Yeah, they just texted that we should pull the plug
December 28, 2017 1:00 PM   Subscribe

The relatives who would take care of my medical decisions and funeral arrangements live far away. People who live close to me who could help are not relatives. Now what? How do I plan for an emergency? Are there any agencies/services who could serve as a link? Who would I talk to about figuring this out?

I live in NYC, my relatives live ~400 miles away. Due to some issues that are not important to detail, I do not think they could physically get to NYC unless someone literally picked them up at their doorstep and dropped them off at mine, basically escorting them the whole way and taking care of all logistics. I cannot think of any service that would do that, though I would certainly make arrangements and pay for it if it did.

There are two general areas I'm concerned about:
(1.) Medical emergencies
- Medical decisions need to be made. I assume this has to be done in person?
- I need long-term rehabilitation and care, which would probably necessitate a transfer to be closer to my relatives. Again, does this need to be done in person?
- The real nightmare scenario for me is the one I so callously joked about in my title: The decision needs to be made to take me off life support. I would like for my relatives to see me before I die, but, again, I can't think of a way for them to be physically taken to my side.
(2.) My death
- I believe I would like my body to be transported to the area where my relatives are, if only because that's probably the only way they would get to see me since they can't travel to me. Is this something that could be done remotely?

I can think of a couple friends who I could call on to help with these matters, but this seems like an awful burden to bear, in particular the part where they are coordinating with my family about figuring out my wishes and/or getting me transported. I'm also wondering if there are any agencies or services that would take care of something like this with just a phone call - as in, someone makes a phone call, and plans are set in motion.

Thanks.
posted by unannihilated to Law & Government (8 answers total) 5 users marked this as a favorite
 
I can think of a couple friends who I could call on to help with these matters, but this seems like an awful burden to bear, in particular the part where they are coordinating with my family about figuring out my wishes and/or getting me transported.

IANAL, TINLA, and the following would not lessen the emotional burden (quite the opposite), but an option that you do not mention in your post that would at least potentially reduce the logistical burden is legally granting one of those friends medical power of attorney. Upside: if you trust them to, it would be in their power to sign off on your behalf for whatever decision your family comes to. Downside: they would also have the legal authority to override any decision your family comes to.

Medical power of attorney generally only applies in the event that you are incapacitated and unable to make your own decisions, and generally does not extend power of attorney to any non-medical aspects of your life such as finances. However, the specifics are governed by state law, so you would want to look into how New York treats it, probably with an attorney.
posted by solotoro at 1:36 PM on December 28, 2017 [1 favorite]


(2) It is definitely possible to get your body shipped remotely, but you'll want to talk to local funeral homes (both one local to NYC and one local to your family) to price this out in advance and make sure you've covered all the legalities as that varies a lot by state. Also, some prelim research indicates that the price can be as much as $1500 for that service so something else that occurs to me is that you want to make sure to set aside a substantial portion of your estate for funerary expenses.
posted by peppercorn at 1:41 PM on December 28, 2017


First, you should have a living will, in which you can go into some detail about what-if scenarios as guidance to the doctors and others treating you.

Separately from the living will, you should have a healthcare proxy or healthcare power of attorney, which designates a specific person to make medical decisions for you if you are not able to do so yourself. Whoever you designate obviously should have a copy of your living will, and you should discuss your wishes with them so they have as much guidance from you as possible.

The person you designate does not have be physically present. So it could be your out-of-town relatives if you trust them to make the right decisions for you. But more likely, you will want someone who can interact directly with your caregivers. But it does not have to be a friend. You could appoint an attorney, and instruct them to try to make arrangements for your relatives to be brought to you if at all possible, and to arrange for rehab or extended treatment, if needed, in their vicinity. And you could set up a pre-arranged funeral through any funeral home, where the funeral director would take care of transporting your remains to their location and would follow whatever other wishes you have for ceremonies, burial, etc.

Here's some guidance specific to New York State. And some more here. See also the NY Attorney General's comprehensive guidelines.
posted by beagle at 1:41 PM on December 28, 2017 [3 favorites]


Actually, if you have a person that you trust to understand the issues involved and make the decision that you would want made that should be your medical/health care power of attorney. Doctors know how to pick up the phone and call when it comes to the big decisions. You just need to make it clear to the hospital when you check in (and to anyone who knows you who might be notified if you are unconscious, including ICE on your phone) who that person is.

You will want to have a legal document written up to make this official - you can also use it to designate your preference for end-of-life decision making so whoever does get the call will lhav more confidence that the decision you would have wanted (a great consolulation at a difficult time) You can also specify a desire for long term care to happen close to home, although depending on how safe it is travel, that may or may not be practical.

I am not a lawyer but I think you can also designate in your will someone with the power to make funeral arrangements - this would include power to authorize a local funeral home to collect your body and ship it back home for the funeral. They do this all the time. If you are really worried, you can do the leg work on who should they call. But you can specify that you wish to buried or cremated in the place of your choice.
posted by metahawk at 1:44 PM on December 28, 2017 [2 favorites]


Medical decisions are made over the phone all the time. Just make sure they have a healthcare power of attorney.
I’m sure your friends would come see in the hospital if your family can’t make it.
posted by SyraCarol at 2:31 PM on December 28, 2017


To empower someone to make medical decisions on your behalf, you need a medical power of attorney. But to provide guidance to whoever has medical power of attorney, plus serve as proof of your wishes, you will need to make advance directives. Having had medical power of attorney for two people in their final stage of life, I can tell you that the advance directives were the really important part, and the power of attorney did little more than establish that I had the authority to make the decisions.
posted by DrGail at 3:46 PM on December 28, 2017


In my unfortunate experience with these things, you really, really need to have a person on the scene, not 400+ miles away, when this stuff happens. The hospital listens to the person there crying more than they do whatever DNR paperwork you have on file. (I'd say ask me how I know, but....don't.) However, the issue with friends is that friends can drift apart* and just because your friend is a great person for being in charge of you medically now doesn't mean that they will always be in your life for that. I don't know the legal issues with changing that status if you drift away from them or have a dramatic friend breakup, but you might want to look into that. Is it legally possible for you to change who has your medical proxy if that person stops talking to you and you can't get their cooperation any more? At any rate, if it's at all possible, try to pick someone as reliable as a family member that's near you.

* I had one friend who I considered being my person because most of my relatives aren't close to me at all and the one that is disagrees with me on DNR (see above), but she's moved out of state and has progressively drifted away for the last few years and I only hear from her a few times a year to indicate that she's still alive. I don't even know what I'd do now if I had given her medical power and wanted to take it away because who the hell knows if she'll still even be talking to me by next year at the rate her depression seems to be going.
posted by jenfullmoon at 11:27 PM on December 28, 2017


As an aside, if your relatives cannot make what should be fairly simple travel arrangements (I mean 400 miles is a car ride or a short flight) are you sure they would be good at making these kinds of decisions/executing your wishes, organising long-term care or funeral arrangements? Overcoming travel logistics is not emotionally charged whereas that kind of crisis is. Clearly I know nothing about why they would struggle with travel but consider if they really are the best people to support you in these scenarios. An attorney may indeed be the way to go.
posted by koahiatamadl at 4:16 AM on December 29, 2017


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