End-of-life planning: why, how, and when?
End-of-life planning is the act of preparing for death. In our death-averse culture, we are often discouraged from thinking or talking about the end of our own lives — “It’s too morbid, too dreadful, it’ll make your loved ones sad, why do it now? You have so much time!” But the truth is that none of us are guaranteed another day, and having a plan in place for the event of your death is a wise and compassionate thing to do. An end-of-life plan takes the burden off of our loved ones, as some of the painful or difficult decisions have been made ahead of time. And planning for your death can itself be a richly rewarding experience, as you learn more about yourself and your desires for your legacy.
As a death doula, I don’t exactly shy away from discussing end-of-life matters, from the practical to the physical to the spiritual. But I understand that the process can seem overwhelming, it can feel heavy, and it can be difficult to talk about with our loved ones. So in this post, I’ll try to walk you through the processes around end-of-life planning and make them easier to understand and begin.
What is End-of-Life Planning?
End-of-life planning encompasses a thoughtful and intentional process aimed at making crucial decisions about the final stages of one's life. Ideally, it’s a holistic, comprehensive approach to anticipate and manage various aspects, ensuring that an individual's wishes are honored and their loved ones are guided through this challenging period. The key components of end-of-life planning include the formulation of advance directives, which articulate specific healthcare preferences in case one becomes unable to communicate, and the appointment of a healthcare proxy or power of attorney.
Additionally, end-of-life planning extends to considerations of financial matters, the distribution of assets, and the establishment of wills or trusts. It is a multifaceted strategy that addresses not only the medical and legal dimensions but also the emotional and spiritual aspects of an individual's final journey. By engaging in end-of-life planning, individuals gain a sense of control, ensuring that their values and desires shape the course of their care, and relieving their loved ones of the burden of making difficult decisions during an already challenging time.
The Benefits of End-of-Life Planning
So why plan for the end of life? First, it provides a certain peace of mind. Knowing that one’s affairs are in order, that one’s family is taken care of, and that one’s final wishes have been recorded and witnessed, instills a kind of confidence and ease. End-of-life planning also eases the burden on loved ones, as it anticipates the difficult and sometimes painful decisions that must be made at the end of life. It’s also empowering—to envision the end of life, envision it the way you want it, and take steps to control the elements of it that are possible to control. It’s also a sound financial step, as it anticipates the costs surrounding end-of-life and makes provisions for possible expenses, as well as helps avoid unnecessary expenses.
There are also emotional and spiritual benefits to end-of-life planning. I have found that meditating on the kind of legacy I hope to leave has helped me focus on the right things right now, rather than getting distracted by things that matter less. And it can deepen spiritual practice by encouraging you to consider the spiritual implications of death and dying.
Conversations and Communication
Key to the end-of-life planning process are open and honest discussions with loved ones. If you find your loved ones are averse to end-of-life planning, death doulas are a wonderful resource for both having those discussions and also finding ways to encourage open and honest communication with your loved ones. It can be difficult to initiate these kinds of conversations, but death doulas have many resources to help facilitate discussions and open those lines of communication.
Some cultures are more death-averse than others, so depending on your family history and background, you may find it more difficult to initiate conversations about death and dying. These cultural and personal barriers can be discouraging, but again, worth the effort. A doula trained in cultural considerations around death can be a useful resource here as well.
Advance Directives and Legal Considerations
There are a few different advance documents to consider when planning for end-of-life. Living wills, advance care directives, healthcare proxies, durable power of attorney—it can get confusing! Here’s a breakdown of what some of these legal documents do (adapted from this list):
Living Will/Health Care Directive/Advance Care Directive - outlines wishes regarding end-of-life care, should you become unable to communicate on your own. Includes medical treatments such as tube feeding, pain management, medication, resuscitation, etc.
Last Will and Testament - outlines wishes for after you die, how you want your assets to be distributed, and includes the appointment of an executor and beneficiaries. After death occurs, a court process called probate takes place to authorize and execute your last will and testament.
Living Trust - outlines how financial assets should be distributed once you die. The trust owns your assets while you’re still alive, and once you die, those assets will be distributed without the need for probate.
Financial Power of Attorney - grants a trusted person the right to handle your legal and financial affairs
General - gives the appointed person the power to sign legal documents, pay bills, and make financial decisions on your behalf, but the power ends when you die.
Durable power of attorney - extends the appointed person’s power to when you become incapacitated and unable to make your own decisions.
Health Care Power of Attorney/Medical POA/Health care proxy - Once you are unable to make medical care decisions on your own, this document authorizes a trusted person to act on your behalf regarding medical decisions and treatments, including life support.
Do Not Resuscitate Order (DNR) - declares your wishes to not be resuscitated should your heart stop and you’re unable to breathe on your own. Without a DNR in place, medical personnel are required to perform CPR and do their best to resuscitate patients.
Legal documentation is crucial during end-of-life planning, to ensure that your wishes are carried out the way you want. You may include a Letter of Competency, which is a letter written by your doctor that attests to your mental capacity at the time you draft your will or other legal documents. This will help quell disagreements about whether you were in your right mind when you signed these documents.
A doula can help you consider all of these documents and can help you ensure you include all of your wishes. It is also recommended to consult with a lawyer if you anticipate any disputes over these documents.
Emotional and Spiritual Considerations
Even if you and your loved ones are open to discussions around death and dying, the emotions that come up during these conversations can be intense. It’s important to be prepared for this, to expect it. Your emotional and spiritual responses to end-of-life planning depend greatly on your own circumstances—whether you are facing terminal illness, helping someone else with end-of-life planning, or perhaps just preparing early. Regardless, it can help to speak with a mental health professional, a clergy member, a death doula, or another trusted third party to process these emotions, as well as spiritual and existential concerns.
The Role of the Death Doula
As a death doula, my role is walking alongside those preparing for end-of-life. While I typically work with those facing a terminal diagnosis, I am happy to assist those who are just exploring what death and end-of-life means to them. A death doula can help facilitate conversations among family members and loved ones, offer support, guidance, and education around death and dying, and practical help with legal documents and other logistical elements. As doulas, we companion those exploring the end of life with a listening ear, acting as sounding board, guide, assistant, and facilitator as necessary.
When considering and planning for the end of life, it’s important to consider the practical, the emotional, the physical, and the spiritual. End-of-life planning offers peace of mind, eases the burden on family and loved ones, and can facilitate significant emotional and spiritual growth and understanding. If you are interested in exploring what death and dying means to you, I encourage you to find a local death doula, or reach out to me, and get that conversation started. Here are some other useful resources:
