Planning for your end of life

Megan Marley

A sad, stark fact of life: 10 out of 10 people die.

It may not be easy to think about the end of your life, but if you plan ahead it can bring peace of mind for both you and loved ones in knowing your wishes.

“It can be a real gift for our families to not only do things like plan for your funeral and estate, but even to think about your medical wishes at the end of life,” said Dr. John Morris, director of the office of Catholic Healthcare.

With end of life care, the Church teaches we are obligated to do things that are ‘ordinary and proportionate’ to sustain life—treatment that offers reasonable hope of benefit and is not an excessive burden.

“If you need a respirator to continue breathing while you’re healing from surgery you’d do that…if you had an infection you’d take antibiotics—all these normal things that healthcare and medicine have created to help prolong life,” he said.

“Artificial nutrition & hydration should be maintained pretty much up until the end if it’s needed, because it’s not difficult to place that and it’s not overly burdensome.”

However, prolonging life is not an absolute—there are times where you can forego, withhold or withdraw treatment.

“Those would be times where it’s because it’s not effective or it’s becoming a burden,” said Morris.

Discerning if treatment is ineffective and burdensome takes input from both the medical team’s expertise and a patient’s experience.

“You hear this so often with cancer: ‘well, we can do really aggressive chemotherapy and it’ll extend your life three months.’ If people really understand three months, is that worth it for most of us?” Morris said. “Maybe if you’ve got affairs to get in order, maybe if you’re trying to reconcile with family, but for someone else to say ‘three months…maybe there are better ways to spend my last months of life than hooked up to machines and ill.’” he said. “You really have to understand what the treatment is, and what not accepting it is.”

“The Church really tries to clarify the intention—whether it’s of the doctors, the patient or family—can never be to hasten death, because that moves us into euthanasia. However, we can focus on goods other than physical life: we can ease physical suffering through pain medication and help a person prepare for death so they’re not suffering,” he continued.

“I think talking to priests can really help clarify and make sure you heart is in the right place, that this isn’t about hastening death but is about taking care of yourself or a loved one.”

Since each person’s situation is unique, ethical decisions in end of life care are made on a case-by-case basis.

“I know people wish there was a checklist—I have to do these 10 things and I don’t have to do these 10—but it doesn’t really work that way. You have to make these decisions on an ongoing basis, and it can often change for a patient from day to day,” Morris said.

When you can no longer communicate as to your own healthcare, advance directives are a way to make sure your wishes for medical treatment are known.

Living Wills were quite popular in the 80s and 90s—today, the concept is more formalized as a ‘health care directive’ or ‘health care treatment directive’. This sort of document allows you to approve or decline certain types of treatment in advance.

“These are usually one to two page documents that a person can start giving a checklist, like I really wouldn’t want to be kept alive artificially for more than a few months or if I start needing CPR repeatedly I wouldn’t want that,” Morris said. He said it’s important to review/revise these documents from time to time, and make sure they are readily accessible for family.

There are also a number of planning booklets—such as ‘Five Wishes’ or ‘Caring Conversations’—to help guide this planning process.

“A couple of times over the course of my parents’ end of life months, a question would pop up ‘is that really what mom wants or dad wants?’…I would be able to say, look at the booklet, page 5…being able to look at mom’s own handwriting and see that this is what she wanted was very reassuring,” he shared.

However, a health care directive “can be contested, especially in the state of Missouri…we have an open surrogate law that any first blood relative has equal say in the care of a loved one, so even if there’s someone who’s married and their spouse is making the decisions, an adult child can come in and challenge…it can be a problem if there have been just general statements or you’ve talked with your wife but not your kids,” said Morris. “The best thing to do is to get a Durable Power of Attorney for Health Care (a.k.a., a ‘Health Care Durable Power of Attorney’).”

“This should be somebody you don’t only give written directives to but you speak to, you talk to so that they really understand what your values are, your treatment values and your Catholic faith, and will advocate for that,” he explained. “Paper is always static…but if you get a living breathing person in your stead, they can take in the new data of what’s happening in your health situation and changes if they understand your values.”

“Another thing to mention is when couples are separated, there are often a lot of trust issues where you wouldn’t want your spouse to speak for you…when that’s in process, they should get a durable power of attorney because that spouse, before it’s finalized, can come in and speak for them.”

To help make these sorts of decisions, the Missouri Catholic Conference website has a PDF guide to end-of-life decisions and a form for granting durable power of attorney entitled ‘A Catholic Guide to End-of-Life Decisions for Individuals and Families’.

Planning ahead can also help your family through the visitation and funeral process.

“We encourage people to come in and make their wishes known ahead of time—we try to cover a many details as we possibly can,” said Steve Pierce, president of Muehlebach Funeral Care and co-manager of diocesan Catholic cemeteries. “Doing that, there’s no second guessing on the family’s part as to what they’re wishes were and they can carry it out.”

Details that can be planned ahead of time include the type of service, where to hold the service, prayers, scripture readings, music, memorial donations, flower preferences, clothing, clergy, pallbearers, mortuary details and military honors. Main Catholic aspects to planning include if there should be a Mass of Christian Burial and whom they would like to officiate.

“We keep a file on the decedent, and we encourage them to make sure the family knows of their wishes and even give copies to them to have. We also encourage folks not to put them in a safety deposit box, as they may not have access to them immediately,” Pierce said.

He also encourages those planning their funeral in advance to speak with their family members and get their input.

“The funeral process and the vigil process is for the family, the Mass and the prayers are for the deceased,” he said. “The emotional side of things is very important—for those people who have planned their funeral ahead of time, the stress of whether or not [the family is] doing what their family member or loved one wanted is relieved.”

Advanced planning with your estate can also clearly designate what you want done with your assets.

“Estate planning is just making the plans for your future gifts, to give away your assets that you have or anticipate to have at the end of your life,” said Laura Gray, diocesan director of Planned Giving.

Some basic terms for the process of passing on your assets include wills, trusts, annuities and beneficiary designations. There are a variety of conditions, specifications and tax consequences for each that a financial advisor could thoroughly explain.

A will is instructions to your survivors and the probate court about how you want property distributed—it is a revocable, private document that takes effect after death. The assets given in a will (or a trust) is generally known as a bequest.

“The most common way people think about [estate planning] are wills and making a bequest in their will,” Gray said.

A trust is another legal document that is always private and holds assets during your lifetime; after death, the trust transfers the assets, or benefit from them, to family or charity designated. Unlike a will, a trust must take title to the assets before it can pass them on to survivors.

“There are so many different ways to set those up,” said Gray. “Some can be changed, others not so much.”

Annuities are a contract that a person enters into with a financial institution; the institution receives your assets to invest them then later pays you from that investment.

“You can have income with both trusts and annuities during your lifetime,” said Gray.

Beneficiary designations direct financial assets such as life insurance, an IRA, 401(k), 403(b) or other retirement plan to the person(s) or charity indicated upon your death.

“Naming someone as beneficiary of your life insurance and retirement plans can go completely outside of your will so it doesn’t have to pass through probate; you can also set up your bank accounts to be payable on death—you can set things up to pretty much avoid probate by how you organize,” Gray said.

Whether you have a mansion and a yacht or a simple cottage, it can be daunting to look at the many different ways to plan your estate; Gray recommends speaking with a financial advisor to see what’s best for your situation.

““It’s just taking the time to sit down and think some of this through and realize how many assets you actually have,” she said.

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Sunday
December 15, 2019
Newspaper of the Diocese of Kansas City ~ St. Joseph