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Green funerals help planet, wallet

For years, Dr. David Wong has questioned why religious people, who say their souls go to heaven, would go to such extremes to protect their dead body by embalming, select expensive wooden caskets and then even protect the casket. Perhaps green funerals are the alternative?

By Dr. W. Gifford-Jones

[H]ow would you react if you saw people dumping 800,000 gallons of formaldehyde, a carcinogenic substance, into the earth every year?

Then witness them cutting down four million acres of forests annually? I suspect the environmentalists who fight underground oil pipes would be raising holy hell about formaldehyde and rampant destruction of trees. Yet this is what it takes to bury the U.S. dead every year. So why are environmentalists so silent?

Now, a film called “Echo Death Takeover: Changing the Funeral Industry” has been produced by The Order of Good Death, founded by funeral owner Catlin Doughty who advocates green funerals.

Some readers may wonder why I’m writing about death when I’m trained to keep people alive. But pollution of many types is currently causing serious respiratory and other health problems. Moreover, for years I’ve questioned why religious people, who say their souls go to heaven, would go to such extremes to protect their dead body by embalming, select expensive wooden caskets and then even protect the casket. And although I’m not a religious authority, don’t they always say at funerals, “Ashes to ashes and dust to dust?”

So, what to do about the current burial procedure? Formaldehyde was discovered by a chemist, August Wilhelm von Hofmann, in 1867 and it quickly replaced arsenic as the prime way to embalm bodies. Now we know that formaldehyde is a hazardous substance, highly toxic to humans. It is linked to cancer and irritates the eyes, nose and throat.

Some readers would reply, “But what about cremation? Is this more eco –friendly?” Unfortunately, where there’s fire there’s smoke. Cremation also produces harmful substances such as carbon dioxide, hydrochloric acid, sulphur dioxide, dioxin, mercury from amalgam dental fillings and carcinogens.

If the body is embalmed, smoke also contains vaporized formaldehyde which remains in the atmosphere. That is, until it bonds with water. Then we are rained on with formaldehyde. So be sure to take a good raincoat and hat if attending a rainy funeral. Besides, cremation requires heat that could be used for other purposes.

So, what is a green funeral? It’s a process called alkaline hydrolysis, also called flameless cremation or water cremation. The body is placed in a pressurized steel container filled with 95 per cent water and five per cent potassium. For the next three hours the body undergoes chemical decomposition, reducing it to soft bone fragments. This mixture of amino acids, peptides, sugar and salt can then be used for fertilizer.

Water cremation is not an illogical proposition for the next century. It’s now legal for human disposal in four U.S. states and in 14 for pets.

Are there negatives to water cremation? I imagine some would be disgusted at the dissolving of a loved one in a warm alkaline bath. But, surely, it’s less psychologically shocking than having Grandpa inserted into a fiery inferno.

Another alternative is to wrap the body in a biodegradable shroud made of cotton or unbleached bamboo, place it in a biodegradable casket in a shallow grave and let bacteria break down all these ingredients.

So, what’s going to happen? I hope that good sense will one day finally prevail and the days of spending thousands of dollars on today’s burial rites will finally end.

Shakespeare, in his play “Hamlet,” describes the scenario of life and death so well. He wrote: “Worms are the emperor of all diets. We fatten up all creatures to feed ourselves and we fatten ourselves for the maggots when we are dead. A man may fish with the worm that hath eat of a king and eat of the fish that hath fed of that worm.”

This is not a pleasant thought or the best bedtime reading. But regardless of how expensive the casket is the worms finally win. So, isn’t there a better way to protect the planet and return all the minerals and other elements to the earth?

So, what is my wish on death? My family knows I want a simple bench along the waterfront in Toronto where people can relax and enjoy the view. My ashes beneath can help the trees grow.

Complete Article ↪HERE↩!

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Will your life end well? An Oscar nominee and palliative care advocate on what’s new in death

Shoshana Ungerleider, founder of the End Well symposium and the Ungerleider Palliative Care Education Fund

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Shoshana Ungerleider is a leading palliative care advocate as well as a practicing physician at California Pacific Medical Center in San Francisco. In her work as an activist and educator on end-of-life issues, she’s been focused on creating a more human-centered approach to how we die. To this end, Ungerleider has started a philanthropic organization dedicated to education about end-of-life issues, launched an annual symposium on the end-of-life experience called End Well, and helped produce documentary films on the subject, including the Oscar-nominated Extremis and End Game, which was released on Netflix earlier this month. The Business Times spoke to her about what’s behind her passion for palliative care and how a better understanding of death is essential to a better health care experience.

As an internist who works in a hospital, how did you first get interested in palliative care?

Sort of the weird thing is that I never set out to be any kind of advocate for end-of-life issues. But really early on in my residency, I experienced so many patients in the ICU who were dying of lung cancer, of liver disease, of end-stage something and I realized that nothing that we were going to do was really going to reverse their age or their underlying medical problems. But nonetheless we were still kind of doing things to them because we could and not because we necessarily should. It turns out that far too many people spend their last moments of life suffering. They’re in pain. They’re hidden away from their loved ones. And to me it’s coming down to the fact that we’re not doing as a job both as health-care providers but also society at large of having honest conversations early and often about what matters most to us.


 
Are there generational differences in terms of people being open and comfortable about conversations around death?

Millennials are, for whatever reason, really open and honest about mortality and making sure that they get what they want and have some autonomy. There’s a similar thing with baby boomers interestingly, really wanting to have a say and maintain control. There are organizations like Death over Dinner in Seattle, where they kind of helped you curate and facilitate a conversation around the dinner table with friends, family or loved ones. Also, The Dinner Party, which is another group founded by some young women who lost their parents which is more focused on grief, and loss, and creating an open conversation around their table. So it’s fascinating to me just how much innovation is happening around this seemingly very taboo topic.

Many doctors feel that death is ultimately a treatment failure. But have you seen an evolution from the physician and provider side when it comes to end-of-life care?

There’s been, over the last 15 years, a shift in medical education. So people are realizing that teaching doctors how to have hard conversations is really critical. We need to be doing more of it and there needs to be sort of core academic competence models coming out of our national accrediting bodies that haven’t happened yet. But the field of palliative care is brand new. It’s only been a specialty that’s been board certified since 2008. There has been a radical shift in the last 10 years to now being a very much more popular field. They talk about it often and medical students and residents are much more open to the idea that doctors still have a place in healing, even when a cure is no longer an option.

One of your stated goals is to make the end-of-life process more human-centered and less clinical, cold and impersonal. What role is technology playing in that shift?

There’s a few apps out there that are really helping to facilitate advanced care planning, meaning the kinds of documentation and discussion that need to take place to make people’s end of life care preferences known, like Cake out of Boston. There are also a few entities researching the use of virtual reality in terms of both therapeutically helping to treat pain and anxiety, but also for recreational use. So some places in Canada and the UK are specifically using it for patients who are in hospice and want to mark things off their bucket list. So while they can’t travel but they might be able to experience Niagara Falls or go climb Everest virtually.

Are there things that American culture regarding death can learn from other places around the world?

It’s really interesting because everybody always asks if there are countries or societies that do this well, and the answer to that is no. Nobody has figured out the best way to support patients, to support families, to think about caregiving from a civic perspective. The one really interesting case study that I always point to when I talk about this is La Crosse, Wisconsin. It’s a town of about 50,000 people where one leader in the community decided that he was going to make his hometown just like a great place to die. How he went about this was in the mid-2000s he figured out a way to really encourage people to do a lot of advanced directives, so that it became just a commonplace thing. In 2009, something like 95 percent of the people that died (in La Crosse) had filled out an advanced directive. In the United States we have 10,000 baby boomers turning 65 every day. Never in the history of our country will so many people die in such a short time span, so it behooves all of us to start thinking about innovative solutions to caregiving.

So you’re probably the person I’ve talked to who’s thought about these issues the most, how has your perception of your death had changed?

Something sacred is happening. You get to see a very intimate window into someone’s life and really the mystery of what binds us together as human beings. For me, being reminded of my mortality makes my life sweeter. It’s more rich when you know that one day it will end.

Complete Article ↪HERE↩!

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Everything You Need to Know about Thanatophobia- The Fear of Death

By Nancy Walker

[D]eath anxiety is not a distinct disorder but might be connected to problems of anxiety and depression such as:

  • Panic disorders
  • Panic attacks
  • Post-traumatic stress disorder PTSD
  • Hypochondriasis

Thanatophobia is quite different from necrophobia, which refers to a general fear of the dead or dying things, or anything that is linked with death.

In this article, we will discuss thanatophobia or death anxiety, explore the signs and symptom, reasons, and treatments for this problem.

What is Thanatophobia?

The word thanatophobia has been derived from two Greek words, Thanatos meaning death, and Phobos meaning fear. Hence, thanatophobia means the fear of death.

Being anxious about death is quite normal and a part of human behavior. However, in some cases, people may suffer from an intense form of fear or anxiety when they think about their own death or the process of dying in general.

A person may feel extreme fear and anxiety when they think that their death is inevitable. Other than this, they are also likely to experience the following symptoms:

  • Fear of separation
  • Worry about leaving the dear ones behind
  • Fear of suffering from a loss

When these fears and disruptive thoughts become so intense that they stop the sufferer from performing his daily activities, this condition is known as thanatophobia.

In the most severe forms, these feelings can hinder the patients from living their lives and performing daily activities. Their fears tend to center on things that may cause death such dangerous objects or contamination.

Diagnosing Thanatophobia

Doctors do not consider thanatophobia as a separate condition, however, it can be considered as a specific phobia.

As per the Diagnostic and Statistical Manual of Mental Disorders, a phobia refers to an anxiety disorder that relates to a specific situation or an object.

The fear of death may be considered as a phobia if it:

  • Arises every time the person wonders about dying
  • Continues to persist for a period of more than 6 months
  • Interferes with the life and relationships of the patients

Some of the key symptoms that a person is suffering from a phobia of dying include:

  • Immediate anxiety or fear when thinking about the process of dying
  • Panic attacks that may lead to hot flushes, dizziness, sweating, and increased heart rate
  • Avoiding situations where the concept of death or dying is discussed
  • Feeling pain in stomach or general sickness when thinking about dying
  • A general feeling of anxiety or depression

Phobias may lead to a person feeling extremely isolated and avoiding any contact with family and friends for long periods of time.

The symptoms may come and go throughout the entire life of an individual. Someone suffering from a mild form of death anxiety can feel their anxiety heightening when they think about their own death or the death of a loved one, particularly when he himself or any family member is seriously sick.

If the death anxiety is connected to another depressive condition, the patient is likely to suffer from the symptoms related to that particular disorder as well.

Types and Causes of Thanatophobia

While thanatophobia refers to the general fear of death, there are a lot of types of this disorder which depends on what the patient is focusing on.

Phobias are often experienced by a specific event occurred in the patient’s past, even though the person does not always remember it. Some particular triggers that lead to thanatophobia include a traumatic event related to the near death of self or a loved one.

A person who is suffering from a severe illness has a high risk of developing thanatophobia. This is because chronic patients are always anxious about dying, however, ill health is not necessary for someone to experience death anxiety.

Most of the time, thanatophobia is related to psychological illness.

The experience of thanatophobia may differ from person to person and mainly depends upon individual factors like:

  • Age: A study performed in 2017 suggested that older adults are more likely to experience the process of dying as compared to the younger ones who fear death itself.
  • Sex: As per a 2012 research, women are more likely to suffer from the fear of death, which may be their own or that of a loved one.

It is common for the medical professionals to connect anxiety near death to a range of different mental illnesses such as PTSD, depressive disorders, and anxiety.

How to Treat Thanatophobia

Social support networks can help protect a person from thanatophobia. Some people are likely to come to terms with their deaths with the help of their religious beliefs but this may perpetuate the anxiety related to death in others.

People enjoying a good health, high self-esteem, and a belief that they have spent a fulfilling life are less likely to fear their death as compared to others.

A doctor usually recommends a person suffering from thanatophobia to receive a treatment for phobia, anxiety, or any other problem that may be triggering this fear. The treatment involves a talking or behavioral therapy. These therapies teach the individuals to focus on their fears and work through them by expressing their concerns.

The treatment options for thanatophobia usually include:

Cognitive Behavioral Therapy

Cognitive behavioral therapy or CBT includes working with the patient in order to alter his behavioral patterns in such a way that he adopts newer ways of thinking.

In this therapy, the doctor works in collaboration with the patient to come up with practical solutions in order to overcome the anxiety and depression. This eventually leads to the development of strategies that make the patient unafraid and relatively calm when he talks or thinks about death.

Exposure Therapy

Exposure therapy works by helping someone face their fears. Instead of suppressing the feelings of death in a person, this therapy encourages the patients to expose them and acknowledge them.

A therapist will work very carefully in order to expose a person to his fears but ensuring that he is in a safe environment. This is repeated until the response of a person towards the factor causing anxiety reduces.

The person is able to confront his own thoughts and feelings without any fear.

Medicines

If a patient has been diagnosed to have a certain mental disorder such as PTSD or generalized anxiety disorder (GAD), he may be prescribed to take anti-anxiety medications such as antidepressants or beta-blockers.

Using these medications together with other psychotherapies can be extremely effective.

Relaxation Therapies

Practicing self-care can boost the overall mental health of a person. It can also help a person to cope with his fears and anxieties. Avoiding caffeine and alcohol, sleeping well, and eating a healthy diet are some of the easiest ways to practice self-care.

When a person suffers from anxiety, specific relaxation techniques can reduce the stress on their minds and reduce the fears. They may include:

  • Performing deep breathing exercises
  • Focusing on certain objects in a room, like counting the tiles on the floor, or meditation

Outlook

While it is completely natural to express concerns about your future and the future of your loved ones, if the death anxiety persists in your behavior or more than 6 months, it indicates that you require medical help.

The fear of death can be overcome by different ways and your mental health professional can guide you through them in a better way.

Complete Article ↪HERE↩!

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What does a good death look like when you’re really old and ready to go?

David Goodall a day before his assisted death in Switzerland.

By

[H]awaii recently joined the growing number of states and countries where doctor-assisted dying is legal. In these jurisdictions, help to die is rarely extended to those who don’t have a terminal illness. Yet, increasingly, very old people, without a terminal illness, who feel that they have lived too long, are arguing that they also have a right to such assistance.

Media coverage of David Goodall, the 104-year-old Australian scientist who travelled to Switzerland for assisted dying, demonstrates the level of public interest in ethical dilemmas at the extremities of life. Goodall wanted to die because he no longer enjoyed life. Shortly before his death, he told reporters that he spends most of his day just sitting. “What’s the use of that?” he asked.

Research shows that life can be a constant struggle for the very old, with social connections hard to sustain and health increasingly fragile. Studies looking specifically at the motivation for assisted dying among the very old show that many feel a deep sense of loneliness, tiredness, an inability to express their individuality by taking part in activities that are important to them, and a hatred of dependency.

Of the jurisdictions where assisted dying is legal, some make suffering the determinant (Canada, for example). Others require a prognosis of six months (California, for example). Mainly, though, the focus is on people who have a terminal illness because it is seen as less of an ethical problem to hasten the death of someone who is already dying than someone who is simply tired of life.

Why give precedence to physical suffering?

Assisted dying for people with psychological or existential reasons for wanting to end their life is unlikely to be supported by doctors because it is not objectively verifiable and also potentially remediable. In the Netherlands, despite the legal power to offer assistance where there is no life-limiting illness, doctors are seldom convinced of the unbearable nature of non-physical suffering, and so will rarely administer a lethal dose in such cases.

Although doctors may look to a physical diagnosis to give them confidence in their decision to hasten a patient’s death, physical symptoms are often not mentioned by the people they are assisting. Instead, the most common reason given by those who have received help to die is loss of autonomy. Other common reasons are to avoid burdening others and not being able to enjoy one’s life – the exact same reason given by Goodall. This suggests that requests from people with terminal illness, and from those who are just very old and ready to go, are not as different as both the law – and doctors’ interpretation of the law – claim them to be.

Sympathetic coverage

It seems that the general public does not draw a clear distinction either. Most of the media coverage of Goodall’s journey to Switzerland was sympathetic, to the dismay of opponents of assisted dying.

Media reports about ageing celebrities endorsing assisted dying in cases of both terminal illness and very old age, blur the distinction still further.

One of the reasons for this categorical confusion is that, at root, this debate is about what a good death looks like, and this doesn’t rely on prognosis; it relies on personality. And, it’s worth remembering, the personalities of the very old are as diverse as those of the very young.

David Goodall died listening to Beethoven’s Ode to Joy.
 
Discussion of assisted suicide often focuses on concerns that some older people may be exposed to coercion by carers or family members. But older people also play another role in this debate. They make up the rank and file activists of the global right-to-die movement. In this conflict of rights, protectionist impulses conflict with these older activists’ demands to die on their own terms and at a time of their own choosing.

In light of the unprecedented ageing of the world’s population and increasing longevity, it is important to think about what a good death looks like in deep old age. In an era when more jurisdictions are passing laws to permit doctor-assisted dying, the choreographed death of a 104-year-old, who died listening to Ode to Joy after enjoying a last fish supper, starts to look like a socially approved good death.

Complete Article ↪HERE↩!

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Can food help us cope with grief?

After the death of someone close food can seem unimportant. Grieving can make us lose our appetite and the motivation to cook, but food can also play an important healing role in remembering those who have gone.

bowl of borscht

By Anne-Marie Bullock

[R]ob Tizzard lost his mother Rita just after his 30th birthday.

“It was very sudden. She had a problem in her leg and you think nothing of it, and then I got a phone call saying she was in hospital and she had cancer,” he explains.

“It was a huge shock and just five weeks later she was gone. She taught me to appreciate the little things in life, so I have managed to deal with it well.”

In his kitchen, the smell of cinnamon fills the air, as he has been making bread pudding. It is a dish that holds wonderful memories of his mother, and he has been trying to replicate it.

“She used to make it using crusty bread – to use up the stale bread,” he says.

“I’ve left the bread to soak in the milk and the eggs overnight, rather than for just an hour. I just want to get it as close as I can to the way she made it. Hers seemed to cook browner than mine.

“Mum used to make it as a gift for friends a lot. I’m not sure if she liked it that much herself but friends would rave about it and loved her way of doing it and practically beg her to make it.

“Growing up I was interested in cooking and she’d sit me on the kitchen surface as she made cakes and tried new recipes.”

Clinical psychologist Dr Claudia Herbert says cooking can have restorative powers for those grieving, once the initial pain is overcome.

“Food is a connective aspect in our lives and they would have probably shared many experiences that would have involved the preparation, shopping for or sharing of food and taste experiences – this can lead to memories which can be triggered in a positive or negative way,” she explains.

“It may lead to sad or bitter reaction earlier in the bereavement process, but later on a reminder may connect them to the loving memories they shared.

“It can give them a sense of comfort and eating the food may bring them back to the good times they enjoyed.”

Many people have memories of loved ones tied up in food.

For me, Sunday afternoons at Grandma Joan’s were a wonderful time, and she always fed us well, and taught us how to bake and decorate cakes (and how to clean up afterwards).

I lost her several years ago and shepherd’s pie is a comforting food for both my sister and I, which reminds us of her.

Mine never quite tastes as good. I wish I’d listened more carefully to her instructions, but I will keep trying.

I know others still trying to conjure up the magic balance that emulates their grandmother’s goosnargh cakes (a type of shortbread), gravy, or pea and ham soup.

Keen cook and food blogger Bridget Blair has already thought about how to preserve the culinary influence of those close to her.

She has compiled an album of treasured recipes from friends, relatives and neighbours which she shares with her children, and plans to pass down the family.

The battered book is covered in splatters and fingerprints but each recipe has a story attached.

“I do have that smug factor because not everyone has these recipes,” says Lucy Blair, her daughter.

“These have been handed to us by someone quite special and not just some bloke off the telly.”

Geoffrey Wicks has learnt to cook since his wife died and loves a good trifle

But sometimes the early painfulness of losing someone special can remove the pleasure of food, and leave people unmotivated to cook.

Some hospices now run cookery courses to help relatives in the bereavement process, like at the Hospice of St Francis, in Berkhamsted, Hertfordshire.

I went along to meet six people, who had all lost someone, and watched as they cooked a dinner of lasagne, goats cheese and herb bread and trifle – dishes they had asked to learn to make and which they ate together.

Some of them had started with no cooking skills at all, having lost a partner or parent who took on that role.

“I’d been struggling for a year before I came on the course – eating takeaways, not proper food, and putting on weight,” says course attendee William Knight.

“My mum was a very good cook so I’d let her get on with it, but unfortunately that meant I didn’t get the experience.

“I would go in a kitchen and panic – I could burn water. By the end of the first day on the course I had learnt more than I thought I ever would and now have confidence to cook,” he says.

Jo Ash lost her husband a year ago.

“You don’t want to do anything as you’re in a bubble,” she says.

“It was far worse than I thought it would be – I’ve lost family members before but never a partner – it’s like losing half of your own body.

“You just get to a stage where you can’t make anything because it’s showing a form of love and you just can’t do it. This has helped me get cooking again and get interested.”

Geoffery Wicks lost his wife a year ago and has since learned key skills and has mastered several dishes including a personal favourite, trifle.

“I’m of that generation of men who hasn’t a clue and his wife did all the cooking. I found myself unable to do anything except open ready-made packets. I became an expert at that,” he says.

But the course has meant he has been able to embrace cooking and find enjoyment in life once again.

“My dream is to do a roast dinner as I’ve never been able to do that. Last week I made a ‘coq au vin’ – yes there are pictures to prove it and they all enjoyed it.”

Complete Article ↪HERE↩!

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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.