Living Will - Your choices for End-of-Life Decisions

A living will spares family members the anguish of having to make difficult decisions, and it helps them to discuss situations in advance and come to terms with the loved one's wishes.

Doctors themselves are concerned about these ethical issues and living wills provide needed direction. Living wills can also assist the medical profession struggling between the ability to save life, and the need to reduce suffering.

No one really likes dealing with their own mortality, but a living will allows control over medical treatment in near-death situations, and it removes the stress and guilt associated with these decisions from family members and friends.

A living will form may be provided to your physician and other healthcare providers, allowing them to follow your wishes for medical care. The form states whether you wish your life to be artificially prolonged if you are a patient with a catastrophic illness or accident. The form must comply with the laws of your state, since the laws vary by state. A form for a living will may require two witnesses to attest to your signature and/or that the form be notarized.

When living wills are combined with the appointment of a healthcare agent, they are often referred to as advance directives for medical care. If the advance healthcare directive provides for the appointment of an agent to make care and treatment decisions, the agent should not also serve as a witness. Many forms also allow you to appoint a successor health care proxy in case the first health care agent is no longer able to serve. The person you select as your agent should be someone you trust and doesn't need to be a family member. The representative should be someone who understands and shares your values and lives in your area.

Living wills may also be used to express your wishes for organ donations and final arrangements.

A healthcare power of attorney or other medical directive doesn't take effect until a medical expert determines you are permanently unconscious.  An advance directive form may be freely revoked while you are still competent and not incapacitated.   A copy of your advance medical directive form should be provided to any healthcare agent you appoint, your doctor and other healthcare providers, and any close friends and relatives whose cooperation may be needed.  Some provinces and states also have a living will registry for living wills and other advance health care directives.

Medical Treatment Options for You to Decide Upon

When you make an advance directive for healthcare or form for living will, you will need to make medical care decisions in advance. The following are some of the medical treatment options and healthcare decisions you should consider if you were to become hospitalized in a persistent vegetative state:

 · Cardiopulmonary resuscitation (CPR) is a method of reviving a patient's heart by a device that delivers an electric shock to stimulate a heart that has stopped beating.

 · Artificial ventilation is a procedure for providing oxygen to you through mechanical means when you are unable to breathe on your own.

 · Artificial nutrition and hydration provides fluid and nutrition through intravenous means or a tube when the patient is unable to be fed.

 · Dialysis cleans your blood and maintains proper fluid levels when your kidneys fail.

 · Pain medication can ease discomfort for a patient but may affect awareness of surroundings.

Other Advance Directives

Some other forms individuals may use to give advance instructions to make healthcare decisions on their behalf and state medical treatment preferences include:

Do-Not-Resuscitate Order (DNR)- this form states your preference not to be resuscitated and instructs healthcare providers not to use CPR if your heart stops beating.

Mental Health Care Directive - the patient may state treatment preferences for mental healthcare, such as consent to psychoactive medication, electroshock therapy, restraint, isolation, or medication in this advance directive.

Conclusion

You can save your loved ones much additional trauma in an already difficult situation by creating advance directives for medical decisions or a living will. By taking the time to complete a form for a living will, you can have the peace of mind of knowing that your wishes for medical treatment and life-prolonging procedures will be followed and that those closest to you will be spared from having to make difficult medical care decisions.

It’s not easy to talk about how you want the end of your life to be. But it’s one of the most important conversations you can have with your loved ones.  This FREE Starter Kit will help you get your thoughts together and then have the conversation.

http://theconversationproject.org/starter-kit/intro/

 

For more information

For BC Canada go to http://www.trustee.bc.ca/pdfs/STA/It%27s_Your_Choice-Personal_Planning_Tools.pdf

 For our friends in the United States you can go to http://www.uslegalforms.com/livingwills/?auslf=livcom

 

How to Talk to the Children and Teens About the Newtown, CT, Tragedy

How to Talk to the Children and Teens in Your Life About the Newtown, CT, Tragedy by Alan D. Wolfelt, Ph.D.

Once again we are faced with the traumatic, violent deaths of a group of innocent people, this time precious children in Newtown, Connecticut. I have been asked to provide some guidelines on how to communicate with children and teens about this tragedy. If you know of others who might benefit from this information, I invite you to forward this article to them.

First, it’s important to remember that children can cope with what they know, but they can’t cope with a reality they are over-protected from. As a father and as a counselor, I understand the instinct to want to protect children from such tragic news. But the reality is that many if not most of the children and teens in our lives (with the exception of the very youngest) have already heard about the recent school shooting from their peers, social media, or television. They have been exposed to the fact that 20 first-graders were shot by a stranger who barged into an elementary school. Many of them have also seen photos of the killer and of the children and teachers who were killed. Some may have read the horrific details of the massacre.

The point is, we cannot protect children from the tragedy, but we can let them teach us how they feel about it. As the caring adults in their lives, we have the responsibility to be available to them when they are struggling to understand what happened or if they have fears that the same thing could happen in their schools. We also have the responsibility to be honest with them within the boundaries of what is developmentally appropriate for a given child.


Listen (and observe), then respond


Watch the children in your life a little more closely this week and in the weeks to come. Notice if they are listening to news of the shooting, reading news online or in print, sharing stories that other kids have told them at school, or asking questions about the shooting. If it’s on their mind, or if you think it might be, then it’s your turn to ask a couple open-ended questions. "What have you heard about the school shooting that happened last week?" "Are the kids or teachers at your school talking about the kids who died in Connecticut?" You can also share your feelings: "I’ve been feeling sad about the children who were killed last week."

Also watch for a change in behavior. Children who are more irritable or aggressive than usual or who are complaining of physical ailments uncharacteristically may essentially be telling you that they have absorbed some of the nation’s horror and anxiety about what happened at Sandy Hook Elementary.

When ignored, children and teens feel all alone in their grief. Respond to them with sensitivity and warmth. Use a caring tone of voice; maintain eye contact when talking with and learning from them. This commitment to actively listening tells children that their feelings will be respected.

Remember that often kids don’t want to have a long conversation about the tragedy. They don’t want to be "talked at." But if they’re given the opportunity, many will tell you what’s on their mind, allowing you a glimpse into their reality. Respond based on what they tell you or show you through their behaviors. Use their words and level of understanding. Don’t over-explain. Keep it simple and honest and loving. Let them know you’re someone they can talk to about the tough things.

Also, some kids, especially younger ones, may truly not be concerned about the shooting because it seems like just another far-away story that doesn’t affect them. That’s why it’s important to listen and

observe, then respond. Allow for a discussion but don’t insist on one if the child isn’t telling or showing you she’s sad, anxious or perplexed. Let the child lead.


Safety first


If a child is expressing, verbally or behaviorally, that she is afraid, reassure her that you and the other grown-ups in her life are doing everything you can to make sure that she is safe. Because it’s true, it’s OK to say, "This kind of thing almost never happens. It’s a one-in-a-million situation. You’re protected."

Teens are ready to handle the more nuanced truth, which is that safety can’t be 100 percent guaranteed in anything we do in life. Model living each day with boldness, resilience, meaning, and purpose for the teens in your life.

Many kids will find it helpful to review school safety and security procedures, and indeed, this is happening at schools across the country as I write this. Physically show them the security measures in place and step through the drills.

In the home, if a child seems to be regressing to the behaviors of younger kids—such as wanting to sleep with mom and dad, bedwetting, thumb-sucking, etc., these are signs that this child simply needs some extra attention right now. Don’t punish him for the regressive behaviors. Indulge them for now. And spend extra time with him in the coming days and weeks. Be available when he gets up, when he comes home from school, after dinner, and on weekends as much as you can.


Be the grown-up


We as a nation have been traumatized by the shooting at Sandy Hook Elementary. The multiple, violent deaths of precious young children and the adults who cared for them can result in intense feelings of shock, fear, anxiety and helplessness. Some of us confront these feelings by obsessively watching TV coverage of the event or talking about it with anyone and everyone.

While it’s normal and natural for us to try to integrate the reality of what happened in these ways, this kind of exposure may be too much for children. So limit your media viewing and conversation about the tragedy in front of your children. Younger kids, especially, don’t need to know and aren’t developmentally mature enough yet to handle all the details.

Be calm, reassuring, and positive. Be the caregiver. If you need to talk about your own thoughts and feelings about what happened, find another adult to talk to out of earshot of the kids. Never lie to children or hide the truth from them, but do limit their exposure.

Older kids, especially teens, may, like many adults, work through their thoughts and feelings by engaging with the national media and conversation about the shooting. Try watching the news together with these teens and talking about what you see. Be careful not to reverse roles. Don’t display your own grief so much that the child is forced to take care of you instead of the other way around. Seek outside support for yourself if you need it.


Search for meaning … together


As we all struggle to understand what can never be understood, we naturally turn to rituals and faith. If you attend a place of worship and there is a message about the shooting during the service, this may be helpful for your older child to hear. Model prayer, meditation, singing, spending time in nature or whichever activities are helpful to you in connecting to your spirituality. Attending a service or candle-lighting in memory of the children who died may be helpful for your family.

Participating in activities that connect us as humans can also be meaningful at this time. Children of all ages can participate in activities like making cards to send to the surviving children at Sandy Hook Elementary or supporting children in need in your own community through volunteer efforts like food or toy drives.

If a child wants to talk about where the children who died "went," be honest with her about your beliefs and ask her about hers. Encourage this conversation without feeling you need to know all the answers.


Thank you for being an adult who is committed to helping children learn to navigate our challenging times and emerge as resilient, communicative, and compassionate adults themselves. The world needs more communicators and compassion-givers. Perhaps if we work on these learned skills together, one day we will have no more need of articles like this one.



About the Author
Dr. Alan Wolfelt is a respected author and educator on the topic of healing in grief. He serves as Director of the Center for Loss and Life Transition and is on the faculty at the University of Colorado Medical School's Department of Family Medicine. A father of three, Dr. Wolfelt has written many bestselling books for and about grieving children and teens, including Healing Your Grieving Heart for Kids, Healing A Child’s Grieving Heart: 100 Practical Ideas for Families, Friends, and Caregivers, and Healing Your Grieving Heart for Teens. Visit www.centerforloss.com to learn more about helping children in grief and to order Dr. Wolfelt’s books.


Provided by the National Funeral Directors Association

Tribute to All the Children and Adults who Died this year

 Christmas in Heaven

They still light that tree in the city square

They are red, white, and green shinning everywhere

And I wish you were here

And I wonder…

Is the snow falling down on the streets of gold?

Are the mansions all covered in white?

 

Are you singing with angels Silent Night?

And I wonder what
Christmas in Heaven is like.

 

There’s a little manger scene

down on

Third and Main

I must have walked right by it a
thousand times

I see it now in a different light

'Cause I know you are there

 

 

 

And I wonder...

Are you kneeling with shepherds before Him now?
 

Can you reach out and touch His Face?

Are you part of that glorious Holy Night?

 

I wonder what Christmas
in Heaven is like.

 


 

Is the snow falling down on the streets of gold?

Are the mansions
all covered in white?

Are you singing with
angels Silent Night?

 

 

 

 

 

 

And I wonder what
Christmas in Heaven
  is like...

 

This is a song performed by  Sarah Schieber go to Youtube

http://www.youtube.com/watch?v=YVE7H2QUD-U

Should a Child or Children Attend a Funeral?

Should a Child or Children

 Attend
a Funeral? 

The funeral will have a long-term impact on the child, whether he attends or not.   Attending without appropriate education, information and support can leave a child confused and fearful.   Not attending can isolate a child and often leads to regret or resentment later.   Children should be given the opportunity to choose the level of participation they are comfortable with and not be pressured into making a decision based on parents' needs.   The most helpful thing a parent can do is to give the child choices.

Give the children clear explanations

of what will happen at the funeral

• Who will be at the funeral service?
• What is going to happen?
• Where will the service take place?
• When will the funeral happen?
• Why are we doing this?
• What is expected of the child?

 

What about viewing the body? 

Below is a list of important facts
a child might want
to know
before choosing to view the body.

 

The body is:  

 

• is in an open or a partially open casket
• is cool in temperature
• does not move
• cannot talk or see you
• will not come back to life
• may have markings, etc. from injury or illness
• will look and feel different than the person did before death
• may have a different smell 

What are the options for involving children

and teens in the memorial service? 

• Would you like to sleep at home or elsewhere tonight?
• What of the person's possessions, if any, would you like to keep?
• When do you think you will be ready to return to school?
• Do you want to see the cremated remains?
• Would you like to see the death certificate or the obituary?
• Would you like to participate in a support group?
• How would you like to memorialize the person on the anniversary or special occasions?
•  

After the memorial service / funeral 

• Would you like to sleep at home or elsewhere tonight?

• What of the person's possessions, if any, would you like to keep?

• When do you think you will be ready to return to school?

• Do you want to see the cremated remains?

• Would you like to see the death certificate or the obituary?

• Would you like to participate in a support group?

• How would you like to memorialize the person on the anniversary or special occasions?

            

Remember

Funerals do not have to be scary

for children or anyone.

It gives us a chance to 
say goodbye

to our loved one

and the way
things used to be. 

Advice from The Healing Place 

http://www.thehealingplaceinfo.org/funerals.html

Trauma & Coping Strategies - YES, Death is Trauma

Trauma & Coping Strategies

 

YES - Death is Trauma

 

After a trauma, people may go through a wide range of normal responses.

Such reactions may be experienced not only by people who experienced the trauma first-hand, but by those who have witnessed or heard about the trauma, or been involved with those immediately affected. Many reactions can be triggered by persons, places, or things associated with the trauma. Some reactions may appear totally unrelated.

Here is a list of common physical and emotional reactions to trauma, as well as a list of helpful coping strategies. These are NORMAL reactions to ABNORMAL events.

Physical Reactions

Aches and pains like headaches, backaches, stomach aches

Sudden sweating and/or heart palpitations (fluttering)

 

Changes in sleep patterns, appetite, interest in sex

Constipation or diarrhea

Easily startled by noises or unexpected touch

   

More susceptible to colds and illnesses

   

Increased use of alcohol or drugs and/or overeating

Emotional Reactions

 

 

 

Shock and disbelief

 

 Fear and/or anxiety

Grief, disorientation, denial

 

Hyper-alertness

 or hyper vigilance

 

 

Irritability

 restlessness, outbursts of anger

or rage

 

    Emotional swings 

like crying and then laughing

 

Worrying or ruminating

 intrusive thoughts of the trauma nightmares

 

Flashbacks

feeling like the trauma is happening now

 

Feelings of helplessness

panic, feeling out of control

 

Minimizing

 the experience

 

 

Attempts to avoid

anything associated with trauma

 

Tendency to isolate oneself

 

Feelings of detachment

 

Concern over burdening others

with problems

 

Emotional numbing

or restricted range of feelings

 

Difficulty trusting

and/or feelings of betrayal

 

Difficulty concentrating

or remembering

Feelings of self-blame  

and/or survivor guilt

 

Shame

 

 

Diminished interest

in everyday activities or depression

 

Unpleasant past memories resurfacing

 

Loss of a sense of order

or fairness in the world; expectation of doom and fear of the future

Helpful Coping Strategies

    Mobilize a support system 

 reach out and connect with others,

especially those who may have shared the stressful event

 

 

    Talk about the traumatic experience

with empathic listeners

 

    Cry

 

    Hard exercise

like jogging, aerobics, bicycling, walking

 

    Relaxation exercise

like yoga, stretching, massage

 

    Humor

 

    Prayer and/or meditation

listening to relaxing guided imagery; progressive deep muscle relaxation

 

    Hot baths

    Music and art

 

    Maintain balanced diet

and sleep cycle as much as possible

 

   

Avoid over-using stimulants

like caffeine, sugar, or nicotine

 

    Commitment to something

personally meaningful and important every day

 

    Hug those you love

pets included

 

    Eat warm turkey

 boiled onions, baked potatoes, cream-based soups,

these are tryptophane activators,

which help you feel tired but good (like after Thanksgiving dinner)

 

    Proactive responses toward

personal and community safety 

organize or do something socially active

 

    Write about your experience

in detail, just for yourself or to share with others

 

 

People are usually surprised that reactions to trauma can last longer than they expected. It may take weeks, months, and in some cases, many years to fully regain equilibrium. Many people will get through this period with the help and support of family and friends. But sometimes friends and family may push people to "get over it" before they're ready. Let them know that such responses are not helpful for you right now, though you appreciate that they are trying to help. Many people find that individual, group, or family counseling are helpful, and in particular, EMDR (Eye Movement Desensitization and Reprocessing) is a phenomenally rapid and wonderful therapeutic method. Either way, the key word is CONNECTION ask for help, support, understanding, and opportunities to talk.

The Chinese character for crisis is a combination of two words -- danger and opportunity. People who fully engage in recovery from trauma discover unexpected benefits. As they gradually heal their wounds, survivors find that they are also developing inner strength, compassion for others, increasing self-awareness, and often the most surprising -- a greater ability to experience joy and serenity than ever before.

Written by Patti Levin, LICSW, PsyD

 

David: Please let everyone know that I give permission for my fact sheet to be used by anyone, either as a whole, or in part, as long as my name appears somewhere on it for credit. [Specifically,] its OK to make unlimited copies [of this document] for educational and non-commercial uses in a disaster situation, provided no fee is charged. People can also contact me by email or by telephone (617) 227-2008. Warmly, Patti 13 September 2001