Stuff From my Funky Brain

"Burial or cremation?"

"Do you want an autopsy?"

"Who is to be informed of this death and invited to the funerary service?"

OR

"Will you be suspending curative efforts or switching to hospice?"

"Will you be placing [patient] into a care home or keeping them with you?"

"Do you consent to homecare services?"

"Do you accept the current diagnosis or do you wish to hear additional opinions?"

OR

"Do you want to try an organ transplant?"

"Do you want to enroll in a clinical trial?"

"Are we permitted to perform blood transfusions on this patient?"

"Are we permitted to provide this patient with psychiatric interventions?"

OR

"Are we putting this money into a trust or dividing it among family members?"

"Are we selling this house or gifting it to an heir?"

"Are we selling the deceased patient's furniture or donating it?"

"Are we burying this body or giving it to science?"

That is for Durable Powers of Attorney, both healthcare and financial.

"What's a living will, then?" is a detailed list of instructions left regarding care during your period of incapacitation, especially when Death is the expected outcome. Where as a DPOA might specify only a few short things: "No ventilator" or "Don't donate my heart, take everything else" or "No pig valves, not even to save me", a living will can be more elaborate, and doesn't necessarily name a singular decision maker. Many states in the US do not treat living wills as legally binding. But, in the absence of more concrete documents, they can be a valuable guide for family members and key members of your care team. We encourage these often in palliative and end of life care, due to those patients being at risk for extended periods of incapacitation.

If you have MS, Huntingtons, Cerebral Palsy, HiV, Schizophrenia, Bipolar Disorder or a history of psychosis, a family history of Alzheimers and/or Parkinsons and/or Vascular Dementia, I urge you to consider a living will. If you do extreme sports or otherwise frequently risk severe head trauma and/or prolonged oxygen deprivation, I strongly urge you to consider a living will. If you have a history of severe substance abuse and/or suicide attempts, I strongly urge you to consider a living will.

"Ha! No WAY man, I ain't signing away my rights to NOBODY. I'm staying in control 'til the moment I die." Unfortunately, no. You will not. If you are unconscious, you cannot make choices. If you become too psychotic to find your way outside and collapse from dehydration because you think your tap water is poison, they will not let you make your own decisions. If you begin suffering from dementia and believe your are seven years old and still in your hometown, they will not let you make your own decisions. If you are effectively brain-dead but breathing on your own, you cannot make your own decisions.

I have had many patients who thought it worked like this, and I have needed to explain to them that their logic is flawed. Your refusal to acknowledge these laws does not exempt you from them, and if you do not choose an advocate/decision-maker ahead of time and then are determined to need one, The System will simply choose for you.

"If I don't pick somebody, who gets to make decisions about my care?" Your next of kin. Who your next of kin is determined be goes like this:

Do you have a LEGALLY MARRIED SPOUSE? If yes, that is your next of kin. Marriage trumps everything else. Keep in mind, if you are living apart from a person you are not "with" but are still LEGALLY married to, that person is still next of kin. Even you no longer speak to them regularly, they can absolutely seize power over your healthcare and your finances. Even if you are currently legally married to your first choice decision maker, fill it out anyway. They are actively working to strip us of our rights, so dig your heels in.

If there is no spouse, they will seek out any adult children you may have, and assign Next of Kin to the eldest one.

If there are no adult children, they will seek out your parents. Yes, even if you are an out and proud trans lesbian, and they are aggressively cruel MAGA cultists who exclusively refer to you through the use of slurs.

If there are no parents, they will seek out your siblings and give decision making over to the either the oldest one. Or, more often at this point, whoever picks up the phone first. Yes, even if you hate your siblings, they have a much firmer claim over you than your friends or your partner in a world without marriage equality.

If there is NO biological family willing to step up and make choices for you, THEN they will turn to friends and unmarried partners, but, the bio family can sue to reclaim their rights at any time.

"Jay, that's not true!! When I was in the hospital and couldn't speak for myself, I didn't have that filled out and they still knew to call my girlfriend instead of my mom. Doctors understand that families are complicated, they wouldn't do this!"