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Death is definite. The average life expectancy in Hawaii is 81. Yet, despite strong aspirations and best estimates, the precise time of our death is unknown. Sadly, there is a deep cultural tendency to avoid making preparations for what is arguably the most profound event in life. Still, we must face the inevitable. Doing so will increase the chances of a gentle, more harmonious death not only for the dying, but also for loved ones. Take these practical steps:
>> Consider an estate plan, living trust, will: It is not just for the wealthy. If you have any substantial assets to speak of, such as a home or a 401(k), it is important to make arrangements. The potential benefit of doing so is to minimize the time and cost of probate in which the courts sort out who gets what. A living trust considers the amount of inheritance tax to be paid to the state and federal government. A formal plan also helps ensure that your wishes are fulfilled with respect to who inherits what, including ohana or any charitable contributions.
There are many young professionals who already have started a family but still owe substantial education debt with no assets. In this case, if your health is reasonable, you can get life insurance. The cheapest type is called “level term,” where monthly payments are modest and remain fixed for up to 20 or 30 years. After that, premiums stop, but there is no more insurance and no residual cash benefit. However, this life insurance can form the basis of a living trust and result in great peace of mind as one’s career is developing, debt is being paid off and the keiki are growing up.
>> Complete advance health directives: These can be completed at your doctor’s office or through an attorney. In the event of a hospitalization or a major procedure, they should be in your record. Here you make choices about under what conditions you might or might not wish to prolong life through medical means.
>> Select durable power of attorney for health care: This person will make health care decisions in the event you are incapacitated. It is a comfort to know that someone you trust can advocate for your wishes if you are unable.
>> Make funeral arrangements: Recently, I helped my mother get through a couple of surgeries and onto dialysis. Hopefully, she will have some good years left. I think so. Still, she had always been resistant to making her own funeral arrangements. I went down and got everything set up and prepaid. There is a fair bit involved, but it gave the family and Mom peace of mind once it was done. Doing so frees up the ohana to come together and grieve rather than be distracted by handling logistics at a time of loss.
>> Prepare for the time of death: The actual process of death is so fearful to most that in recent years a bill was signed into law by which patients can request a medical prescription to cause death. Those in favor of creating this public option argue that “it’s my life. I want to determine my own exit, and I don’t want to suffer.” Many express worry over loss of control in a complicated medical system and want to avoid being an emotional or financial burden to loved ones.
But in cases where death is not sudden, for the vast majority, patients can be made comfortable as death draws near, and it is possible to facilitate a gentle, natural death. Palliative care is a medical specialty that offers comfort measures even concurrent with curative care, and hospice either at home or in a caring facility is well suited for those who are expected to die within six months.
Preparing for death, even if it would appear to be many years away, is wise. Doing so involves placing one’s material affairs in order such that intentions for inheritance are cleanly met without probate or ill tax effects. It also means making decisions for advanced health directives and to decide who will have durable power of attorney for health care if you become incapacitated. Making previous funeral arrangements eases the burden on loved ones at the time of your death. Finally, and perhaps most important, it is well advised to prepare for death not only spiritually and psychologically, but also to understand professional resources available, including palliative care and hospice.
Ira Zunin is a practicing physician. He is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.
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