Planning for End of Life Events

Accident Information
DC Hospital Association Advance Directive: Your Durable Power of Attorney for Health Care and Living Will for use in the District of Columbia, Maryland and Virginia

Other Forms, including:

Information for Meeting Records
Personal Information for Death Certificate
Relatives and Friends to be Notified
Offices to be Called
Information for Obituary
Outstanding Obligations

Planning for End of Life Events

Facing Death

If you would indeed behold the spirit of death, open your heart wide unto the body of life. For life and death are one, even as the river and the sea are one. Your fear of death is but the trembling of the shepherd when he stands before the king whose hand is laid upon him in honor.

-- Kahlil Gibran, The Prophet.

Facing death is one of the great challenges human beings encounter. Death too often seems the incontrovertible to all we know. But in fact it is the next step, a fulfillment of living, a transition into a spiritual state we can only anticipate but never truly know until it happens.

Every human culture since the dawn of time has ritualized death in one form or another, be it royal tombs, carved likenesses of the deceased, ceremonial meals, embalming, complex inheritance laws or saintly relics. Friends have chosen to commemorate the passing of loved ones with the same dignity and simplicity that is used in worship and other aspects of our community life. Friends are encouraged to prepare wills and make arrangements for the appropriate donation or disposal of their earthly remains while still fully able to make such arrangements. Soon after their death, a memorial meeting for worship is usually held to gather relatives and friends together to celebrate the gift of life as it was lived by the deceased.

The community of Langley Hill Friends draws together over loss of members and other loved ones in mutual support as needs arise. In helping each other to grieve and cope with both worldly and spiritual ramifications of imminent or recent death, we have strengthened loving bonds among people in the Langley Hill community and beyond. Memorial meetings for worship have helped us all learn new and treasured aspects of those who have died. Composing memorial minutes, planning memorial meetings for worship, attending memorial meetings, and providing food and other help to bereaved families are some of the ways individuals contribute while they themselves are grieving. Other activities offered at this time have included circles of healing hearts or of singing voices.

Various parts of the Meeting community are responsible for assisting with advance planning for death and for helping when a death occurs amongst us. The Committee for Care and Clearness maintains forms and records, such as copies of Information for Meeting Records and medical Advance Directives provided to it by friends in our Meeting community. This Committee will periodically remind attenders of the wisdom of updating or submitting this information. The Committee also will aid the bereaved family in making clear what assistance is needed and will see that any help available from within the community is provided. Memorial meetings for worship are jointly arranged with the Ministry and Worship Committee, with the help of the House and Grounds Committee. The Ministry and Worship Committee, with the cooperation of the family, may write a memorial minute about the deceased.

Our community can receive loving gifts of ministry and nurture from a Friend approaching his or her own death through sharing openly about loss, faith, struggle, hope, longings, and love. Friends have gathered in hospital rooms, nursing homes, and members' homes to hold special meetings for worship, to read aloud, visit, sing, or just be with the dying person in the moment, often connecting tenderly to the extended families of those who are passing from among us. Such sharing provides comfort to everyone present and helps us all grow in spirit and community.

Each of us can face death with less anxiety for ourselves and ultimately for others if we prepare in advance for the event. This packet of information contains a variety of lists and forms, queries, advices and references to help us make specific preparations. As we complete and file such forms, we hope that we will be able to rest easier in future years, confident that our wishes at the time of death will be clearly known. Please talk with your relatives and close friends, to explore and explain your plans with them, especially the decisions relating to advance medical directives. These talks often transmit our values and long-term advice, as well as our other decisions, to our survivors. Some call this process “ethical wills”. Young people are also encouraged to take part in considering these matters to the extent that they are ready.

All are encouraged to embark on this planning with an attitude of prayer and humility. We hope that these materials will help you focus on the more spiritual aspects of your preparation for death.

The materials in this packet reflect current Meeting practices and local laws as of July 2005. They include a number of forms for those wishing to document their preferences in such matters as medical directives and after-death treatment, as well as prepare in advance information that would be needed in the event of an emergency. They also outline what members and committees of the Meeting can do to help others in facing death and grieving. In addition, a folder in the Meeting Library lists services to turn to for burial, and cremation, as well as grief support groups. Friends seeking a more in-depth discussion of these issues are encouraged to explore documents noted in the resource list below.

Queries To Help in Preparing for Death

In 1993 the Langley Hill Monthly Meeting of the Religious Society of Friends convened a working group on concerns with death and dying. This group immediately discerned that its concern was not with the Meeting's procedures invoked by an attender's death, but rather with the spiritual challenges of preparing for death, either one's own or another's, and of recovering from the death of one for whom one cares deeply. They agreed that the roadside sign, "Are you prepared to meet your maker?", was not enough to guide our preparations for transition to death, and they united on a quest for helpful queries. The result of their effort to help focus seeking on this topic is reproduced below.

Preparing for My Death

Do I need help now in preparing for my death or incompetence?
Death often comes by surprise, interrupting lives in the midst of life's progress. What if I should die before I wake? If I knew my death was imminent, how would I devote my remaining time? Should I do any of that activity now, or on a daily basis?
Am I prepared to meet my maker? What do I need to do or feel now in order to be ready for death? Can I accept that I did all that I did, and can't undo it?
How would I prefer to face death? As something to ignore until it happens? As a wholly negative phenomenon? As a personal transition to Heaven or Hell? As an adventure?
Is there someone, or are there others, whom I would like to help prepare for my death or incompetence? Do I want to approach them to seek that help? If so, how?
Do I give myself and others enough space and opportunity for forgiveness to take place genuinely?
Are there things I can do now that would ease the experience for those who would suffer or be burdened in the event of my sudden death? Are there words of comfort or pieces of information that I can prepare in advance to help those people with their grief or their new responsibilities?
Are there matters that I want to communicate with others about before I die?
In what kind of relationship do I want to be with others before I die? Are there conflicts that I want to resolve, or people I want to forgive or be forgiven by? How can I restore more healthy relationships with them?
Do I want my nearest and dearest to minister to my needs if I have a long final illness? Do I want to be with one of these people as I die? Do I hope to be able to say goodbye?
How would I like to be remembered? What can I do or feel now to create that memory?

Are there other jobs I need to do before I die? What are the most important loose ends that should be tied up before I die? How important are they? What can I let go of?
Do I feel burdened with my material possessions and their disposition upon my death? Have I communicated effectively how they are to be distributed and used? Would parting with some of them before my death be helpful?
How can I develop a sense of completion about my accomplishments? Can I let go of the uncompleted parts of my life? What can I do now that will make letting go easier or better?
In what contingencies would the quality of living become more important to me than the quantity of life?
Are there circumstances in which I would consider using a nursing home? What would those circumstances be, and how would I want a nursing home to meet my emotional and physical needs?
What forms of life-preserving care would I be willing to accept? Would I want to be able to control my pain in my last illness? Are there circumstances in which I would not want to have painkillers administered to me? If I needed painkillers that deprived me of consciousness, would I want to have an opportunity for trials of withdrawal and painful consciousness?
If faced with an incurable terminal illness, would I want to be treated for secondary conditions that could kill me if left untreated?
What frame of mind do I want to be in as I die? Fighting it? Giving up the ghost? Looking forward to an adventure? At ease with the transition to what is beyond?
How can I let go of fear of death, in myself and in others?
How can I accept death and living as they coexist in me?
Do I want to have special elements in the ceremonies following my death?
How else do I want to prepare for what follows my death? For me? For others?

Helping Another Prepare for Death, and Recovering from Another's Death

How shall I honor the life of someone I love? How can I live best with the consequences of the rough edges of my relationship with the person who died? How am I going to remember him or her? What will I cherish about the spirit of that person? Can I picture the essential goodness of the person? Can I accept the features of that life with which I disagreed?
How can I help a dying person who denies any negative feelings about weakness or his own impending losses come to terms with the inevitability and closeness of his or her death?
How shall I help myself and others live with the loss of someone very close?
Anyone who depended emotionally on someone who died will grieve. Grief can take months or years to subside, and it may last longer if suppressed. Can I allow myself to vent my grief: How, and with whom? Whom shall I call upon to help me to survive and emerge from the depressing times ahead? How can I help others who are going through this same process with me? Is professional counseling needed?
Whom can I ask to help fill the gaps left by the loss? In practical matters? In spiritual guidance? In being with me and with others affected by the loss? What can I take on myself?
Whom shall I ask to help with the consequences of the last illness, if any, and the memorials and other formalities to mark the passing? Who should be notified of the death?
How can I arrange my life to give myself timely opportunities to work through my grief? How do I accept that others may need a different amount of time, or different conditions to work through their grief? How can I get others to understand my grieving needs, and how can I learn to understand theirs? How can I make asking for help more comfortable, after others appear to have resumed their normal lives?
Is my support for someone who grieves confined to conventional comforting? How can I persist in my support for someone who is grieving for an extended period of time, or whose grief returns? How can I communicate a real willingness to be available for help, or sympathy when I feel I cannot help?
How can I best be supportive if I feel I can’t or won’t take on much of the responsibility to help another work through grief? How can I communicate that support?

Medical Issues

While you are healthy it is difficult to think about what information will be needed and what decisions must be faced when you are not conscious and able to communicate your wishes. But then it may be too late for you to control the decisions or even provide the information. Thus it is important to record in advance the essential information that will be needed for appropriate treatment. Indeed, hospitals are now required to ask if entering patients have filled out an advance directive and to provide a form for one if they have not.

Accident Information

Fill out and carry with you a paper providing the information that a hospital emergency room will need quickly if you arrive unable to provide it clearly yourself. If you have serious allergies, a rare blood type, or take medications, this information could prevent serious complications or save your life. A form for such information is enclosed in this packet with two versions: one for your wallet, one for your briefcase or car glove compartment.

Advance Directive

This packet includes a generic Advance Medical Directive form for the District of Columbia, Maryland, and Virginia, to state your desires regarding medical treatment in the event you are unconscious or otherwise unable to make your wishes known to those caring for you. An electronic version, as a Microsoft Word attachment, is available from [email protected]. An advance directive includes both a living will and a durable power of attorney, which were previous versions of the document that now incorporates applicable provisions of both.

An accident or a stroke could put you into a coma with severe brain damage. What would be your wish about the use of life-maintaining treatments if the chances of your recovery were negligible? Or were believed by two or more doctors to be non-existent? In the event of such a tragedy the guidance of such a document can be of tremendous help to your loved ones, the medical care givers, and, if necessary, the courts. More detailed forms and instructions, tailored for Maryland, Virginia, and the District of Columbia (as well as other States) are available from http://www.caringinfo.org. More general advice about these issues also can be found at http://www.putitinwriting.org/putitinwriting/index.jsp. (See the Resources section below).

It is most important to discuss these documents and your wishes as outlined in them with your doctor, your spouse, your children if any, and whoever else is named in the forms to make decisions on your behalf if you are unable to do so. Many of these people are likely to be involved at a time of a medical crisis. Give them copies of the documents well in advance, if possible. They should fully understand and, to the extent possible, be willing to implement your wishes. Without such discussion and understanding it is quite likely that even your written wishes will be ignored because of the weight of life preservation momentum in the medical establishment and among relatives in shock, regardless of your desire to die with dignity.

Changes in State laws and perhaps in your own wishes indicate that you should review and perhaps change your medical directives at least once every five years.

Please note that the Advance Directive includes under "Other Wishes", opportunity to indicate whether you are willing to donate your body, or organs taken from it, for medical purposes. This could be a gift of sight, renewed health or even life to a fellow human being. You are encouraged to consider this opportunity seriously. If you do choose to be a donor, it is useful to carry in your wallet indication to that effect, since action to retrieve needed organs must be quick after an accidental death. MD and VA driving licenses now provide an opportunity to indicate a willingness to donate organs. Organ donation decisions also require discussion and understanding with your loved ones and doctor, for the reasons explained above.

There is now a way to assure that your Advance Directive is available, should it be needed when no one knows where to retrieve a copy. A government study found that this happens 40% of the time! The Harvard guide, listed below in section II.B of the Resources, suggests that you keep and distribute a medical directive tracking record, to tell you and others where to find copies of which directive. There are two national registries of advance directives that provide registration for a fee and give access only to medical personnel. They are noted in the resources section, below. The National Electronic Archive of Advanced Directives (NEAAD), referred to in the previous edition of this packet, has gone out of business.

Property Issues: Why Have a Will?

It is important to prepare a will or other formal document indicating the disposition you desire for your property in the event of your death. Lack of a will often leaves confusion and controversy, and is likely to cause unnecessary trouble for your survivors. It is the basic way for you to assure that those you wish to be the beneficiaries of whatever you leave behind will in fact receive the shares of your estate that you intend, or to make clear your bequests of specific items. In the absence of a will or other such document, this disposition will be carried out as dictated by state law, which may be different from your wishes and lead to unnecessary hardship and resentment for your survivors. The provisions of local laws for this are summarized on the next page.

If you have minor children, another major reason for having a will is that you can use it to designate whom you would want to be their guardians in the event that you and your spouse were no longer available. Here again, state law may designate guardianship succession that is different from what you would want.

A will need not be complicated, but its signature must be duly witnessed, usually by at least two non-relatives. This is often done in a lawyer's office so that the witnesses would be available in case of need to testify that you were of sound mind when making the will. Many local lawyers are available to help write wills, and standard formats are also readily available in libraries and on computer programs.

“Avoiding Probate”, on a subsequent page, includes a brief discussion of two ways to avoid the court-supervised probate process required for property covered by a will. Court-supervised probate may be time-consuming and is often quite expensive. These alternatives are: a) designation of beneficiary, and b) a Living Trust. The latter alternative has advantages over a will, some of which may be important to you, but needs to be carefully crafted and would be more expensive to prepare than a will.

For anyone desiring them, copies of a standard, lawyer-drafted will form covering many options, and of a living trust form, both taken from the Quicken Family Lawyer computer program, are available from the Committee for Care and Clearness.

Ethical wills, which indicate the values and advice you want to communicate to your survivors, can be separate documents, and they are not required by any laws. They may be useful in helping your family and friends to understand what you think is important to pass on to them, but experience has shown that discussions about these matters are more likely to be remembered than written documents.

Local Laws Governing Intestate Estates

If you don’t have a will or property distribution trust at death, your survivors can expect this:

District of Columbia: http://dccode.westgroup.com/toc/default.wl?RLT=CLID_TOCRLT553226&oFindType=V&oDocName=DC010380939&oDB=DC-ST-WEB%3BSTADC&DocName=DC010380979&FindType=X&DB=DC-TOCWEB%3BSTADCTOC&RS=WLW2.07&VR=2.0

All to the spouse, if no descending child or parent remains;
Three-fourths to the spouse, if no child remains but a parent does;
Two-thirds to the spouse with descending children, one-third to any other children.
One-half to the spouse, if the spouse has non-descending children;
One-half to the spouse without descending children but descending children remain;
If no spouse, to the children or their descendants in shares equal to the number of descending children or later generations represented;
If no spouse or children, to grandchildren, parents, siblings, their descendants, more distant relatives, or the DC government, in that order, with equal shares to multiple individuals in each category above.

Maryland:

http://government.west.thomson.com/toc/default.wl?RLT=CLID_TOCRLT161226&oFindType=V&oDocName=MD&oDB=MD-ST-WEB%3BSTAMD&DocName=MD008117865&FindType=X&DB=MDTOCWEB%3BSTAMDTOC&RS=WLW2.07&VR=2.0

All to the spouse, if no descending child or parent remains;
If there are minor children, one half to the spouse, one half to children or their Descendants;
If no minor children, $15,000 plus 1/2 of remaining property to spouse, rest to children or their descendants, or if none to parent;
If no children or their descendants, $15,000 plus ½ of remaining property to spouse, rest to the parents of the deceased;
If no spouse, all to the descending children and their children, in shares equal to the number of descending children or later generations represented;
If no spouse, children or grandchildren, all to the decedent’s parents and their other children. But parents who committed domestic violence or didn’t pay child support may not inherit;
If no spouse, children, or parents, then to siblings, their descendants, or more distant relatives with equal shares to multiple individuals in each category above;
If none of the above, to the County Board of Education unless the decedent was on Medicaid, in which case it goes to the Department of Health & Mental Hygiene;
Death within 30 days of decedent’s eliminates claim.

Virginia: http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+64.1-1

All to the spouse, if no descending child or parent remains;
If there are children/grandchildren not of the surviving spouse, 2/3 to children/grandchildren, 1/3 to spouse; but spouse may stay in the family house until death, if she pays applicable taxes;
If no spouse, to the children or their descendants in shares equal to the number of descending children or later generations represented;
If no spouse or descendants, to the parents;
If no spouse, children, or parents, then to siblings, their descendants, or more distant relatives with equal shares to multiple individuals in each category above, then to more distant relatives, including the spouse’s relatives after the descendants’;
If no surviving relatives can be found, to the Commonwealth.

Avoiding Probate

When using either of the methods below, you still need a 'pour-over' will to cover anything not covered by designation of beneficiary or trust.

Designation of Beneficiary

One method of keeping designated assets out of probate and speeding and simplifying their transfer at your death is to designate beneficiaries of specific securities or accounts. This is standard practice with insurance policies, IRAs and annuities. It is also possible with bank accounts, broker accounts and other real and personal property in those states that have adopted the Uniform Transfer on Death Security Registration Act. These states include Maryland and Virginia, but not the District of Columbia. Banks, brokers etc. are not required to provide this service, but if they do, they will provide the requisite registration form. The Committee for Care and Clearness has a copy of the Act available for review.

Living Trust

Unlike a will, a Living Trust is not a matter of public record in its details, it is not probated in a court (saving time and, especially in DC, much expense), and the Trustee does not act under court supervision. The Trustee is whomever you designate, usually yourself so long as you are able, thereafter your spouse, child, friend and/or financial advisor as you specify in the Trust document. The Trustee has full control of the property in the Trust within the terms of the Trust.

One advantage of a Living Trust over a will is that should an accident or dementia make you no longer able to manage your assets, your spouse or other designated follow-on trustee can take over that management without going to court, simply by showing a doctor's certificate of your incapacity and the trust document to the trust's bank, broker, etc. The Executor of your will would have to wait until you died and then go to court to be empowered. A Living Trust can be changed or revoked by you at any time. It becomes irrevocable at your death or established incapacity.

Another advantage, if your estate is larger than the exemption from federal estate tax ($1.5 million for deaths in 2005, and going up to $2 million in 2006 and $3.5 million in 2009, but coming back down to $600,000 in 2011) is that your children can be named as heirs of the property in your trust, but to receive it only following the death of your spouse. Property in your trust so transferred would be covered by your estate tax exemption. While the transfer of your property to your spouse at your death in the absence of a Trust would be tax-free, only the spouse's exemption would be available when the estate is passed on following his/her death. Thus, use of the Trust can preserve the applicable estate tax exemptions of both husband and wife, one of which would be lost if ownership of the estate simply passed at the first death to the surviving spouse. Given the increase in real estate values in recent times, this could be a matter of concern, if you own your home and have paid off all or most of the mortgage. If it is owned jointly, its full value becomes part of the estate of the surviving spouse.

Another advantage of a Trust is that property put into a trust is valued for your Gift/Estate tax purposes at the time of gift to the trust. Any appreciation in its value does not become part of your estate for tax purposes, though any income taken from the trust is subject to the recipient's income tax.

What makes the Living Trust possible is transferring title to property as a gift: from you to the Trust, you as Trustee retaining control. Such gifts are tax-free up to the amount of your estate tax exemption.

Preparatory Information for the Meeting and your Family

You can facilitate matters at the time of your death by providing in advance essential information that will be needed then by the Meeting and your family. Forms for this purpose are in the right-hand side of this binder. They include Information for Meeting Records, Accident Information, Personal Information for Death Certificate, Relatives and Friends to be Notified, Offices to be Called, Information for Obituary, and Outstanding Obligations. Please let your loved ones know where to find all but the first of these forms when you die.

Information for Meeting Records:

The Meeting community will want to be helpful to your family, without being intrusive, at its time of crisis and loss. This form allows for the recording of information needed quickly at your death by your family and the Meeting, including your desires concerning the disposition of your body, your desires concerning funeral and/or memorial service and expressions of condolence, and a short list of those who should be notified immediately. Having this statement on file with the Committee for Care and Clearness and at home could save your family much concern and uncertainty and enable the Meeting to be helpful to your family in their time of loss. Providing such information to the Meeting is particularly important for those who are living alone.

Accident Information:

The larger copy of this form is for your car’s dash compartment. The smaller one is for your wallet or purse. These forms can provide a vital link to your loved ones if you are in an accident and can’t communicate with them directly.

Personal Information for Death Certificate:

The attending doctor or funeral director will need this information to fill out the death certificate.

Relatives and Friends to be Notified:

This is a useful guide to your survivors listing the people whom you wish to be notified of your death, and how to contact them.

Offices to be Called:

Similarly, this form tells your survivors whom to contact concerning your legal and financial relationships. Often banks and other entities will want copies of the death certificates in order to change the ownership of an account.

Information for Obituary:

This form puts in one place the information you deem relevant to your obituary.

Outstanding Obligations:

This form summarizes information about your creditors, so that your survivors will pay your estate’s debts in an orderly fashion.

Also in this packet there is a Checklist for Survivors When Death Occurs, which may help the surviving family and Meeting, to assist your survivors in coping with the myriad details needing attention following a death.

After a Death

How to Help Grieving People

People who have suffered a death of someone close to them need support. Such comforting often includes help with the immediate care of family and planning for the funeral or memorial service, as well as a spiritual or psychological dimension. After religious services, they need to feel loved by listening, caring friends. Then they can better work through the normal grieving process.

Immediate help may be in the form of food for the family and offers to take children for a visit or to a movie. An important service is for someone to answer the telephone and to call others who need to be notified, or to accompany the bereaved to a funeral home.

The presence of a caring friend is most important. If you want to say something, the simplest expression is best: "I am sorry."

DO NOT say "I know how you feel." or "It is God's will."

Become a listener. If the bereaved person finds it difficult to talk, you may ask very careful and gentle questions, starting perhaps with less important details of the memorial service.

If the person asks "Why?", you do not have to answer. No one knows the answer to this question.

Be reassuring: "It's good to cry. Crying is healing."

Familiarize yourself with the various stages of grief so you can help your friend to know what to expect.

Another later approach can be "Many people normally feel anger mixed with grief at this time. This is not bad. You need to understand it."

Make it clear that you accept whatever your friend says or feels. Be prepared to recommend against the inappropriate use of alcohol or other drugs, which only mask and postpone emotional pain.

If thoughts of suicide are expressed, do not show shock or rejection. Suggest counseling or support groups where one can get sympathetic support and understanding.

Suggest postponing moving or other major decisions.

Suggest exercise that helps with relaxation and sleep.

Do not forget that grief lasts for many months and even years, and that thoughtful notes, calls, invitations and little gifts will be very welcome until it lets up.

Checklist for Survivors When Death Occurs

This outline is intended as a guide for a number of decisions to be made and actions to be taken when a person dies. It is highly desirable that the decisions be discussed with the individual before death occurs if possible, so that the individual's wishes may be carried out.

The hours and days immediately following a death can be a time of confusion, as well as sorrow, and a time when the family welcomes the presence of an assistant, a close friend, relative, or member of the Meeting. This person can act either as a consultant or as one who will take charge of necessary matters, delegating some responsibilities, insofar as possible, while coordinating efforts to avoid duplication or omissions. The checklist provided below can be helpful to the family and the assistant to ensure that all matters are addressed in the days immediately following death. The items are presented in rough chronological order.

1. Immediately after a person dies, professional personnel and next of kin should be notified as appropriate under the following circumstances:

Death in the Home (unexpected, or following an illness): Call:

Primary care physician, if known
Paramedics or police (911)
The physician, paramedics, or police may call a coroner if required
Next of kin

Death in a Hospital or Nursing Home: Call:

Primary care physician (staff should call)
Next of kin

Death in an Accident:

Paramedics or police will see that the body is sent to a hospital or coroner

2. In all cases of death, the person must be declared dead, cause of death determined, and a physician's or coroner's signature obtained to legalize the death certificate, which is then recorded and filed with the appropriate state agency within a few days of death. At least 20 copies of the death certificate will probably be needed (e.g., for insurance filing, bank accounts, Social Security, Veterans Administration, etc.). The following information may be needed for the death certificate, depending on the jurisdiction:

First, middle, and last name of deceased, address, and phone number
Date and place of birth
Race or ethnic identification
Country of citizenship
Last occupation of deceased; employing firm; length of employment
Marital status, and name and occupation of spouse, if married
Next of kin (if other than spouse) and relationship
Name and birthplace of deceased's father
Maiden name and birthplace of deceased's mother
Social Security number
Highest level of education
(If veteran: rank, branch and dates of service, serial number)

3. The next step immediately after death is to determine the removal and disposition of the body, after the physician or coroner has released it. If a copy of the deceased's wishes and instructions is available, the family and assistant should consult it. Ideally, the deceased has filled out the Information for Meeting Records, and filed it with Committee for Care & Clearness. Available options include:

Organ donation: The body will be removed to a hospital.
Willed to science: The body will be removed to a medical school of prior choice.
1. (This decision must be concurred in by the senior surviving next of kin.)
Cremation: The body will be removed either to a mortuary or immediately to a crematorium. In Virginia, the body must be taken to a medical examiner before cremation.
Burial: The body will be removed to a mortuary.
Home Care: In the DC Metropolitan area families can get assistance and support in preparing the deceased at home for cremation or burial. See section V.A of the Resources section, below.

The survivors should notify the choice among these options immediately to those with custody of the body.

4. The Committee for Care and Clearness, through a specified individual, will try to assist the family during the hours and days following the death, as requested. Soon after a death a family member or the designated contact with the Meeting should notify the clerk of the Meeting or the clerk of the Committee for Care and Clearness, who will notify the Meeting’s attenders of the death.

5. The assistant can then help the survivors in making arrangements for the next few days, including such items as:

Coordinating the supplying of food;
Making a list of immediate family, close friends, employer, and business associates. This information may be available from the deceased's personal phone directory and also the forms in the right-hand side of this packet. The family member or assistant should notify each person by phone or arrange to have some of them call others.
Determining whether flowers will be accepted. In substitution or addition, determine a memorial or charity to which gifts may be made, especially one which was identified by the deceased.
Arranging for appropriate child care, and other special needs of the household, such as cleaning or transportation, which might be done by family or friends.
Arranging for family members or friends to take turns answering the door and telephone, keeping a careful record of calls and gifts (e.g., flowers).

6. The family should arrange for a funeral and/or Memorial Meeting in accordance with the deceased's wishes. The clerk of House and Grounds Committee should be notified if the Meeting House will be used for a Memorial Meeting for Worship, and the clerk of Ministry and Worship should be contacted for assistance in scheduling the Memorial Meeting and in preparing the Memorial Minute.

7. Within a week or two following death a family member should notify the deceased's lawyer and the personal representative such as the will executor, if known.

8. In the same time frame, the family member should notify insurance companies. Be sure to check all life and casualty insurance and death benefits, including Social Security, Veterans administration, credit union, trade union, fraternal, etc. Also check on income for survivors from sources such as Social Security.

9. Within a few days of the death, the family member or assistant should assemble the information needed for an obituary, including:

Name
Age
Place of birth
Cause of death
Occupation
College degrees
Memberships held
Outstanding works
List of survivors the immediate family
Time and place of Memorial Meeting for Worship
Note whether flowers will be accepted
Note preferred charity to receive gifts

The information should then be phoned or faxed to newspapers. There may be a charge for the obituary. Organizations with whom the deceased was connected also may want to receive the same information.

10. A house sitter will be needed while family members attend funeral, memorial meeting for worship, or burial services, especially if the death notice is published.

11. The family or assistant should arrange for the disposition of flowers sent to the home or the Memorial Meeting for Worship.

12. The family or assistant should prepare a list of distant persons to be notified by letter or printed notice, prepare the letter or notice, and mail as appropriate.

13. The family or assistant should prepare a list of persons to receive acknowledgments of flowers, calls, food, or other assistance. Appropriate acknowledgments should then be sent.

14. The family should check promptly on all debts and installment payments. Some may carry insurance clauses that cancel them. If there is to be a delay in meeting payments, the family can consult with creditors and ask for more time before payments are due.

15. If the deceased was living alone, the family should notify the landlord and utility companies, and tell the Postal Service where to forward mail. The family should also take precaution against burglars until the deceased's possessions have been disposed of.

16. The Committee for Care and Clearness should consult with the family to arrange to have the death recorded in the Meeting's records.

Meeting Services Relating to Death and Dying

Preparatory

Copies of this packet of materials will be available in the Meeting Library for the use of members and attenders. Also in the Library is a Visitor's Packet in Case of Death containing useful reference materials. As noted in the resource list, the Meeting Library contains a number of books on death and dying.

The clerk of the Committee for Care and Clearness will maintain a file of copies of Information for Meeting Records completed by members and attenders. If requested, the clerk of the Committee for Care and Clearness will also file copies of Advance Directives, Wills or Trust Agreements, and other preparatory information. The clerk of the Committee for Care and Clearness will periodically remind members and attenders to update or submit Information for Meeting Records and other related information.

If requested, the clerk of the Committee for Care and Clearness will appoint a clearness committee to meet with family members faced with difficult questions such as terminal illness, lasting coma, serious brain damage, or chronic pain.

Following death:

The clerk of the Committee for Care and Clearness will contact the family concerning immediate needs. If requested, s/he will appoint one or more persons to assist the family with such matters as registering the death, notifying friends, notifying newspapers, banks, pensions, insurance companies, etc., answering the telephone, and helping living to continue.

The Ministry and Worship Committee will work with the family and the House and Grounds Committee on planning a memorial service in line with the wishes of the family and the deceased as expressed in the Information for Meeting Records. The Ministry and Worship Committee will help prepare a memorial minute in consultation with the family.

Resources for further advice and information

The organizations, printed materials, and websites described below have been gathered together in 2005 to supplement the Packet on Planning for Death or Incompetence, by Langley Hill Friends Meeting. Printed matter in the Langley Hill Library is marked with an asterisk (*).

I. Preparing for Death

A. Organizations

Compassion and Choices, P.O. Box 101810, Denver, CO 80250, (800) 247-7421, www.compassionandchoices.org, formerly the Hemlock Society and its Foundation, is “dedicated to empowering individuals to make informed decisions and receive the best care possible at the end of life, through support, education, legal and legislative advocacy.

Death With Dignity Alliance, 11 Dupont Circle, NW, PO Box 98058, Washington, DC 20090-8058, (202) 969-1669; www.dwda.org. Suicide and materially helping another to commit suicide are criminal acts in Virginia; even so, this organization offers information on expanded end-of-life choices.

Caring Connections (See II. Medical Issues, below.)

B. Printed Materials

Avonheim, Dr. Judith and Doron Weber, 1992, Final Passages: Positive Choices for the Dying and Their Loved Ones, New York: Simon and Schuster for the Philip Lief Group, Inc., 285 pp. A sympathetic guide to various end-of-life choices, with lots of good reference materials listed.

Becket, Marilyn R., 1992, Last Touch: Preparing for a Parent's Death, Oakland, CA: New Harbinger Publications, 143 pp. A short set of intimate stories about how one family coped with their aging father's passing away.

Corr, Charles A., Clyde M. Nabe, and Donna M. Corr, 1994, Death and Dying. Life and Living, Pacific Grove, CA: Brooks/Publishing Co., 482 pp. + references. A comprehensive textbook on all the issues associated with death and dying.

Cox, Donald, 1993, Hemlock's Cup. The Struggle for Death With Dignity, Buffalo: Prometheus Books, 3 11 pp. A history of the evolution of the right-to-die movement, analyzing many of the issues involved.

Harwell, Amy, 1995, Ready to Live, Prepared to Die: A Provocative Guide to the Rest of Your Life, Wheaton, IL: Harold Shaw Publications, 155 pp. Written by a cancer patient to inspire others how to live fully, this book includes a provocative checklist of preparations.

*Kavanaugh, Robert E., 1972, Facing Death, Los Angeles: Nash Publishing, 226 pp. This personal and sensitive account by a priest explores mourning in America and the complex feelings associated with the end of life. First the dying person needs to receive permission to pass away from every important person he will leave behind. Only then can he voluntarily let go of every person and possession he holds dear.

*Kubler-Ross, Dr. Elisabeth, 1969, On Death and Dying, New York: Macmillan Publishing Co., 289 pp. Based on interviews of terminally ill patients, this classic study outlines the six stages through which dying patients progress -- denial, anger and resentment, depression, acceptance, and hope. "The more we are making advancements in science, the more we seem to fear and deny the reality of death."

Kubler-Ross, Elisabeth -- a variety of titles stemming from her classic, On Death and Dying (see above).

*Lyman, Mary Ely, 1960, Death and the Christian Answer, Wallingford, PA: Pendle Hill Pamphlet No. 107, 16 pp. In the face of our society's general denial about death, hers is an appreciation of mortality, an explanation of Christ's holistic life-giving assurances based on faith and God's love. " ...The Christian view of the human spirit makes growth in love the central and crucial principle of its life."

Moller, David Wendell, 1996, Confronting Death: Values, Institutions, and Human Mortality, New York. Oxford University Press, 305 pp. A readable sociological survey of how our society got to this point concerning how we deal with death.

Nearing, Helen, 1995, Light on Aging and Dying, Gardiner, ME: Tilbury House Publishers, 153 pp. A lovingly compiled anthology of comforting and challenging favorite passages.

*Smith, Bradford, 1965, Dear Gift of Life: A Man's Encounter With Death, Wallingford, PA: Pendle Hill Pamphlet No. 142, 38 pp. As the author faces his final months with cancer, he shares rich meditations on the meaning and wonder of life; the intensity of life in finite time. "If we cannot speak freely of death, we cannot really speak freely of life."

C. Websites

www.myhealthdirective.com offers forms and (for a fee) a registry for living wills, durable powers of attorney, and advance directives.

www.uslivingwillregistry.com offers (for a fee) a registry for your completed living wills, etc.

II. Medical Issues

A. Organizations

Caring Connections, (800) 658-8898, is a project funded by the Robert Wood Johnson Foundation, housed in the National Hospice and Palliative Care Organization, http://www.caringinfo.org. It provides free information, resources and motivation to learn actively about end of life issues, as a consumer outreach effort. Its advance medical directive forms, available on its website, are kept up to date with local legal requirements, and are recommended for use, perhaps with some modifications to indicate specific preferences.

Hospice Link, (800) 331-1620, provides resources and referrals to hospices.

Montgomery County Government, Information & Assistance for Seniors, (240) 777-3000, provides free advice to Montgomery County residents about finding and selecting home care and support services.

Montgomery County Government, Telephone Reassurance Program for Caregivers over 60, 240-777-2600, offers informal advice and support for older caregivers.

Virginia State Anatomical Program, 400 E. Jackson St., Richmond, VA 23219, (800) 786-2479; has a form, to be executed in triplicate, to be signed by two witnesses as well as a person wishing to donate his or her body to medical science.

B. Printed Materials

*Harvard Medical School, A Guide to Living Wills and Health Care Proxies: How to Protect Your Right To Make Crucial Health Care Decisions, Cambridge, MA, 2005, 33 pages. This is a brief but complete guide to decisions and documents relating to all forms of advance medical directives. It describes the details you may want to include in your living will or health care proxy, offers a resource list, gives forms for health care proxies, a living will worksheet, a generic living will, and an advance care directives tracking sheet. It also briefly describes for each State its laws and contact numbers relating to these documents, such as who can sign as witnesses.

The forms themselves can be downloaded in .pdf format from http://www.health.harvard.edu/downloads/LWforms.pdf.

C. Websites (not verified for accuracy)

http://www.caringinfo.org, the website of the National Hospice and Palliative Care Association, based in Alexandria, provides medical advance directive forms tailored for local jurisdictions and kept current with legal developments. These forms generally are preferred to the advance directive form provided with this packet.

http://www.putitinwriting.org. is a Website sponsored the American Hospital Association, which provides detailed information and advice about advance medical directives.

www.americanhospice.org offers advice and links about hospice care.

http://www.practicalbioethics.org/mbc-cc.htm offers detailed tools to help with decisions related to disability and end-of-life issues.

III. Property Issues

A. Legal Services

Virginia State Bar, Virginia Lawyer Referral Service, (804) 775-0808, will refer you to a lawyer in Virginia who specializes in wills, estates, and trusts. The initial consultation will cost you $35 for up to ½ hour.

DC Lawyer Referral Service of the Bar Association of the District of Columbia provides referrals by telephone for DC lawyers with a specialty in estates and trusts. Call (202) 296-7845 between 8:30 a.m. and 6:30 p.m. M-F. See www.badc.org/html/lawref.htm.

District of Columbia Bar has a free advice and referral clinic every Saturday morning from 10-12 a.m. at Bread for the City, 1525 7^th St., NW, and Max Robertson center, 2301 Martin

Luther King, Jr. Ave., SE. with services as described in http://www.dcbar.org/for_the_public/programs_and_services/advice.cfm.

The Maryland State Bar Association provides a County-by-County list of phone numbers for local bar association lawyer referral services, at http://www.msba.org/public/referral.htm. The number for Montgomery County is (301) 279-9100.

IV. Preparatory Information for the Meeting and for Your Family

B. Printed Materials

*AARP, 1988, Tomorrow’s Choices: Preparing Now for Future Legal, Financial, and Health Care Decisions, Washington, DC, 65 pages. A succinct guide to life choices facing aging people.

V. After A Death

A. Organizations

The Compassionate Friends, P.O. Box 3696, Oak Brook, IL 60521; www.compassionatefriends.org., provides peer support for bereaved parents.

Funeral Consumers’ Alliance, Inc.; 33 Patchen Rd., S. Burlington, VT 05403; (800) 765-0107; [email protected]; www.funerals.org; This organization offers through its local affiliates and website a large number and variety of very useful resources, including funeral price surveys, advice on what to ask for when seeking a simple burial or cremation, and other consumer rights relating to dealing with physical remains. Its local affiliates, which charge modest dues for membership and materials, include:

Memorial Society of Metropolitan Washington, 1500 Harvard St., NW, Washington, DC 20009; (202) 234-7777; [email protected]; www.funerals.org/DC/;

Funeral Consumers Alliance of Maryland and Environs (FCAME), 9601 Cedar Lane, Bethesda, MD 20814; (301) 564-0006; [email protected];

Memorial Society of Northern Virginia; 4444 Arlington Blvd., Arlington, VA 22204; (703) 271-9240.

International Theos Foundation, 322 Boulevard of the Allies, Suite 105, Pittsburgh, PA 15222, provides peer support for widowed persons and their families.

Widowed Persons, 1909 K. St., NW, Washington, DC 20049, provides peer support to widowed persons .

Crossings: Caring for Our Own At Death, P.O. Box 721, Silver Spring, MD 20918, (301) 593-5451, [email protected], http://www.crossings.net/. This organization helps families at the time of death and afterwards, working to “integrate dying and after-death care back into our family and community life”, creating “opportunities for families to complement the loss and grief of death with healing and love”.

U. S. Social Security Administration Offices:

Phone 1(800) 772-1213; www.socialsecurity.gov. (open M-F, 9 a.m. – 4 p.m.):

6295 Edsall Rd., Alexandria, VA
2300 S. 9^th St., Arlington, VA
11212 Waples Mill Rd., Fairfax, VA
8700 Centerville Rd., Manassas, VA
333 Hawaii Ave., NE, Washington, DC
2100 M Street, NW, Washington, DC
3244 Pennsylvania Ave., SE, Washington, DC
1905-B 9^th St., SE, Washington, DC
6400 Old Branch Rd., Camp Springs, MD
337 Brightseat Rd., Landover, MD
7701 Greenbelt Rd., Greenbelt, MD
51 Monroe St., Rockville, MD
Wheaton Plaza, 11160 Viers Mill Rd., Wheaton, MD

B. Printed Materials

*A Friends Memorial Service, Friends General Conference, a small, 3-page handout for memorial services.

*Federal Trade Commission, Funerals: A Consumer’s Guide, Washington, DC, (877) FTC-HELP; www.ftc.gov, 22 pages. The Government’s consumer guide to funeral services, outlining rights and types of funerals and associated financial arrangements.

Fitzgerald, Helen (n.d), The Mourning Handbook- The Most Comprehensive Resource Offering Practical and Compassionate Advice on Coping with All Aspects of Death and Dying, New York: Simon and Schuster, 317 pp. An excellent survey of ways to cope, punctuated with first-person accounts, and enriched by a good bibliography and other references.

*Fuller, Dorothy Mason, 1971, Light in Hours of Darkness, New York & Nashville: Abingdon Press, 80 pp. This anthology provides passages of comfort for the grief-stricken. E.g., "Death is but Crossing the World, as Friends do the Seas; They live in one another, still." William Penn:

*James, John W. and Frank Cherry, 1988, The Grief Recovery Handbook: A Step-by-step Program for Moving Beyond Loss, New York. Harper and Row, 175 pp. Written by the founders of the Grief Recovery Institute, this manual emphasizes honesty, preparation, and emotional sensitivity. "Grieving is a growth process." They give specific steps, to be explored with a partner, to get beyond debilitating grief.

*Morgan, Ernest, 2001 (Fourteenth Ed.), Dealing Creatively With Death: A Manual of Death Education and Simple Burial, Hinesville, VT, Upper Access, Inc., 160 pp. This is a classic, frequently updated, on the subjects indicated, with lots of good, practical advice about coping with the problems associated with death.

Rando, Therese, 1991, How to Go On Living When Someone You Love Dies, New York: Bantam Books, 339 pp. A compassionate roadmap to grieving.

*The Conduct of Funerals for Friends, Philadelphia Yearly Meeting, a small, 6-fold pamphlet on this topic, possibly for the bereaved.

C. Websites (not verified for accuracy):

http://www.griefsupportservices.org/newgrief/index.php , National Grief Support Services, offers a variety of services and publications to help those who are grieving.

http://www.pbs.org/pov/pov2004/afamilyundertaking/resources_03.html. This website, a summary of a PBS program in 2004, provides resources relating to funerals conducted at home. See Crossings, above.