Some Practical aspects to plan for the end of life

Some of you more practical individuals have no doubt been desiring to read about the more practical side of the end of life scenario. I’ve done a little bit of research into this aspect of preparing for the final transition, and here’s what I’ve come up with.

First, a lovely quote from Respecting Choices that reminds us that planning for the end of life needs to be an ongoing process that is fluid and flexible – always open to the changes and vicissitudes of life:

One of the greatest misconceptions about advanced care planning is that it is a static process, a one-time event. Attempting to plan for all possibilities in a single document or at a single point in time is both impossible and unnecessary.

Every state has its own end-of-life related laws and regulations. A wonderful resource that we have here in Washington state is End of Life Washington. This is a website and an office in Seattle – formerly Compassion & Choices of Washington – which guides people in planning for the final days of their lives. They can be reached at: 877.222.2816 or 206.256.1636.

End of Life Washington provides free end-of-life counseling and client support services statewide to “qualified patients” desiring a “peaceful death.”

Staff members encourage advance planning and set a new standard in Washington state for advance planning documents with their End of Life Washington Advance Directive, one of the best advance directives available in the United States.

They promote the use of Physician Orders for Life-Sustaining Treatment (POLST form, a medical form for emergencies) for those living with serious illnesses. They provide these and many other documents at no cost.

They created and played a key role in leading the coalition that passed Initiative 1000 (the Washington Death with Dignity Act) into law in November, 2008 with nearly 60 percent of the popular vote. They now steward, protect, and uphold this law. For details, see this link.

They advocate for better pain management, patient-directed end-of-life care, and expanded choice for the terminally ill. They do not suggest, encourage, or promote suicide or euthanasia.

And there is never a fee for their services.     

I discovered through the Senior Center in Shelton that Julie Cook is an attorney in town who specializes in end-of-life related issues, including wills and estate plans. She comes to the Senior Center at least a few times a year to offer a free hour-long talk for members. She’ll be coming again in March or April, so contact the Shelton Senior Center (360-426-7374) if you have an interest in this.

The Advance Directive is basically an expression of your wishes around life support issues. There are Health Care directives that you can work on to plan ahead related specifically to your health care needs; there is also a Physician’s (Final) Directive – the “unplug me papers” – that you can work on with your physician. You may want to consider appointing a Health Care Power of Attorney as well a Financial Power of Attorney for your end of life time when you may not be able to make your own decisions. By appointing a Financial Power of Attorney, it’s sometimes possible to avoid a guardianship, which can be quite costly.

And then there are other organizations that help people begin the end of life care conversations, such as the Five Wishes – “changing the way we talk about and plan for care at the end of life” and the Conversation Project – “dedicated to helping people talk about end-of-life care.”

Finally, I wanted to mention – for those who have connections in Seattle – that a friend in Seattle was able to receive help with a will and a Health Care Directive through an attorney who she found at the Seattle Senior Services at 206.448.5720. For Seattle residents, a packet of information, including a worksheet which assists in gathering the information needed for the documents, can be requested and received. At the one-hour FREE appointment with the attorney, the following two documents were produced: A last will and testament and a durable power of attorney for health care and health care directive.

Blessings of courage and love to all as we take practical steps to face the end of life, and especially as we take the steps to have those important and necessary conversations with family and loved ones.


String of celebrity deaths opens up conversations

Starting on the 10th of January when British singer, star, and trailblazer David Bowie (69) made his final transition, the world has been seeing quite a few celebrities make their exit from this earth: The revered British actor Alan Rickman (69) and musician Rene Angelil (73), Celine Dion’s husband (and manager), both died of cancer on January 14th. Then, Glenn Frey (67), the Eagles’ songwriter, guitarist and founding member made his transition on Monday, January 18th due to complications from several illnesses.

All of these Transitions, especially coming all at once, have got our attention. And in some cases, they have been helping us think about and reflect on death in some new ways. David Bowie’s death in particular, one in which Bowie clearly made some deliberate preparations, has clearly been assisting those persons already in the midst of dealing with end of life issues.

A Daily Mirror article published an article on January 18 titled “How David Bowie inspired a cancer patient at the end of her life – read doctor’s letter in full” (for full article, see: had a letter penned by Dr. Mark Taubert, a palliative care consultant at Vlindre NHS Trust in Cardiff.

In his moving letter, the end of life care expert Dr. Taubert told David Bowie that his death had sparked a “weighty” discussion with a dying woman in the hospital. He added that it had also opened up the possibility for some patients so that they could die at home, rather than in an institution. He wrote on the blog page of a British Medical Journal: “We discussed your death and your music, and it got us talking about numerous weighty subjects, that are not always straightforward to discuss with someone facing their own demise. … In fact, your story became a way for us to communicate very openly about death, something many doctors and nurses struggle to introduce as a topic of conversation.”

Dr, Taubert also wrote in his letter to Bowie that many of the people he talks with as part of his job “think that death predominantly happens in hospitals, in very clinical settings, but I presume you chose home and planned this in some detail. … This is one of our aims in palliative care, and your ability to achieve this may mean that others will see it as an option they would like fulfilled.”

These endings and reflections are reminding me of a powerful book that I found very meaningful several years ago, by a young Jewish scholar named Erica Brown. Her book is titled: Happier Endings: A Meditation on Life and Death (2013), and it is a remarkable, practical book covering a wide range of topics related to death and our culture (more at Erica Brown’s link).

One of the things I especially liked about this book, besides how practical and full of many stories and aspects of life and death it incorporated, is that Brown critiques Elizabeth Kubler-Ross’s stages of grief.

She says that the first four states of grief – Denial, Anger, Bargaining, and Depression – actually all come under the one category, “Denial.” She then states that the last stage, Acceptance, needs to actually be called “Resignation,” not Acceptance, because usually people in our culture are not very good at accepting death. Rather, we become resigned to it. I believe this to be true.

But then she adds that there’s one more category that needs to be added: That of “Inspiration.” When someone is able to say the words “I need to be prepared” for death, then this intention gives the person Inspiration – in other words, “permission to love more fully, to say the words they’ve wanted to say for a lifetime, to repair and heal troubled relationships, and to entertain a range of ethereal and spiritual thoughts and actions often previously closed off, sealed, or masked by the pragmata of everyday anxieties. … Inspiration is an admission of possibility. It is the last gift we give the living.”  (p. 8)

I like this concept of bringing Inspiration into the topic of death! And I like to think that this is at least in part what I help people do, by writing about death, grief, change, transitions and endings of all kinds, calling people’s attention to these sorts of things that we’d normally rather not focus on.

Please share your thoughts and comments with us below.David BowieHappier Endings