mired in cliche and euphemism, that deep metaphors of “passing” become thinned to nothing, to sentimentality. The iterations of “losing the battle” and the valorising, endlessly, of “courage” is a way of making the bereaved feel they need to enact a particular role. And then there is the “being strong”. If you are told how wonderful you are for not showing emotion, or for continuing as before, where does that leave being scared? How about denial? Or anger, terror, desolation, loneliness? How about confusion? Why only endurance, resilience, strength? In this need to name, to find precision, accuracy is a measure of love. I think of Marion Coutts’ book The Iceberg, on her dying husband Tom Lubbock’s language, Joan Didion’s The Year of Magical Thinking, charting everything, weighing her responses to her grief. This is different, they say, writing this is a work of mourning.

The greatest of these books find a language that encompasses the sheer confusion of bereavement. In her forthcoming book Everyday Madness: On Grief, Anger, Loss and Love, Lisa Appignanesi writes that “Death, like desire, tears you out of your recognisable self. It tears you apart. That you was all mixed up with the other. And both of you have disappeared. The I who speaks, like the I who tells this story, is no longer reliable.” This is the other loss, that of selfhood, of control, of a forward momentum, of certainty. Appignanesi’s grief at the untimeliness of her husband’s death makes time itself deranged. Her days and weeks and months go awry. Her sense of the past is also called into question. It is excoriating: “My lived past, which had been lived as a double act, had been ransacked, stolen.” Bereavement, she notes, has a deep etymology of plunder. It tears you apart. Where all these registers go wrong, you oscillate between kinds of behaviour that are disinhibited, a derangement of self. It can be physical, a falling, a losing your way. I think of the crow in Max Porter’s Grief Is the Thing with Feathers as the deranged, ransacking presence in a family where the mother has died.

A deranged, ransacking presence’ … Cillian Murphy in Grief Is the Thing with Feathers.

These are images that go deep into history. In the Book of Lamentations we read that God “has made me dwell in darkness … he has walled me in and I cannot break out … He has weighed me down with chains … He has made my path a maze … He has forced me off my way and mangled me.” The Hebrew word eikh (how) opens the Book of Lamentations and then reappears throughout the text. This how is not a question, more a bewildered exhortation. You are beyond questions. All you can do is repeat.

In Anne Carson’s poem Nox, a response to the death of her brother, she refused to accept any conventional form. So the poem comes like a box, a casket, of fragments, attempts at definitions, parts of memories. This seems appropriate. The shape of grief is different each time. That is why the shard – the pieces of broken pottery that are ubiquitous across all cultures – is often used as an expressive image of loss. Think of Job lamenting to God, sitting on a pile of broken shards. In my own practice as a potter, whenever I pick up pieces of a dropped vessel I notice that each shard has its own particularity. Each hurts.

In her study of the deaths of writers, The Violet Hour, Katie Roiphe writes that “moving on, as a concept, is for stupid people, because any sensible person knows grief is a long-term project. I refuse to rush. The pain that is thrust upon us let no man slow or speed or fix.” Bereavement takes a pathway that is different for each and every one of us. It takes different registers, different words. And that is what I take away from this very particular nine months of reading and reflecting on mortality. That there is change in the public space around death. This change is remarkable and wonderful when it comes to end-of-life care: the hospice movement and the training in palliative care are one of the greatest and most compassionate changes to occur in the last 30 years.

And, more slowly, it is happening outside the hospitals and clinics and hospices. People do want to read and talk about grief. For this we have to be grateful to those writers who are trying to find their own shard-like languages to express their own bereavements.

Complete Article ↪HERE↩!

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Acceptable Ways to Dispose of My Body

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[I] might die at any moment. My roof might collapse when my millennial neighbors throw a party that is too cool! I could finally freeze to death from never buying a winter coat! We could all die from (insert terrifying thing Trump is doing today)! So it’s important to plan ahead. While most Americans opt for cremation or embalming, five years of living in Brooklyn have made me much too alt for either. Here are some other suggestions.

Donate my body to pranks.

Spray-paint my bones gold and sell them at Free People.

Let doctors use my body to practice surgery, but make sure they’re not plastic surgeons. I spent a lot of time and effort while alive making sure I wasn’t hot; I don’t suddenly want to be hot when I die.

Roll me into the ocean—it seems like fun for both of us!

Donate all my organs to science, except for my eyes. It’s not that I’m sentimental about my eyes, it’s just that I want them to be used in that spooky “put your hand in the bowl” Halloween trick, in lieu of peeled grapes.

Cremate me, but only if you find a very hip ceramic, block-painted urn that costs three hundred dollars and was made by someone in Brooklyn who somehow makes pottery as a living.

Add me to the “Bodies” exhibit, and make my skeleton do a gnarly skateboard trick. Have the explanatory plaque read, “Blythe was able to do this in real life and did it constantly.”

Put me in a big jar of formaldehyde, like Stannis Baratheon’s wife does with those fetuses on “Game of Thrones.” When you see people getting creeped out by it, say, “Oh, yeah, I bought that at Free People.”

Compost my body and use the resulting loam on my succulents. It doesn’t matter if I’m the wrong kind of soil for the succulents; I’m already killing them while I’m alive.

Keep losing and re-finding my bones, setting off a media frenzy every time with headlines like, “SKELETON DISCOVERED UNDER PARKING LOT.”

Plant a memorial cactus on top of me. I swear to God, I am going to be reincarnated as a succulent.

Use me as a crash-test dummy to prove that it’s actually not dangerous to put your feet up on the dashboard.

Don’t embalm me, and bury me in a natural coffin in a natural cemetery. See if you can find a plot inside a national park. Make my gravesite a geotag on Instagram.

Complete Article ↪HERE↩!

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Perspectives on Death

Today we are talking about death, looking at philosophical approaches from Socrates, Epicurus, and Zhuangzi. We will consider whether it’s logical to fear your own death, or the deaths of your loved ones.

 

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What happens at the end of life?

By Rachel Schraer

[S]cientists are expecting a spike in deaths in the coming years. As life expectancies increased, the number of people dying fell – but those deaths were merely delayed.

With people living longer, and often spending more time in ill-health, the Dying Matters Coalition wants to encourage people to talk about their wishes towards the end of their life, including where they want to die.

“Talking about dying makes it more likely that you, or your loved one, will die as you might have wished. And it will make it easier for your loved ones if they know you have had a ‘good death’,” the group of end-of-life-care charities said.

Where to die?

Surveys repeatedly find most people want to die at home. But in reality the most common place to die is in hospital.

Almost half of the deaths in England last year were in hospital, less than a quarter at home, with most of the remainder in a care home or hospice.

What happens to human remains?

Dying wishes don’t just extend to where you die but to what happens to your body after death too.

Cremation overtook burial in the UK in the late-1960s as the most popular way to dispose of human remains, and more than doubled in popularity between 1960 and 1990.

Since then it has remained fairly stable at about three-quarters of the deceased being cremated, although it has been creeping up gradually year on year – in 2017 it hit 77%.

Although cremation is thought to be more environmentally friendly, it is not without its own costs. The process requires energy. And burning bodies releases carbon dioxide into the atmosphere.

There are hundreds of “green” burial grounds in Britain where coffins must be biodegradable and no embalming fluid or headstone markers are permitted. Instead, loved ones of the deceased often plant trees as a memorial.

The Association of Natural Burial Grounds says: “Many people nowadays are conscious of our impact on the environment and wish to be as careful in death as they have been during their lives to be as environmentally friendly as possible.”

At natural burial grounds, bodies are generally buried in shallow graves to help them degrade quickly and release less methane – a greenhouse gas.

Some people want to go further than this.

A form of “water cremation” is currently available in parts of the US and Canada, and could come to the UK.

This eco-friendly method uses an alkaline solution made with potassium hydroxide to dissolve the body, leaving just the skeleton, which is then dried and pulverised to a powder.

Sandwell Council, in the West Midlands, was granted planning permission to introduce a water cremation service, but these plans are currently on hold because of environmental concerns.

In December 2017, water providers membership body Water UK intervened and said it feared “liquefied remains of the dead going into the water system”.

Cremation by fire or burial remain the two options for most people, but those that want to do something a bit different could opt to have their ashes turned into a diamond or vinyl record, displayed in paperweight, exploded in a firework or shot into space.

The cost of death

Traditional cremation is cheaper than burial, particularly as space is short, driving up the cost of grave plots. But the cost of funerals in general has been rising.

Insurance firm SunLife, which produces an annual report on the cost of funerals, says prices have risen 70% in a decade.

It put this down to lack of space and the rising cost of land as well as fuel prices and cuts to local authority budgets leading to reduced subsidies for burials and crematoria.

A survey of 45 counties, conducted by the Society of Local Council Clerks, found half of respondents’ local council run cemeteries would be full in 10 years and half of Church of England graveyards surveyed had already been formally closed to new burials.

The same problem faces Islamic burial sites.

Mohamed Omer, of the Gardens of Peace cemetery in north-east London, says the problem is compounded by a growing population and by the fact that Muslims do not cremate their dead.

The Jewish community also do not traditionally practise cremation. David Leibling, chairman of the Joint Jewish Burial Society, says all of the four largest Jewish burial organisations have acquired extra space in recent years.

However, he says it’s not such a problem for the community since synagogue members pay for their burial plots through their membership. This means the organisation can predict how many people it is going to have to bury.

“As we serve defined membership we can make accurate estimates of the space we need,” he says.

What about our digital legacy?

There are growing concerns over what will happen to people’s social media profiles after they die.

The Digital Legacy Association is working with lawyers to produce guidelines on creating a digital will, setting out people’s wishes for what happens to social media profiles – and “digital assets” such as music libraries – after death.

Three-quarters of respondents to the DLA’s annual survey say it’s important to them to be able to view a loved one’s social media profile after their death.

But almost no-one responding to the survey had used a function to nominate a digital next of kin, such as Facebook’s legacy contact or Google’s inactive account manager functions.

Both Facebook and Instagram allow family and friends to request the deceased’s account is turned into a memorial page, while Twitter says loved ones can request the deactivation of a “deceased or incapacitated person’s account”.

Complete Article ↪HERE↩!

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How to Talk to Kids About Death

 

[D]iscussing death with your kids can be a real concern and many tend to avoid it. Death is however an inevitable part of life and it is our responsibility to ensure our kids are aware of it and know it’s okay to discuss it.

If we allow children to talk to us about death, we can give them needed information, prepare them for a crisis, and help them when they are upset. We can encourage their communication by showing attention and respect for what they have to say. We can also make it easier for them to talk to us if we are open, honest, and at ease with our own feelings.

Death is very much a part of our lives on many different levels. We may be surprised at how aware children already are about death. They see dead insects, dead birds and animals on the road or a family pet may have died. Children read about death in their fairy tales, watch it in cartoons and even role-play death in school plays. Without realising it they already have some exposure to the concept.

Problems That Make Discussing Death Difficult

  1. We avoid talking about things that upset us. We bottle it up and hope that by saying nothing will help it go away. Children are sensitive barometers of emotion and are tremendous observers. They know something is wrong by simply watching us. Our body language, emotions on our faces, what we say and what we don’t say are all communicating a message to our kids.When we choose not to discuss an issue with our kids they too hesitate to ask questions. They automatically think “If Mummy and Daddy are so upset that they can’t talk about it, I had better not talk about it either……it must be bad!”. This causes our kids to stress and worry more as they don’t know how we are feeling.
  2.  We feel uncomfortable when we don’t have all the answers. As a teacher and parent myself, kids will often expect us to know everything, even all about death. Take it as a compliment and know that they look up to us.It is okay to say to your child “I’m not sure myself about that” or “I just don’t know the answer to that”. Children respond to this honesty beautifully and feel connected in our openness towards them. It helps them feel better about not knowing everything also. In discussing death, we may find different answers at different stages in our life or grieving process.Share with children your beliefs. Expose them to the belief of others, for example some people believe in afterlife, others do not. Allow them to be comforted in knowing your beliefs and allow them to choose their own.
  3. Death is often a taboo subject– in some cultures death is an integral part of family life. People died in their home environment, surrounded by loved ones (adults and children alike). They comforted each other and mourned together.Unfortunately today death is much lonelier. Many people die in isolation and loved ones miss sharing their last moments. The living has in some ways become separated from the dying; consequently, death has taken on added mystery and, for some, added fear.

Help to diminish this trend and openly discuss death with your child when an appropriate time arises. Model appropriate behaviour regarding death, for example express your sympathy towards someone who has lost a loved one in front of your child. Show them that it is kind to acknowledge a loss and express care towards others.

Developmental Stages of Understanding – A General Guide

  • Preschool children mostly see death as temporary, reversible and impersonal. In stories they read or watch characters will often suddenly rise up alive again after being totally destroyed. It’s not surprising they don’t understand, yet it is appropriate for their age level to think this way.
  • Between the ages of five and nine, most children are beginning to see that all living things eventually die and that death is final. They tend to not relate it to themselves and consider the idea that they can escape it. They may associate images with death, such as a skeleton. Some children have nightmares about them.
  • From nine through to adolescence, children to begin to understand fully that death is irreversible and that they too will die some day.

It is important to remember however that all children develop at different rates and that children experience life uniquely. They have their own personal ways of handling and expressing emotions.

It is not uncommon for a three year old to ask questions about death, for a child to be openly unconcerned about the death of a grandparent yet devastated over the death of a pet. Some children show their understanding of death through playing with their toys.

It is important to explain death in simple terms for young children. For example, when someone dies they don’t breathe, or eat, or feel hungry or cold and you won’t be able to see them again.

No matter how children cope with death or express their feelings, they need sensitive and nonjudgmental responses from adults. Careful listening and observing are important ways to learn how to respond appropriately to a child’s needs.

Talking About Death With Preschoolers or Young Children

Many people feel challenged when approaching the subject of death to preschoolers and young children. They in particular need brief and simple explanations. Using concrete and familiar examples may help. For example, death may be made more clear by explaining it in terms of the absence of familiar life functions – when people die they do not breathe, eat, talk, think, or feel any more; when dogs die they do not bark or run any more; dead flowers do not grow or bloom any more.

Children learn through repetition so they may need to go over this quite a few times. A child may immediately ask more questions, others may be silent, then wish to revisit the subject again later. Children sometimes get confused with what they hear so it is important you check their understanding by revisiting the subject at appropriate times.

As time passes and children have new experiences, they will need further explanations and sharing of ideas and thoughts.

It may take time for a child to comprehend fully the ramifications of death and its emotional implications. A child who knows that Uncle Tom has died may still ask why Aunt Julie is crying. The child needs an answer. “Aunt Julie is crying because she is sad that Uncle Tom has died. She misses him very much. We all feel sad when someone we care about dies.”

There are also moments when we have trouble “understanding” what children are asking us. A question that may seem dreadfully thoughtless to an adult may be a child’s request for reassurance. For instance, a question such as, “When will you die?” needs to be heard with the realisation that the young child perceives death as temporary.

While the permanency of death is not yet fully understood, a child may think that death means separation, and separation from parents and the loss of care involved are frightening.

Being cared for is a realistic and practical concern, and a child needs to be reassured. Possibly the best way to answer a question is by asking a clarifying question in return: “Are you worried that I won’t be here to take care of you?” If that is the case, the reassuring and appropriate answer would be something like, “I don’t expect to die for a long time. I expect to be here to take care of you as long as you need me, but if I did die, there are lots of people to take care of you. There’s Daddy, Aunt Laura and Uncle John or Nan.”

It is important to check which words you use when discussing death with your kids. Some children confuse death with sleep, particularly if they hear adults refer to death with one of the many euphemisms for sleep – “they died in their sleep”, “eternal rest”, “rest in peace.” Resulting from this confusion, a child may be afraid of going to bed, incase they don’t wake up either!
Similarly, if children are told that someone who died “went away”, brief separations may begin to worry them. Grandpa “went away” and hasn’t come back yet. Maybe Mummy won’t come back from the shops or from work. Therefore, it is important to avoid such words as “sleep”, “rest”, or “went away” when talking to a child about death.

To avoid confusion with preschoolers and very young children, it helps to explain that only very serious illness may cause death. When they hear that sickness was the cause of death, we don’t want them to assume that minor ailments are a cause for major concern.

When a child associates death only with old age, they can become very confused when they learn that young people can die too. It is important to explain that most people live a long time, but some don’t. However we do expect that we will live a very long time (always reassure them)!

Religious References

Religion is a real source of strength for many people in a time of grieving. If however religion has not played a part in your child’s life before dealing with death, it may be very confusing and worrying to hear religious references. For example, the explanation “Big sister is with God now” may comfort an adult, but frighten a child. They may fear that God will come and take them away as He did big sister.  Ensure that your child has an affiliation for your terms so they feel familiar and can understand.

Other messages may confuse children, including statements such as “Tommy is happy in Heaven with the angels”. They may wonder why everyone is so unhappy when they say that Tommy is happy. They need to hear about the sadness being felt from losing Tommy, along with our expressions of religious faith.

It is important to help children understand the realities of death, being the loss and the grief. Trying to shelter children from these realities only denies them from the opportunity to express their feelings and be comforted. Sharing feelings between you and your child will benefit you both.

Other Opportunities To Talk About Death

Children tend to be extremely curious when they discover death, particularly dead flowers, birds, trees and insects. This may open windows of opportunity to discuss death further and answer all the detailed questions that may arise. Try to reinforce the concept that all living things eventually die, but it makes room for new things to join us on earth.

Other opportunities to discuss death with your kids arise when well-known persons die and their funeral receives a lot of media coverage. This is a natural time to clarify any misunderstandings they may have about death. If the death is violent or aggressive however, you need to reassure your child that they are safe and most people do not behave this way towards each other.

Attending Funerals

If your child is to attend a funeral, they need to be prepared beforehand for what they might see and hear before, during and after the service. Explain that it is a very sad occasion and that some people will be crying and others feeling very sad.

Seat your child next to you or someone they are familiar with who is able to cope with their questions and be prepared to offer explanations. If your child prefers to not attend the funeral, they must not be forced.

Mourning

We all need to mourn in order to heal our sorrows and move on in our lives. By being open with our emotions and showing our sorrow and tears, expresses to our children that it is okay that they also feel sad and cry. We should never associate tears and expressing feelings with weakness.

Children often feel guilty and angry when they lose a close family member. They need reassurance that they have been, and will continue to be, loved and cared for.

In Summary

A grieving child needs information that is clear and comprehensible for their development level. They need a lot of reassurance that they are safe and loved and be made feel that they can discuss their feelings openly. Children need to maintain their activities and interests as they desire and revisit questions regularly.

When preparing a child for an anticipated death, allow them to help care for the dying person if they desire, receive lots of affection and answer questions, be given information about the physical, emotional, and mental condition of the terminally ill person and be given a choice of visiting or remaining away.

Complete Article ↪HERE↩!