How to Write a Death Plan: Worksheet
By Ashley T Benem, Death Midwife, LMP, Minister
The Plan:
A Death Plan fills in the gaps of information not covered by a living will, last will and testament, Advanced Care Directive or funeral plan. It is designed to tie those plans together in a cohesive way for families and loved ones to follow with ease.
Durable power of attorney for Finances
Durable power of attorney for Health Care
Advanced Directives (Living Will)
Dementia & Alzheimer’s Provision
Last Will and Testament
POLST
Funeral & burial contracts/arrangements / Guiding questions/prompts
When you are ill, what do you want/need? What do you NOT want?
When you are very stressed, what relaxes you and brings you comfort?
When you are stressed, where do you hold or feel tension in your body?
Pre Death / Post Death
Place
Home, hospice, hospital, skilled nursing facility:
rest home, assisted living, convolecesant center, rehab / Preparing the body
Cleaning, dressing, laying in honor, esthetics (makeup, hair), embalming, organ orbody donation
Method
natural course, VSED: Voluntary stopping eating & drinking, Death with Dignity / Transportation
By who, to where, when, in what
Who will attend: Who do you want there?
Family, friends,clergy, Death Midwife, medical caregivers, pets / Vigil
Where, how long
Who will support: Physical, emotional, mental, spiritual
Family, friends, clergy, Death Midwife, medical caregivers, pets / Ceremony/Ritual
Spiritual, ethnic, customary; when, where, facilitated by who, for who
Environment
In what room or space, temperature, lighting, scents, music, noise levels, furnishings, bedding, Focal points: personal items, pictures, flowers, secular objects / Funeral/memorial
When, where, how many attendees (who), facilitated by
Interventions
Medical, comfort measures, spiritual / Deposition of the body
Buried or cremated; in what, where, by who,attendees
Medication
Comfort care, regular regimen / Obituary
Pain control
What level (1-10) and how lucid/conscious
Planning for flexibility: PLAN A: Best case scenario PLAN B: Limiting circumstances PLAN C: accident, unexpected
Include a dated, signed or notarized copy with 1) Advanced Directives, 2) Medical charts, 3) support team, 4) with You.
A Sacred Passing: Death Midwifery Services PO Box 5284 Bellingham, WA 98227-5284 (360)927-5040