THE EPISCOPAL NEW YORKER

Death & Dying

 

Death, and the Triumph of Love


Preparing for Death and Dying


The Good, the Bad and the Goldfish


The Burial of the Dead

 

Graven Images

 

Transcending Death By Reaching Out to the Departed

 

Life — Finite, and Precious

 

 

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Preparing for Death and Dying

By the Rev. Carole Johannsen

How many of us kneel on Ash Wednesday for the imposition of ashes, listen to the reminder that we are dust, and to dust we shall return and take to heart the fact that we shall, indeed, die — sooner or later? Our culture tends to avoid the subject of death. The unspoken message is that if we simply do not talk about it, plan for it or seek to understand it, it will not happen.

Despite our cultural denial, however, there is no case on record where lack of preparation succeeded in forestalling death for anyone. Ignoring the subject of death places decision-making in the hands of others not informed about the dying person’s wishes. Even sadder, survivors, already grieving, are left to guess at their loved ones wishes as they plan a funeral and dispose of worldly goods without guidance.

In The Great Litany, prayed by many parishes on the First Sunday in Lent, we ask God to deliver us “from dying suddenly and unprepared” (BCP 149). The following suggestions are meant to help in that preparation. Some of the steps can be completed and put aside until needed: legalities such as writing a Will and a Living Will and authorizing people to speak for you if necessary. Other stipulations that can be changed but need to be recorded include funeral and burial preferences, legacies and wishes for your last days.

Read and use these guidelines in the light of faith, remembering the last words on Christian hope in our catechism (BCP 862): “Our assurance as Christians is that nothing, not even death, shall separate us from the love of God which is in Christ Jesus our Lord. Amen.”

Preparations for Dying

Legalities:
Three different documents are necessary in order for you to retain control of your dying process, regardless of your condition: a Health Care Proxy, a Living Will and a Durable Power of Attorney. These together constitute “Advance Directives.” Simple, thorough information about these documents, as well as the necessary forms, can be found on the Internet using a search engine, or by calling your state Health Department.

  • The Health Care Proxy (HCP) is the instrument by which you designate a Health Care Agent. This person will be authorized by you to make health care decisions for you when you are no longer able to do so for yourself, and the medical community is obliged to follow those directions as if they came personally from you. An HCP is valid with your signature and the presence of two witnesses, neither of which can be the designated Agent. An attorney is not necessary.
  • A Living Will provides an indisputable written declaration of your preferences for medical treatment, particularly life-sustaining measures. With your choices thus recorded and an Agent appointed, you can be sure your preferences will determine your care at the end of your life. Like the HCP, a Living Will requires your signature and the presence of two witnesses.
  • A Durable Power of Attorney appoints an “Attorney-in-Fact” to manage your financial affairs. This declaration must be signed (or otherwise executed if the physical act of writing is impossible) before a Notary Public. Note that, while this document allows your designee to manage your finances, it does not allow him or her to make medical decisions for you. Such decisions requires a Health Care Proxy.

Personal Preferences:

  • Assuming you reach a point in your life when you can no longer care for yourself, where would you prefer to be cared for? Most people readily choose to be cared for at home by loved ones, but sometimes the necessary care requires professional help. Hospice can assist with nursing visits and support from social workers, chaplains and volunteers, and it is paid for by Medicare and private medical insurance. When 24-hour physical care is required, however, it may be necessary to consider a round-the-clock Home Health Aide or a nursing home, which involves additional expense. Long-term care insurance is worth considering while you are still healthy for just such possible scenarios.
  • Plan the environment of your last days. How would you like to spend your time? End-of-life illness often makes it difficult to read or watch TV, but not to listen. What music would you like to hear? If you are likely to choose Mozart but your children are apt to drop in a Led Zeppelin CD to pep you up, you’d best put your preferences in writing and make sure everyone knows about them. The same is true for books and articles that willing volunteers might read to you: make your choices now. You can refine this list for as long as you live! If you are bedridden, where would you like your bed to be? Next to a window? Surrounded by bookshelves? In the midst of family activities? Choose the color of your sheets, the fragrance in your room, the details that create an atmosphere of peacefulness for you as your body weakens and your spirit prepares to grow into a new life.
Relationships:
  • Perhaps the most complicated element of preparation for death is reconciling old hurts and misunderstandings with those we love. Clergy and social workers can help, and often the pressure of limited time can cut through resentment that has endured and separated for years. But those same professionals are available even without the catalyst of terminal illness, and the earlier such reconciliation begins, the more time there is to enjoy the fruit of it. Reconciliation is a necessary part of preparation for dying if death is to be peaceful, but by no means does it require the immediacy of death to begin.
  • How would you like to be remembered? In some sense, this is a lifelong question, but given where your life has come and gone so far, what is it that you would most like the world, and especially your loved ones, to remember? You might try writing an ethical will, a custom that began in the Middle Ages among European Jews, who often wrote a “letter” to their descendents putting forth their values, their perceptions of the world, their hopes for a future they could not influence personally. Along with your possessions, these written statements can be included with your Last Will and Testament, but your actual conversation about these thoughts of your heart can only enhance their importance.

Spiritual:
Pay attention to what the Church teaches about death and life everlasting. The Burial of the Dead: Rite One (BCP 469) and Rite Two (491) are arguably the most eloquent and comforting services in our prayer book. Pay attention to the rubrics (directions in italics) and read in the suggested scripture passages for funerals, then flip to the Catechism in back of the prayer book and read the section on Christian Hope (861). Make an appointment with your parish priest to discuss these readings. Christians acknowledge “the resurrection of the dead and the life of the world to come” every time they recite the Nicene Creed, but going deeper and applying it to yourself is a profoundly moving experience that dilutes the fear of death and dying.

Preparations for Death
When you have made choices for your last days on earth, you should then plan and record your decisions about the funeral and burial, distribution of your estate and, if pertinent, the care of your minor children.

  • Your Last Will and Testament orders the distribution of your worldly goods and, if you have minor children, determines who shall have legal guardianship. The importance of having a will cannot be overstated; if you die before a will is drawn, the state makes decisions regarding your children and your estate. A will is wise stewardship: the gifts given to you in your life should be responsibly relinquished by you after your death. While the writing and filing of a will does not require the services of an attorney, legal advice helps to avoid costly mistakes and problems for your survivors.
  • The Funeral Director will know what questions to ask you as you plan and, in the future, will help your survivors with the final details. Be aware that many funeral homes are part of corporate chains, and you may prefer an independent family operation. This is one of many questions to ask as you interview several funeral directors. Learn what purchases must be made at the time of death and what they cost, and then record your preferences. It is easy for the bereaved to spend more money than necessary when making funeral choices. Be very careful about pre-payment plans, and do not sign anything without outside consultation.
  • The Burial Service can be as simple or as elaborate as you like, but your willingness to consider your preferences and make them known to your survivors is a generous and loving act. Families agonize over what a deceased person would have liked: what were favorite hymns? Bible readings? Who should read or otherwise participate in the service? Let your survivors know what choices best reflect your life and your faith. Do remember that a funeral has several specific purposes: It is a time for the survivors to celebrate the life of the deceased (not to summarize or review it!), to comfort one another in grief and to praise God for the Resurrection of Christ and the promise of resurrection for each one of us. The Burial Office in the Prayer Book does not make room for a eulogy (a remembering of the details of a deceased person’s life), although some clergy will permit a brief eulogy by a relative or friend at the beginning or end of a service. Rather, it calls for a homily, which puts the tragedy of death into the context of Christian faith. Don’t expect your preacher to remember how you loved his roses; do expect the priest to talk about going from “strength to strength” in the Kingdom of God. (See article “The Burial of the Dead.”)
  • Disposition of your body: Is your preference for burial or cremation or donation of your body to science? If burial, where? If cremation, do you want your ashes buried in a cemetery or a church garden, or given to a loved one for disposition as he or she chooses? Remember that by the time your body is respectfully laid to rest, your spirit will already be in that light perpetual of which we sing now, in hope.

Where to Keep Copies of Your Wishes

  • In your own home or office, a place your loved ones know and can easily access;
  • With your loved ones and those you have appointed to specific roles in your care;
  • In your attorney’s safe;
  • With your parish priest.