March 18, 2017

Soul Midwives

'Midwives' of mercy: The new breed of inspirational carers helping to ensure people's dying days are spent in the comfort of their own homes has sprung up in the U.K

Soul midwifery is a unique approach to end-of-life care. In the words of Felicity Warner, the woman who founded it, 'just as a birth midwife ensures a safe delivery into this world, the soul midwife's role is to do the same for the dying, to make a good death possible, a dignified, peaceful and even enriching experience'.

 Felicty Warner Soul Midwife
Felicity Warner

The work of soul midwives was recognized when Felicity Warner was named 2017 End of Life Care Champion by the National Council for Palliative Care and the Royal College of Nursing. The seed for soul midwifery was planted more than 20 years ago when Felicity, now 58, was working as a journalist and interviewed several women dying of breast cancer.  The women told 'how lonely it felt to be dying despite their medical care and their families around them'.

Not only were their doctors and nurses too busy to talk about death and dying but, surprisingly, Felicity found the women were becoming increasingly distant from friends and family who couldn't cope with the reality and masked it with platitudes such as: 'You'll be feeling better soon.'  Researching how people died before the rise of modern 'curative' Western medicine, Felicity found a range of practices 'that had in common the fact that they respected the act of dying as a sacred time'.

She established soul midwifery in 2004, and has since trained 600 soul midwives — many already have a health practitioner qualification — with an initial three-day course, followed by an apprenticeship lasting around a year.
Qualified soul midwives' costs are in line with local rates for services such as counselling, though many also work as volunteers at hospices or use the qualification to help care for a terminally ill relative.
Posted by Jill Fallon at 6:05 PM | Permalink

January 31, 2017

Hidden in plain sight

Alexander the Great's last will and testament may have been found 'hiding in plain sight' 2,000 years after his death

The fabled last will and testament of Alexander the Great may have finally been discovered more than 2,000 years after his death. A London-based expert claims to have unearthed the Macedonian king's dying wishes in an ancient text that has been 'hiding in plain sight' for centuries.  The long-dismissed last will divulges Alexander's plans for the future of the Greek-Persian empire he ruled.  It also reveals his burial wishes and discloses the beneficiaries to his vast fortune and power.

 Alexander The-Great Will

Evidence for the lost will can be found in an ancient manuscript known as the 'Alexander Romance', a book of fables covering Alexander's mythical exploits.  Likely compiled during the century after Alexander's death, the fables contain invaluable historical fragments about Alexander's campaigns in the Persian Empire. 

Alexander the Great is arguably one of history's most successful military commanders. Undefeated in battle, he had carved out a vast empire stretching from Macedonia and Greece in Europe, to Persia, Egypt and even parts of northern India by the time of his death aged 32

Historians have long believed that the last chapter of the Romance housed a political pamphlet that contained Alexander's will, but until now have dismissed it as a work of early fiction. But a ten-year research project undertaken by Alexander expert David Grant suggests otherwise.  The comprehensive study concludes that the will was based upon the genuine article, though it was skewed for political effect.

He believes that Alexander's original will was suppressed by his most powerful generals, because it named his then unborn half-Asian son Alexander IV and elder son Heracles as his successors.  Rather than accepting the leadership of what the Macedonians saw as 'half-breed' sons, which would have been 'unthinkable', they fought each other for power in a bloody period of infighting and civil war known as the 'Successor Wars'.

The revelation is detailed in Mr Grant's new book, 'In Search of the Lost Testament of Alexander the Great.'
Posted by Jill Fallon at 11:43 AM | Permalink

April 14, 2016

Psychedelic therapy for the dying: " “Oh God, it all makes sense now, so simple and beautiful."

LSD's impact on the brain revealed in groundbreaking images thanks to 20 volunteers at the Imperial College, London.

 Lsd Brain Scans

David Nutt, the government’s former drugs advisor, professor of neuropsychopharmacology at Imperial College London, and senior researcher on the study, said neuroscientists had waited 50 years for this moment. “This is to neuroscience what the Higgs boson was to particle physics,” he said. “We didn’t know how these profound effects were produced. It was too difficult to do. Scientists were either scared or couldn’t be bothered to overcome the enormous hurdles to get this done.”
The brain scans revealed that trippers experienced images through information drawn from many parts of their brains, and not just the visual cortex at the back of the head that normally processes visual information. Under the drug, regions once segregated spoke to one another.  Further images showed that other brain regions that usually form a network became more separated in a change that accompanied users’ feelings of oneness with the world, a loss of personal identity called “ego dissolution”.

In Aeon, A good trip Researchers are giving psychedelics to cancer patients to help alleviate their despair — and it’s working

‘Patients would tell me that they’ll never be able to get out from under the rock that hangs over them and that their psyche is always filled with the fact they have cancer,’ Stephen Ross said. ‘But those feelings evaporated under the influence of psilocybin. They almost uniformly experienced a dramatic reduction in existential anxiety and depression, and an increased acceptance of the cancer, and the changes lasted a year or more and in some cases were permanent.’
Ross, the 42-year-old director of the Division of Alcoholism and Drug Abuse at Bellevue Hospital in New York, is an unlikely apostle for psychedelics. He became fascinated with end-of-life issues when he was growing up in the affluent Los Angeles suburb of Pacific Palisades and his physician mother took him to hospice centres. ‘She introduced me to the concept of a good death,’ Ross said. ‘When I was an intern at Columbia, I spent three months in the cancer wards and I watched people die there,’ he continued. ‘But those were bad deaths, full of anxiety and pain, and we didn’t learn anything about palliative care.’
Ross is part of a new generation of researchers who have re-discovered what scientists knew more than half a century ago: that psychedelics can be good medicine. At such elite research centres around the world as NYU, Johns Hopkins, UCLA, and the University of New Mexico, psychedelic research is inching its way back to respectability,

John Tierney wrote in 2010 in the New York Times, Hallucinogens Have Doctors Tuning In Again

Scientists are especially intrigued by the similarities between hallucinogenic experiences and the life-changing revelations reported throughout history by religious mystics and those who meditate. These similarities have been identified in neural imaging studies conducted by Swiss researchers and in experiments led by Roland Griffiths, a professor of behavioral biology at Johns Hopkins.

In one of Dr. Griffiths’s first studies, involving 36 people with no serious physical or emotional problems, he and colleagues found that psilocybin could induce what the experimental subjects described as a profound spiritual experience with lasting positive effects for most of them. None had had any previous experience with hallucinogens, and none were even sure what drug was being administered.

In the New Yorker The Trip Treatment wherein Michael Pollan explores the current research into psychedelics that is yielding exciting results after being shut down for decades.

As I chatted with Tony Bossis and Stephen Ross in the treatment room at N.Y.U., their excitement about the results was evident. According to Ross, cancer patients receiving just a single dose of psilocybin experienced immediate and dramatic reductions in anxiety and depression, improvements that were sustained for at least six months. The data are still being analyzed and have not yet been submitted to a journal for peer review, but the researchers expect to publish later this year.

“I thought the first ten or twenty people were plants—that they must be faking it,” Ross told me. “They were saying things like ‘I understand love is the most powerful force on the planet,’ or ‘I had an encounter with my cancer, this black cloud of smoke.’ People who had been palpably scared of death—they lost their fear. The fact that a drug given once can have such an effect for so long is an unprecedented finding. We have never had anything like it in the psychiatric field.”
Many researchers I spoke with described their findings with excitement, some using words like “mind-blowing.” Bossis said, “People don’t realize how few tools we have in psychiatry to address existential distress. Xanax isn’t the answer. So how can we not explore this, if it can recalibrate how we die?”
Griffiths’s double-blind study reprised the work done by Pahnke in the nineteen-sixties, but with considerably more scientific rigor. Thirty-six volunteers, none of whom had ever taken a hallucinogen, received a pill containing either psilocybin or an active placebo (methylphenidate, or Ritalin); in a subsequent session the pills were reversed. “When administered under supportive conditions,” the paper concluded, “psilocybin occasioned experiences similar to spontaneously occurring mystical experiences.” Participants ranked these experiences as among the most meaningful in their lives, comparable to the birth of a child or the death of a parent. Two-thirds of the participants rated the psilocybin session among the top five most spiritually significant experiences of their lives; a third ranked it at the top. Fourteen months later, these ratings had slipped only slightly.

Furthermore, the “completeness” of the mystical experience closely tracked the improvements reported in personal well-being, life satisfaction, and “positive behavior change” measured two months and then fourteen months after the session. .... Griffiths believes that the long-term effectiveness of the drug is due to its ability to occasion such a transformative experience, but not by changing the brain’s long-term chemistry, as a conventional psychiatric drug like Prozac does.
“I don’t want to use the word ‘mind-blowing,’ ” Griffiths told me, “but, as a scientific phenomenon, if you can create conditions in which seventy per cent of people will say they have had one of the five most meaningful experiences of their lives? To a scientist, that’s just incredible.”

The case of Patrick Mettes
On an April Monday in 2010, Patrick Mettes, a fifty-four-year-old television news director being treated for a cancer of the bile ducts, .... His diagnosis had come three years earlier, shortly after his wife, Lisa, noticed that the whites of his eyes had turned yellow. By 2010, the cancer had spread to Patrick’s lungs and he was buckling under the weight of a debilitating chemotherapy regimen and the growing fear that he might not survive. The article, headlined Hallucinogens Have Doctors Tuning In Again mentioned clinical trials at several universities, including N.Y.U., in which psilocybin—the active ingredient in so-called magic mushrooms—was being administered to cancer patients in an effort to relieve their anxiety and “existential distress.” ...Patrick had never taken a psychedelic drug, but he immediately wanted to volunteer. ...

Patrick made the call anyway and, after filling out some forms and answering a long list of questions, was accepted into the trial. ... After the screening, Mettes was assigned to a therapist named Anthony Bossis, a bearded, bearish psychologist in his mid-fifties, with a specialty in palliative care. Bossis is a co-principal investigator for the N.Y.U. trial..... Mettes was scheduled for two dosings—one of them an “active” placebo (in this case, a high dose of niacin, which can produce a tingling sensation), and the other a pill containing the psilocybin.
Bossis noted that Mettes was crying and breathing heavily. Mettes said, “Birth and death is a lot of work,” and appeared to be convulsing. Then he reached out and clutched Kalliontzi’s hand while pulling his knees up and pushing, as if he were delivering a baby.  “Oh God,” he said, “it all makes sense now, so simple and beautiful.”.....

“From here on, love was the only consideration. It was and is the only purpose. Love seemed to emanate from a single point of light. And it vibrated.” He wrote that “no sensation, no image of beauty, nothing during my time on earth has felt as pure and joyful and glorious as the height of this journey.”  Then, at twelve-ten, he said something that Bossis jotted down: “O.K., we can all punch out now. I get it.”
Great secrets of the universe often become clear during the journey, such as “We are all one” or “Love is all that matters.” The usual ratio of wonder to banality in the adult mind is overturned, and such ideas acquire the force of revealed truth. The result is a kind of conversion experience, and the researchers believe that this is what is responsible for the therapeutic effect.
Patrick Mettes lived for seventeen months after his psilocybin journey, and, according to Lisa, he enjoyed many unexpected satisfactions in that time, along with a dawning acceptance of death.......In April, his lungs failing, Mettes wound up back in the hospital. “He gathered everyone together and said goodbye, and explained that this is how he wanted to die. He had a very conscious death.”

Mettes’s equanimity exerted a powerful influence on everyone around him, Lisa said, and his room in the palliative-care unit at Mt. Sinai became a center of gravity. “Everyone, the nurses and the doctors, wanted to hang out in our room—they just didn’t want to leave. Patrick would talk and talk. He put out so much love.” When Tony Bossis visited Mettes the week before he died, he was struck by Mettes’s serenity. “He was consoling me. He said his biggest sadness was leaving his wife. But he was not afraid.”
Despite the encouraging results from the N.Y.U. and Hopkins trials, much stands in the way of the routine use of psychedelic therapy. “We don’t die well in America,” Bossis recently said over lunch at a restaurant near the N.Y.U. medical center. “Ask people where they want to die, and they will tell you at home, with their loved ones. But most of us die in an I.C.U. The biggest taboo in American medicine is the conversation about death. To a doctor, it’s a defeat to let a patient go.” Bossis and several of his colleagues described the considerable difficulty they had recruiting patients from N.Y.U. ’s cancer center for the psilocybin trials. “I’m busy trying to keep my patients alive,” one oncologist told Gabrielle Agin-Liebes, the trial’s project manager. Only when reports of positive experiences began to filter back to the cancer center did nurses there—not doctors—begin to tell patients about the trial.
Bossis ..... hopes that “the legacy of this work” will be the routine use of psychedelics in palliative care. But he also thinks that the medical use of psychedelics could easily run into resistance. “This culture has a fear of death, a fear of transcendence, and a fear of the unknown, all of which are embodied in this work.” Psychedelics may be too disruptive for our society and institutions ever to embrace them.
Posted by Jill Fallon at 4:17 PM | Permalink

November 1, 2015

Medicare will reimburse doctors for conducting end-of-life discussions

Doctors should have been doing this all along, but the pressures on billing made it difficult, so now End-of-Life Discussions Will Be Reimbursed by Medicare

The federal government will pay doctors who speak with patients about the type of medical care they want when they are near death, a turning point after a similar proposal six years ago ran into opposition and was stripped from what became the Affordable Care Act.

The rule announced Friday by the Centers for Medicare and Medicaid Services will reimburse, starting Jan. 1, health-care providers if they choose to have conversations with Medicare patients about advance care planning—also known as end-of-life discussions. The decision affects about 50 million beneficiaries and could ripple through the health-care industry. Private insurers often follow payment practices adopted by Medicare, the national insurance program for seniors and the disabled.

Efforts to provide compensation to doctors who hold such consultations was opposed in 2009 by mostly Republican opponents of the health-care overhaul, who said the law would lead to “death panels” tasked with seeking out cost savings by rationing care. A provision to pay physicians for such end-of-life counseling was stripped from the final bill.

But the rule, proposed in July, hasn’t triggered the same backlash as before. Since 2010, legislation that would allow reimbursements to physicians for advance planning discussions has gained bipartisan support and backing from hospice and physician groups. Some private insurers already have begun paying providers for the discussions, as have a handful of state Medicaid programs.

The public also supports the move. Eight in 10 people in the U.S. said Medicare and private health insurers should pay for end-of-life conversations, according to a September poll by the Kaiser Family Foundation.
Posted by Jill Fallon at 7:34 PM | Permalink

February 12, 2015

Giving it all away

Final tour of duty: Terminally ill veteran on inspirational mission to give away ALL his possessions to fellow soldiers before he dies - including his house

 Bob Karlstand Vet Gives It All Away Veteran Bob Karlstand has only months to live.

The 65-year-old is battling colon cancer and terminal lung disease and fears he won’t make it to his next birthday.  But the former staff sergeant, from Maple Grove, Minnesota, has one final mission before he dies: to give away everything he owns, including his home of 38 years.  His only stipulation is that his home goes to a fellow veteran.

Mr Karlstrand, who retired from an insurance firm, never married or had children and is an only child.  So he has already given most of his belongings, including his furniture, photographs and letters he wrote to his mother – and has given his $1million retirement fund to the nursing school at his alma mater, the University of Minnesota.  He says he had people come into his home and take whatever they wanted.

‘In the end, it’s only material things,’ ….‘I’ve had a good life so I can’t complain at all,’ he said.

He has given the responsibility of finding new occupants for his home to Habitat for Humanity.  When Mr Karlstrand dies, they will refurbish the property, then find and help a veteran and his family move in.

Many people without living relatives will find themselves in this position.  Mr. Karlstrand's example of estate planning is a good one to follow

Posted by Jill Fallon at 4:02 PM | Permalink

January 23, 2015

"Don’t make the same mistakes my parents did"

Bethany Mandel offers Eight Parenting Lessons I Learned From My Parents’ Early Deaths
Don’t make the same mistakes my parents did. Prepare for death, so if it happens, your children will be as secure as possible.

1. Buy life insurance
2. Make a Will and Arrange Guardians for Your Kids
3. Write Down Your Recipes - The tastes of your childhood can disappear with your parents.
4. Print Photos and Make Albums
5. Write Down Family Stories
6. Give the Gift of Genealogy and Family History - Family history is important to me, probably because I have so little family left.
7. Compile Immediate Family Medical Histories
8. Make Memories, Not Money, the Priority

Posted by Jill Fallon at 11:02 AM | Permalink

November 14, 2014

End-of-life planning in Japan

In the Atlantic, 18 photos illustrate  Modern End-of-Life Services in Japan

Japan expects its population to shrink by nearly 30 million people over the next 50 years, with a thriving market for funerals, graves, and anything related to the afterlife. Funeral business fairs and "end-of-life seminars" are becoming popular events, offering both traditional and high-tech services and products. Participants can climb into a coffin for a personal test, have their funeral portraits taken after a beauty session, shop for shrouds from a company called "Final Couture," or buy a plot in a modern indoor multi-story cemetery that robotically retrieves tombstones for mourners, based on the swipe of an identity card

 01 Japan End-Of-Life
Posted by Jill Fallon at 2:42 PM | Permalink

November 10, 2014

October 2, 2014

Your Nose Knows

When you lose your sense of smell, it's definitely time to make sure your affairs are in order since that lose of the sense of smell predicts death within five years, according to new research.

People who can no longer smell peppermint, fish, rose or leather 'may have only five years left to live'

Men and women who have lost their sense of smell are almost six times more likely as others to die within the next five years, a study found.  The inability to identify fish, rose, leather, orange, and peppermint – the five scents used in the experiment – could predict death within five years, scientists said.  While the finding may seem odd, a poor sense of smell raises the odds of death more than established medical conditions including cancer.


The U.S. researchers said that while the dulling of the sense does not directly cause death, it provides ‘early warning that something has gone badly wrong’.

They believe that a simple smell test could be used to identify pensioners most at risk of an early death.
University of Chicago researcher Jayant Pinto said: ‘Of all the human senses, smell is the most undervalued and underappreciated – until it’s gone.’
In the first study of its kind, more than 3,000 men and women aged between 57 and 85 were put through a three-minute smell test.  They were asked to sniff the scent given off by felt tip-pen like gadgets and given four possible answers.
They did this five times.

The fragrances used were, in order of increasing difficulty, peppermint, fish, orange, rose and leather.

Most of the men and women got at least four of the five right, meaning they had a normal sense of smell.
Almost 20 per cent only identified two or three of the smells – indicating a mild loss of the sense.

Some 3.5 per cent got one or none right – and were judged to be ‘anosmic’ – or to have lost their sense of smell.
Five years later, 430 of the men and women had died. Those who had failed the smell test were almost six times as likely to have died as those with a healthy sense of smell, the journal PLOS ONE reports.

The finding could be partly explained by age, gender and socio-economic status. But, even when these were taken into account, someone without a sense of smell was more than three times as likely to have died.

In fact, not being able to smell things provides a more accurate warning of an early death than cancer or heart failure. Only severe liver damage is more strongly linked to dying within five years.

Dr Pinto said: ‘We think that loss of sense of smell is like the canary in the coal mine.
‘It doesn’t directly cause death, but it’s a harbinger, an early warning that something has gone badly wrong.’
Posted by Jill Fallon at 4:40 PM | Permalink

August 21, 2014

Delaware gives executors access to digital assets

About time. Delaware becomes first state to give executors broad digital assets access   Meet the "Fiduciary Access to Digital Assets and Digital Accounts Act."

Delaware has become the first state in the US to enact a law that ensures families’ rights to access the digital assets of loved ones during incapacitation or after death.

Earlier this year, the Uniform Law Commission, a non-profit group that lobbies to enact model legislations across all jurisdictions in the United States, adopted its Uniform Fiduciary Access to Digital Assets Act (UFADAA). Delaware is the first state to take the UFADAA and turn it into a bona fide law.

“This problem is an example of something we see all the time in our high-tech age—our laws simply haven’t kept up with advancements in technology,” said Daryl Scott, in a statement last week. Scott is a member of the Delaware House of Representatives and the lead author of the bill. “By signing this bill into law, we’re helping to protect the rights and interests of the average person in the face of a rapidly evolving digital world."

Jim Halpert, an attorney with DLA Piper, and the director of the State Privacy and Security Coalition, an umbrella group that represents Google, Yahoo, Facebook and other firms, said that he opposes the new Delaware law.

"This law takes no account of minimizing intrusions into the privacy of third parties who communicated with the deceased," he said. "This would include highly confidential communications to decedents from third parties who are still alive—patients of deceased doctors, psychiatrists, and clergy, for example—who would be very surprised that an executor is reviewing the communications. The law may well create a lot of confusion and false expectations because, as the law itself acknowledges, federal law may prohibit disclosing contents of communications."
Posted by Jill Fallon at 12:01 PM | Permalink

August 2, 2014

Wine bar in Gallic hospice

French hospital to open wine bar for terminally ill patients

A French hospital is to open a wine bar for terminally ill patients in an unprecedented but characteristically Gallic way to improve their quality of life.  Patients at the Clermont-Ferrand University Hospital in central France will be able to take part in "medically supervised wine-tasting" sessions.  They will be allowed to invite friends or family over for a drink.

Dr Virginie Guastella came up with the idea because she believes that patients "are entitled to enjoy" their last days.  Patients enthusiastically supported the plan, which has been approved by the authorities. "Why should we deprive people reaching the end of their lives of the traditional flavors of our land?" Dr Guastella said.

The bar will open in September in the hospital's Palliative Care Centre…and stock a range of wines donated by local people. It will also serve whisky and champagne.  If the bar proves successful, doctors at Clermont-Ferrand hope the idea will be taken up by other hospitals in France.
Posted by Jill Fallon at 12:02 PM | Permalink

July 23, 2014

No trust fund for my kids

Philip Seymour Hoffman leaves his entire $35million fortune to his partner because he didn't want his three children to be 'trust fund kids'

Philip Seymour Hoffman rejected his accountant's suggestion he set aside money for his three children because he didn't want them to be 'trust fund' kids, according to new court documents.  Hoffman wanted his estimated $35 million fortune to go his longtime partner and the children's mother, Mimi O'Donnell.  Hoffman also said that he wanted his son to be raised in Manhattan, Chicago or San Francisco.

The Oscar-winning actor, 46 was found dead in his Manhattan apartment in February from a drugs overdose.
Posted by Jill Fallon at 12:32 PM | Permalink

June 14, 2014

His last time in his beloved woods

One Last Look

Snohomish County Firefighters recently responded on a mission of mercy to an elderly hospice patient, and former forest ranger who wished once more to see his beloved great outdoors.

Working with hospice, firefighters granted that wish, wheeling the man up and down forest paths, much to his delight as he took in the sights, sounds, and smells of the Pacific Northwest.


Posted by Jill Fallon at 12:56 AM | Permalink

June 11, 2014

Scale of prices: for a simple death two shillings and sixpence. For the death of a person deeply regretted, five shillings

From the Futility Closet , Supply and Demand

"The Waterford Chronicle requests that persons supplying the Journal with obituaries will attend to the following scale of prices;
for a simple death two shillings and sixpence. For the death of a person deeply regretted, five shillings. For the death of a person who lived a perfect pattern of all the Christian virtues, and died regretted by the whole country, ten shillings. For the death of a person who possessed extensive literature and profound erudition, superadded to which, his whole life was remarkable for piety, humility, charity, and self-denial, one pound. For the death of a lady, whose husband is inconsolable for her loss, and who was the delight of the circle in which she moved, one pound ten shillings. For the death of a gentleman, who had only been six months married, who was an example of every conjugal and domestic virtue, and whose widow is in a state of anguish bordering on distraction, two pounds. For the death of an aristocrat, who was a pattern of meekness, a model of humility, a patron of distressed genius, a genuine philanthropist, an exemplary Christian, an extensive alms-giver, profoundly learned, unremitting to the duties of his station, kind, hospitable, and affectionate to his tenantry, and whose name will be remembered and his loss deplored to the latest posterity, five pounds. For every additional good quality, whether domestic, moral, or religious, there will be an additional charge."

– Birmingham Journal, Aug. 21, 1830
Posted by Jill Fallon at 10:03 AM | Permalink

November 20, 2013

“Life is a creeping tragedy,” the minister used to say. “That’s why we must be cheerful.”

Why does a brush with death make people turn to religion?

Sir John Tavener’s final broadcast on the BBC's Today programme brought home with force the truths of faith.

 John-Tavener-Simone-Canetty-Clarke John Tavener

I listened with unusual interest to Start the Week (Radio 4) on Monday. In January, the programme’s presenter, Andrew Marr, though only in his early fifties, suffered a stroke. He has recently returned to broadcasting. His post-stroke speech has the vocal equivalent of a very slight limp. On Monday, this made what he had to say the more affecting.

Marr told his audience that he is not religious but that, as he has convalesced, he has found himself reading religious poetry and listening to religious music. He has encountered “the possibility of sudden death”, and it has changed him. He reads the 17th-century poems of George Herbert and listens to the cantatas of JS Bach. Why might this be, he wanted to know. Why, in a culture which seems less and less interested in the formal teachings of religion, do many people feel that religious poetry and religious music matter more than ever?
Sir John explained that he had recently had a near-death experience. Since he had been ill, he had been looking back on his life a lot. Although he had moved from the Presbyterianism of his childhood, through Roman Catholicism, to a rather unorthodox version of eastern Orthodoxy, he remembered fondly a Protestant pastor of his youth. “Life is a creeping tragedy,” the minister used to say. “That’s why we must be cheerful.”
At first, Sir John’s illness had “shut everything down. God seemed to have vanished”; but then, as he recovered strength, his belief in God and his capacity to compose music – which, he said, had always gone together – returned. Now his music had become “more essential; more terse”.
Tavener complained that there was “a notable lack of joy in modern art”. He had just set three of Herbert’s poems to music (they will be performed for the first time next year). He quoted Dante: “All my thoughts speak of love.”
John Drury read out one of Herbert’s most famous poems, Love (III). It takes the form of a dialogue between the unworthy soul and Love (who is God, though not so named). The soul is inclined to refuse Love’s invitation to sit at his table, but Love, the perfect host, persuades him. In the dialogue, said Dr Drury, “Love has fewer words, but they are sprightly. In the end, it is Love that matters.” On Tuesday, the end came for John Tavener.

George Herbert, though high-born and ambitious, eventually chose the simple life of a parish priest. He wrote his poems, but never attempted to publish them in life. As he was dying, he asked them to be given to a trusted friend, saying that they were “a picture of the many spiritual conflicts which have passed between God and my soul, before I could subject mine to the will of Jesus my Master”. He asked him to read the book and “if it may turn to the advantage of any poor dejected soul, let it be made public”; if not, he should burn it.

For Herbert, that dejection he referred to was important. It was a horrible thing, but also a grace. In one of his most famous and beautiful poems, The Flower, Herbert compares his formerly depressed self to the plant that seems to die, but doesn’t: “And now in age I bud again,/After so many deaths I live and write;/I once more smell the dew and rain,/And relish versing: /Oh my only light,/ It cannot be/That I am he/On whom thy tempests fell all night.”
[I]f  people do not believe what religion says, why do they turn to its utterances when sick or dying or in fear?

The obvious, cynical, but not completely wrong answer is “Any port in a storm”. But I would argue that something else is going on, too. The chief message of 21st-century Western culture is one of self-empowerment. With technology, money, know-how, rights, medicine, problems can be solved: “You can do it!” Often this is true. But an encounter with really serious things – and nothing is more serious than death – tells you that ultimately you cannot. When you realise this, the paradoxes that are central to the great religions (especially to Christianity, which is the most paradoxical) come home with unique force. When I am weak, then am I strong; you must die to live.

In our culture, millions of people only think about these things too late, if at all. So the people who think about them all the time are helpful – and brave. Which is good reason to give thanks for the life and work of Sir John Tavener.

 Sir John Tavener

Sir John Tavener -  obituary

Sir John Tavener, who has died aged 69, was one of the leading British composers of the day; his predominantly religious and contemplative music — dubbed “holy minimalism” by some critics — was as passionately admired by large numbers of listeners as it was derided by others.
On the occasion of Tavener’s 50th birthday in 1994, the BBC honoured him with a four-day festival of his works on Radio 3, with broadcasts from Westminster Abbey, Westminster Cathedral and the Barbican.

A striking figure, 6ft 6in tall, with long, flowing hair and the ascetic face of a monk, Tavener was received into the Orthodox faith in 1977. Mother Thekla, an Orthodox nun, was not only his spiritual guide but also the librettist of several of his works
Posted by Jill Fallon at 12:56 AM | Permalink

October 28, 2013

The "unbefriended elderly" need this

This actually makes sense for those who find themselves without family and without someone they can trust to act as their health care proxy.  I strongly believe that having a health care proxy in effect that appoints someone you trust to make medical decisions for you can make the difference between a good death and an unnecessarily painful one.

Hiring an End-of-Life Enforcer

The chilling dilemma of “the unbefriended elderly,” who don’t have family or close friends to make medical decisions on their behalf if they can’t speak for themselves, generated a bunch of ideas the last time we discussed it.  One reader, Elizabeth from Los Angeles, commented that as an only child who had no children, she wished she could hire someone to take on this daunting but crucial responsibility.  “I would much rather pay a professional, whom I get to know and who knows me, to make the decisions,” she wrote. “That way it is an objective decision-maker based on the priorities I have discussed with him/her before my incapacitation.” 

Elizabeth, it turns out other people have been thinking the same way.
Last year, Dr. Berman and her co-authors published an article in The Journal of the American Geriatrics Society proposing a new type of professional: the health fiduciary.

“These people would largely be drawn from retired social workers or nurses, people in the helping professions,” Dr. Berman said. They might also be clergy, or perhaps paralegals. “They would need to navigate the health care system,” she added. “They could work comfortably and easily within that world.”

The co-authors envisioned health fiduciaries undergoing up to a year’s training (those already knowledgeable about medical matters and end-of-life decisions would probably need far less), followed by certification in individual states.
Fiduciaries would probably work out of elder law firms or geriatric care management practices, Dr. Berman figures, because clients might retain them so many years in advance that they’d want that kind of continuity.

How much would a health fiduciary cost? In ballpark figures, the authors assumed they’d charge $100 an hour, much less than an attorney or even most geriatric care managers. They might spend 20 hours initially to understand and document a client’s wishes and to later consult with health care providers, the authors theorized — plus additional discussions every few years to see if the client’s thinking or health status has changed.
Posted by Jill Fallon at 3:32 PM | Permalink

September 9, 2013

Why you need Estate planning and estate planning for college students

A family lawyer gives you 7 reasons you need an estate plan—even if you have only $500 in the bank

1. Your health care. Defining how your medical needs will be addressed in case you cannot make health care decisions for yourself is a primary objective of having an estate plan. You also need to consider how you will meet the costs of long-term care. You need to name someone to make decisions for you and tell them how you want them made. This must be legally documented or the person you want caring for you cannot help without going to court first, as is the case with Amanda Bynes' parents.

2. Probate. Probate is an unnecessary, public, and often expensive court process that takes control out of your family's hands and puts that control in the hands of a judge who doesn't know you or what's important to you. A main focus of estate planning is keeping your family out of court, no matter what.

3. Family feuds. Family fights over how assets are divided and distributed are common when there is no estate plan and/or trusted advisor to guide family members. Sadly enough, these fights happen even when amounts of money are small OR even when there is no money at stake. Some of the biggest fights we've seen happen in storage units over sentimental items with no monetary value at all. If you don't want your family to fight, you should plan your estate ahead of time.

4. Beneficiary forms. You likely have several assets that cannot be passed along in a will alone. These include IRAs, life insurance, retirement plans, and annuities, all of which are governed by beneficiary forms that specify who is to receive the assets upon the death of an account holder. Completing these forms properly is estate planning. Completing these forms improperly creates the potential for a hugely disparate distribution and disgruntled beneficiaries.

5. Kids and parents. If you are currently responsible for the care of minor children, elderly parents, or a person who has special needs, you need a plan for the continuation of that care after you are gone.

6. Managing assets. Is your spouse or other family member capable of managing all your assets? If not, you will need to name someone who is capable of doing this now so your assets will be managed wisely for the benefit of your family in the future.

7. Business succession. If you own a business, you will need a succession plan to govern what happens to your ownership shares if something should happen to you. This is especially important if you are in business with a business partner, or you could end up in business with their spouse upon their passing, forcing a buyout when you can't afford it, or worse, a liquidation of the business.

Gerry Beyer addresses estate planning for college students

When a person turns 18, he or she is legally an adult and parents can no longer make decisions for their  child without consent.  Therefore, adult children should take certain actions to have a parent or agent make decisions for them in case of an emergency.  Here are four documents college students should have to ensure they have protection should anything unexpected happens:

Power of Attorney.  This will give an agent the authority to make financial or legal decisions on their behalf.
Health Care Proxy.  This will appoint someone to make medical and end-of-life decisions on their behalf.
HIPAA Release.  This will allow a named person to talk to doctors and receive information concerning their health.
FERPA Release. This will allow a named person to receive information concerning their school performance
Posted by Jill Fallon at 9:55 AM | Permalink

July 11, 2013

Betrayed by her lawyer and accountant for $300 million and they didn't even go to her funeral

Reclusive heiress Huguette Clark was 'incoherent and barely able to hold the pen' when she signed new will excluding her family from $307m fortune

Late Manhattan heiress Huguette Clark was mumbling incoherently and was unable to even hold the pen when she signed her $300 million fortune away to her lawyer, doctor and employees, it emerged today.

The new will was signed in April 2005 in her hospital room at Beth Israel Medical Center where she spent the last 20 years of her life.

Under the watchful eye of her lawyer-beneficiary Wallace Bock, the will superseded the previous one, which gave $5 million to Clark's personal nurse and the rest of her estate to her relatives.  According to court documents, Bock and Huguette's accountant - sex offender Irving Kamsler - were so excited about the signing of the new will 'they went straight from the hospital to a bar to celebrate. Presumably the [will] went to the bar along with them'.

Disturbing details of the 2005 signing were outlined in papers filed in Manhattan Surrogate Court last week, according to the New York Post.
According to Bock's assistant Danita Rudisill, Clark 'mumbled something incoherent' and - with help holding the pen - signed the document 'very slowly, with some difficulty', the family’s court filing said.

Clark's relatives are opposing Bock's motion that the will was properly executed and she knew what she was doing when she signed it.

Lawyer Wallace Bock was also asked to be removed from Huguette Clark's estate  The lawyer is not the only person who was trying to cash in on her vast fortune in the final years of her life.

In the 20 years she spent living in Beth Israel Medical Center until she died in 2011 aged 104, members of staff were said to have researched her life and history and try to come up with ways to 'sweeten her up' and encourage her to donate money.


The dispute over Mrs Clark’s will marked a sad end to the life of solitude that she had lived for the last few decades of her life.

While she stayed at the hospital, her three fabulous homes sat empty: the $100million Bellosguardo estate, a $24million country house in Connecticut and a $100million co-op, the largest apartment on Fifth Avenue overlooking Central Park.

She inherited her wealth from her father, Montana Senator William Clark, and his copper mines but regarded her great wealth as 'a menace to happiness'.

When she died two weeks shy of her 105th birthday the only people present at her burial were funeral home employees.

No wonder the family is suing.  Everyone took advantage of this woman.  Especially shameful is the conduct of her attorney and accountant .

John Morken, the lawyer for Mrs Clark’s family, told the New York Times: ‘What this is about is not just a will contest, it’s about the accountability of professionals.'
Posted by Jill Fallon at 5:33 PM | Permalink

June 27, 2013

Catholic Hospice provides Jewish end-of-life care

Rabbis from Catholic Hospice have been serving patients in the L'chaim Jewish Hospice program for 10 years.

"We recognized a need because of the large Jewish population in South Florida," said Gael Silverman, director of professional services for L'chaim Jewish Hospice. Catholic Hospice plans to open two facilities that will care for Jewish patients. One facility will be in western Broward County and the other will be in southern Miami-Dade County. The program also plans to add several rabbis who will serve assigned areas.

A young Jewish woman was Catholic Hospice's first patient when the Sisters of Mercy started the hospice under the auspices of the Catholic Archdiocese of Miami in 1988. The L'chaim Jewish Hospice program was born in 2003. The Archdiocese's Catholic Health Services took over Catholic Hospice in 2010.

"A Jewish tradition of care, of always putting the patient first," makes the missions of Catholic Hospice and its L'chaim program very similar, said Bonnie Alkema, Catholic Hospice executive director.

Alkema said Catholic Hospice began training its patient care staff in Judaism's "underlying foundation" and traditions in 2008. "End of life is so important. Those traditions and knowledge affect how you end your life, how you die and what you need at the time of death," she said.

Rabbi Ira Eisenman, who joined L'chaim Jewish Hospice 18 months ago, provides pastoral care and offers "counsel, comfort and advice" to patients. "I am there to answer questions and help them get through a very difficult situation and ease their [emotional] pain, if I can," he said.

Commenting on the Catholic-Jewish relationship, Eisenman said, "Our relations couldn't be better. Catholic Hospice itself is a family. We're all working together toward one goal — the best possible treatment of our patients and their families.
"It's a two-way street," Eisenman added.

"The religious question has always been what happens after death," he said. "It has never been [about] what's hanging on the wall."

L'chaim Jewish Hospice removes crosses and crucifixes from the patient's room, if requested.
Posted by Jill Fallon at 9:28 AM | Permalink

June 13, 2013

Recovering the Art of Dying

Recovering the Ars Moriendi

Throughout the history of the world, most people—like the women at the tomb—encountered death on a near daily basis. Death’s brutality over the greater part of the last two millennia cast a long shadow over everyday life as disease, famine, and infant mortality claimed victim after victim. For Christians of yesteryear, this familiarity with the pungent reality of death brought the hope of resurrection into sharp relief, not just in old age, but at every stage of life.

By contrast, Americans have largely outsourced death and dying over the last 150 years, gradually banishing it from sight and thought. Coincidentally, over the same period, many American evangelical groups have adopted a near myopic emphasis on expiation in their discussions (and presentations) of the gospel message. In a culture that sanitizes death and dying while simultaneously and self-reflectively obsessing about guilt, the need for forgiveness trumps the need for resurrection.
Artistically, John Donne’s famous poem “Death Be Not Proud” paints a picture of death’s emasculation in the face of resurrection.  For centuries, familiarity with death gave Christian writers, pastors, theologians, and artists cause to address death and dying from a Christian perspective—not as an intellectual abstraction, but as tangible reality. Although an omnipresent human experience, the resurrection meant death held no power for Christians and therefore, they lived and died differently than other people. Rob Moll thinks they still should.

In his book, The Art of Dying: Living Fully into the Life to Come (IVP, 2010), Moll urges American Christians to re-familiarize themselves with death that we may revive the ars moriendi—the art of dying

From the book's description.

Rob Moll recovers the deeply Christian practice of dying well. For centuries Christians have prepared for the "good death" with particular rituals and spiritual disciplines that have directed the actions of both the living and the dying. In this well-researched and pastorally sensitive book, Moll provides insight into death and dying issues with in-person reporting and interviews with hospice workers, doctors, nurses, bioethicists, family members and spiritual caregivers. He weighs in on bioethical and medical issues and gives guidance for those who care for the dying as well as for those who grieve.

This book is a gentle companion for all who face death, whether one's own or that of a loved one. Christians can have confidence that because death is not the end, preparing to die helps us truly live.
Posted by Jill Fallon at 6:32 PM | Permalink

We are simply too busy to die

We are simply too busy to die

There are obstacles to dignity at the end of life.  Disease inflicted pain and debilitation, cost and confusion, poor planning and fear, all aggravated by our societal ignorance regarding dying, result in unneeded suffering and isolation.  In addition, it occurs to me that a hindrance to control and quality is that we are overwhelmed by the pressure of our day-to-day lives.  In other words, we are simply too busy to die.
We live without self-reflection, life contemplation or honest communication.  On this level five whitewater raft journey, the complex issues, presented at life’s end, are often left behind.
For me there are two lessons to be learned.  The first is take the time, especially when you are healthy and life is “in control,” to discuss and prepare.  How would you or your family manage? Who would take care of whom?  What do they want?  How far would they push?  What about money?  Even one or two quiet family together hours at the kitchen table, so that everyone can speak and listen, can save major strife during a future time of health care chaos.

The second lesson is that when the terrible does happen, as it will to every family, pace yourself. In the absence of a true medical emergency such as trauma, heart attack or acute leukemia, there is usually time to learn, consider and plan.  Work together as a family, get good information from doctors, seek second opinions and move forward carefully.  Take the time to be in control, try not to let the events rush you forward.

Such planning is easy to say, hard too do, but methodical communication and reflection can prevent much suffering and confusion.  Which leaves the primary question for us all; if we are too busy to die, are we too busy to live?
Posted by Jill Fallon at 6:11 PM | Permalink

June 11, 2013

How's the parking?

Packing for the Final Journey

Last week my father asked me to plan his funeral. He’s dying, he knows he’s dying, and he just wants to get on with it already. He’s a practical man, and doesn’t want the burden to fall to my mother or anyone else at a time when everyone is already upset.

I waved him off, telling him we were just planning to put him on flaming ship and set it adrift. He told me not to waste the ship: a rowboat would do fine.

Being People Of A Certain Age, my parents go to a lot of funerals, so they were able to descant on the benefits and drawbacks of all the local undertaking establishments. Jessica Mitford wrote that funeral directors sell “dignity, refinement, high-caliber professional service, and that intangible quality, sincerity.” All of those things take a backseat to convenient off-street parking. There’s almost a palpable sense of irritation at dead people who get waked from places with bad parking, or long walks from the lot to the door. 

That was a helpful criteria in knocking the potential vendors down to one.  Indeed, the parking offered by the final choice was quite good, even memorable.

Parking does indeed make a difference

Posted by Jill Fallon at 9:06 PM | Permalink

May 3, 2013

How Not to Die: The videos of Angelo Volande Angelo Volandes's low-tech, high-empathy plan to revolutionize end-of-life care

He decided to go to medical school, not just to cure people but “to learn how people suffer and what the implications of dying and suffering and understanding that experience are like.” Halfway through med school at Yale, on the recommendation of a doctor he met one day at the gym, he took a year off to study documentary filmmaking, another of his interests. At the time, it seemed a digression.

That man is Angelo Volande who may very well revolutionize the way you die.

Unless you are a doctor or nurse, you don't have much experience in medical end-of-life decisions.    So when it comes to medical decisions that must be made for a family member who is very ill and probably dying, most people would choose the medical care that is most life-prolonging. Of course, I want my mother to be feed even if it means a feeding tube.

But doctors who have lots of experience in such end-of-life decisions choose quite differently.  They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care that they could want.  But, they choose not to have 'heroic' and aggressive treatments.  They chose comfort care and quality of life.  As a result, they are far more likely to have a gentle and serene death.

Angelo Volande is bringing videos to those who are making end-of-life medical decisions so they will know what doctors know.

How Not to Die  Angelo Volandes's low-tech, high-empathy plan to rend-of-life care.

Volandes nods. “Here’s the sad reality,” he says. “Physicians are good people. They want to do the right things. And yet all of us, behind closed doors, in the cafeteria, say, ‘Do you believe what we did to that patient? Do you believe what we put that patient through?’ Every single physician has stories. Not one. Lots of stories.

“In the health-care debate, we’ve heard a lot about useless care, wasteful care, futile care. What we….have been struggling with is unwanted care. That’s far more concerning. That’s not avoidable care. That’s wrongful care. I think that’s the most urgent issue facing America today, is people getting medical interventions that, if they were more informed, they would not want. It happens all the time.”

I think he's right on the money with this.

Unwanted treatment is American medicine’s dark continent. No one knows its extent, and few people want to talk about it. The U.S. medical system was built to treat anything that might be treatable, at any stage of life—even near the end, when there is no hope of a cure, and when the patient, if fully informed, might prefer quality time and relative normalcy to all-out intervention.
What should have taken place was what is known in the medical profession as The Conversation. The momentum of medical maximalism should have slowed long enough for a doctor or a social worker to sit down with him and me to explain, patiently and in plain English, his condition and his treatment options, to learn what his goals were for the time he had left, and to establish how much and what kind of treatment he really desired.

The first film he made featured a patient with advanced dementia. It showed her inability to converse, move about, or feed herself. When Volandes finished the film, he ran a randomized clinical trial with a group of nine other doctors. All of their patients listened to a verbal description of advanced dementia, and some of them also watched the video. All were then asked whether they preferred life-prolonging care (which does everything possible to keep patients alive), limited care (an intermediate option), or comfort care (which aims to maximize comfort and relieve pain). The results were striking: patients who had seen the video were significantly more likely to choose comfort care than those who hadn’t seen it (86 percent versus 64 percent). Volandes published that study in 2009, following it a year later with an even more striking trial, this one showing a video to patients dying of cancer. Of those who saw it, more than 90 percent chose comfort care—versus 22 percent of those who received only verbal descriptions. The implications, to Volandes, were clear: “Videos communicate better than just a stand-alone conversation. And when people get good communication and understand what’s involved, many, if not most, tend not to want a lot of the aggressive stuff that they’re getting.”

Even now, after years of refinement, Volandes’s finished videos look deceptively unimpressive. They’re short, and they’re bland. But that, it turns out, is what is most impressive about them. Other videos describing treatment options—for, say, breast cancer or heart disease—can last upwards of 30 minutes. Volandes’s films, by contrast, average six or seven minutes. They are meant to be screened on iPads or laptops, amid the bustle of a clinic or hospital room.

They are also meant to be banal, a goal that requires a meticulous, if perverse, application of the filmmaker’s art. “Videos are an aesthetic medium; you an manipulate people’s perspective,” Volandes says. “I want to provide information without evoking visceral emotions.
Routine use, however, is far, far away. According to Volandes, only a few dozen U.S. hospitals, out of more than 5,700, are using his videos
Posted by Jill Fallon at 11:44 AM | Permalink

April 30, 2013

“He was a very smart man but he died like an idiot,”

He Left a Fortune, to No One

When Roman Blum died last year at age 97, his body lingered in the Staten Island University Hospital morgue for four days, until a rabbi at the hospital was able to track down his lawyer.

Mr. Blum, a Holocaust survivor and real estate developer, left behind no heirs and no surviving family members — his former wife died in 1992 and the couple was childless.
Much about Mr. Blum’s life was shrouded in mystery…..But perhaps the greatest mystery surrounding Mr. Blum is why a successful developer, who built hundreds of houses around Staten Island and left behind an estate valued at almost $40 million, would die without a will.

That is no small matter, as his is the largest unclaimed estate in New York State history, according to the state comptroller’s office.

“He was a very smart man but he died like an idiot,” said Paul Skurka, a fellow Holocaust survivor who befriended Mr. Blum after doing carpentry work for him in the 1970s.

Gary D. Gotlin, the public administrator handling the case, sold Mr. Blum’s home on Staten Island, auctioned off his jewelry and his furniture and is putting other properties that he owned on the market. Mr. Gotlin’s office, which is overseen by Surrogate’s Court in Richmond County, is also using Mr. Blum’s estate to pay his taxes, conduct an in-depth search for a will and hire a genealogist to search for relatives. If none are identified, the money will pass into the state’s coffers. That, Mr. Blum’s friends said, would be a tragedy, compounding the one that befell him as a young man in Eastern Europe.

I spoke to Roman many times before he passed away, and he knew what to do, how to name beneficiaries,” said Mason D. Corn, his accountant and friend for 30 years. “Two weeks before he died, I had finally gotten him to sit down. He saw the end was coming. He was becoming mentally feeble. We agreed. I had to go away, and so he told me, ‘O.K., when you come back I will do it.’ But by then it was too late. We came this close, but we missed the boat.”

Roman Blum was, by all accounts, an emotional man with a large personality. Six feet tall and handsome, he was a ladies’ man, a gambler and a drinker. He was also enterprising and tough in business.

“He had deeds on his desk piled up to the ceiling of properties he owned,” said Vincent Daino, who was Mr. Blum’s neighbor for 25 years and became his unpaid driver when the older man’s eyesight began to fail. “There were royalties from oil rigs in Alaska, money from his stocks — about once a month he would have me drive him to the bank so he could deposit $100,000 checks.”

In the months after the war, Mr. Blum met a family of survivors with two daughters. One of them, Eva, had been in the Auschwitz concentration camp. He married her, although by all accounts it was not a love match. “It was immediately after the war — he thought she was the last Jewish woman alive, and she thought there were no more men,” said a friend and fellow Holocaust survivor who met Mr. Blum around that time.
The Blums struggled to start a family. Mrs. Blum told her friends that she was unable to have children, and the couple spent thousands of dollars on doctors’ visits. According to stories that swirled around the couple, Mrs. Blum had been a subject of the dreaded Dr. Josef Mengele while at Auschwitz, and his experiments had rendered her infertile.

In the 1960s, on a five-week trip to Israel on the Queen Elizabeth, Mr. Blum found a boy, an orphan, whom he wished to adopt. But friends who were with them said Mrs. Blum begged him not to go through with the adoption, convinced that her doctors would ultimately be able to help them conceive. They did not adopt the boy and never had children.

Then, in 1964, the Verrazano-Narrows Bridge opened, linking Brooklyn and Staten Island, and many in the group, including Mr. Blum, began buying land on Staten Island. Prices were low, and Mr. Blum began developing land and building homes……

By the 1980s, with his business thriving, Mr. Blum decided to relocate to Staten Island. He built a large brick house in the upscale neighborhood of Southeast Annadale, with four bedrooms and five bathrooms, a two-car garage and a pool.

Mrs. Blum did not want to move. “He wanted her to go live with him in his big house with a swimming pool, but she loved the city,” said the friend who wished to be unidentified. “All her friends were there, and with his lifestyle, if she went with him, she knew she would be alone a lot.” Mrs. Blum stayed in Queens and Mr. Blum moved into the new house.

“Fifty years of marriage and he just left,” said Sherri Goldgrub, who married Charles Goldgrub in 1980 and knew the Blums well. “He would sometimes come back and bring her his laundry, but she sat home waiting, thinking he’d be back for dinner.”
After the hospital rabbi found his body in the morgue, he notified Mr. Fishler, the lawyer, who then notified Mr. Blum’s old friends from Queens. To the surprise of many, Mr. Blum had bought a cemetery plot next to his former wife’s. He was buried there.

“It is a heartbreaking story, a tragedy,” said Mr. Pomeranc, who was one of the few people who attended Mr. Blum’s funeral. “I spoke with him three days before he died. We were going to get the whole group together and take a ride out to see him that weekend. But it didn’t happen, and then the next week he passed away.”

Too late, too late.

Posted by Jill Fallon at 12:04 PM | Permalink

April 5, 2013

No more transfer of Delta frequent flyer miles at death

Delta angers frequent fliers by banning them from transferring miles to family members and friends after death

Delta has upset many of its most loyal fliers after the airline quietly terminated a policy that allowed to them to transfer miles to friends and family after death.
The new rule was issued in a recently updated version of the SkyMiles policies book.

Fliers protesting the change have launched an online petition targeting Jeff Robertson, the vice president of the SkyMiles program, Delta CEO Richard Anderson and Delta President Edward Bastian.  Several people used the petition, which was posted Friday, as a forum to express their grievances over the policy change.

Kevin Jenkins from Tempe, Arizona said he would be cancelling his Delta credit card with American Express as a result of the change.  Tim Winship, editor and publisher of, told NBC that flyers are so angry because they equate their miles to money.  'Earning frequent flier miles in the minds of most people is akin to earning money and the idea that your miles - or your money, for that matter - would simply disappear when you die strikes a profoundly disturbing note in the minds of many,' Winship said.

SkyMiles members argue that they specifically fly Delta is so they can pass on their miles, like an inheritance, to family members after their death.
'I have been loyal to Delta for 45 years and this is a slap in the face that I cannot leave my miles to my wife if I die,' said Roy Heffern from St. Ignatius, Montana. 'Maybe my loyalty is misplaced in Delta.'
Posted by Jill Fallon at 9:17 AM | Permalink

March 18, 2013

When dealing with hospice and the end of life cuts close

Two people, knowledgeable and experienced in end-of-life issues for other people, deal with those terrible questions personally.

For a Hospice Pioneer, Still a Tough Call

Mr. Brenner’s voice had already weakened when I spoke with him briefly a couple of weeks ago. He was only 73, but 18 months of declining health and months spent in hospitals and nursing homes had sapped his strength. Still, when I asked how many people he thought he had helped to die, I could hear a quiet pride in his response. “Oh, thousands,” he said.

For more than 25 years, starting in the late 1970s when the word “hospice” still drew blank looks (and years before hospice became a Medicare benefit), Mr. Brenner led nonprofit hospice organizations. Yet when his health faltered, choosing to become a hospice patient himself proved unexpectedly difficult. That’s what I wanted to talk about.

A Mother's Death Tested Reporter's Thinking About End-Of-Life Care

My father and sister looked to me for my thoughts. In our family, after all, I'm the go-to guy for all things medical. I've been a health care reporter for 15 years: at the The Dallas Morning News, Los Angeles Times and now ProPublica. And since I have a relatively good grasp on America's complex health care system, I was the one to help my parents sign up for their Medicare drug plans, research new diagnoses and question doctors about their recommended treatments.

In this situation, like so many before, I was expected to have some answers. Yet none of my years of reporting had prepared me for this moment, this decision. In fact, I began to question some of my assumptions about the health care system.....

We knew her end-of-life wishes: She had told my dad that she didn't want to be artificially kept alive if she had no real chance of a meaningful recovery. But what was a real chance? What was a meaningful recovery? How did we know if the doctors and nurses were right? In all my reporting, I'd never realized how little the costs to the broader health care system matter to the family of a patient. When that patient was my mother, what mattered was that we had to live with whatever decision we made. And we wouldn't get a chance to make it twice.
I asked Fisher: Did he consider what my family did a waste of money?  No, he said. And he wouldn't have found fault with us if we decided to keep my mom on a ventilator for another week or two, although he said my description of her neurological exams and test results sounded pessimistic.

"You never need to rush the decision-making," he told me. "It should always be about making the right decision for the patient and the family. … We have plenty of money in the U.S. health care system to make sure that we're supporting families in coming to a decision that they can all feel good about. I feel very strongly about that."
Posted by Jill Fallon at 1:18 PM | Permalink

January 25, 2013

"When it comes to end of life decisions, the state does not love you"

When it comes to end of life decisions, the state does not love you

Put another way, this man and the NPR host who interviewed him were both certain that Americans, when given the choice, would cheerfully throw Grandma from the train in order to save some money.  Europeans, the Dutchman explained, with their cradle to grave care, would never be pressured into killing themselves.  The beneficent state would pay all the medical bills, so money would not be an issue when it came to life and death decisions.  The only thing that would matter in Europe, said this Dutchman, was the terminally ill person’s wishes.
History has revealed that this Dutchman was absolutely and completely wrong. In America, people have willingly bankrupted themselves to save beloved family members.  Mammon becomes meaningless when an extra treatment might give your child or a young mother a few more days, weeks, or years of life.  People have hearts and souls.  They connect to others, especially to those in their families.

It’s very different in socialist states, where euthanasia is the name of the game, often without the patient’s, or her family’s, agreement.  In England, thousands of terminally ill people were hastened to their deaths by the Liverpool Care Pathway.  It was meant to be a national hospice program that provided palliative care to the terminally ill in their final days.  What ended up happening, of course, when the National Health Service started running out of money is that thousands (even tens of thousands) of elderly patients who were terminally ill, but weren’t anywhere near death’s door, were hastened to their deaths.  They had become too expensive or just too difficult to manage.
It turns out that, twenty-odd years ago, when I heard that Dutchman speak, he had failed to consider two pertinent facts:  First, socialist states invariably run out of money once they finally destroy their productive class; and second, the state has neither heart nor soul.  To you, Patient X is your beloved mother, or brother, or child.  To the state, Patient X is an unnecessary cost to an already strained system.

Bookworm has it exactly right.  Take a look at these recent stories.

Belgium looks at euthanasia for minors, Alzheimer's sufferers

60,000 patients put on death pathway without being told but minister still says controversial end-of-life plan is 'fantastic'

Pathway involves the sick being sedated and usually denied nutrition and fluids
Families kept in the dark when doctors withdraw lifesaving treatment
Health Secretary Jeremy Hunt said pathway was a 'fantastic step forward'
Anti-euthanasia group said: ‘The Pathway is designed to finish people off double quick'

Britain opens inquiry into allegations involving that  end-of-life protocol is operating as a euthanasia pathway

Now sick babies go on death pathway: Doctor's haunting testimony reveals how children are put on end-of-life plan

NHS millions for controversial care pathway  The majority of NHS hospitals in England are being given financial rewards for placing terminally-ill patients on a controversial “pathway” to death.

Victory for care pathway families: Minister pledges new law so patients can't be put on end-of-life regime without consulting relatives

Liverpool Care Pathway Used as Euthanasia

The Liverpool Care Pathway, which was supposed to be restricted to sedating patients whose pain could not otherwise be controlled, has mutated into a form of euthanasia. Not only are UK hospitals paid to to put patients “on the Pathway,” but it has become increasingly clear that it is being misused as a form of euthanasia.
This means that at least some patients who can still eat and drink, are put into comas and deprived of sustenance. That is appropriate when a patient can no longer assimilate food or water at the very end of life.  But making it so they can’t eat or drink water by mouth and then depriving them of the sustenance needed to keep them alive, is killing.  And it hasn’t been restricted to the imminently dying. I don’t know what else to call it but backdoor euthanasia.

Jeremy Hunt orders an inquiry into the Liverpool Care Pathway, and says patients and relatives must be consulted. But will the doctors pay any attention?

Let elderly people 'hurry up and die', says Japanese minister

Posted by Jill Fallon at 12:25 PM | Permalink

January 15, 2013

A Shocking Death, a Financial Lesson and Help for Others

A woman after my own heart.  After her husband died in a bike accident and while still in shock, Chanel Reynolds was consumed by thoughts of all the financial tasks grown-ups were supposed to have done by middle age.  She and her husband had not finished them.

A Shocking Death, a Financial Lesson and Help for Others

In the many months of suffering after Mr. Hernando’s death in July 2009, she beat herself up while spending dozens of hours excavating their financial life and slowly reassembling it. But then, she resolved to keep anyone she knew from ever again being in the same situation.

The result is a Web site named for the scolding, profane exhortation that her inner voice shouted during those dark days in the intensive care unit. She might have called it, but she changed just one word.
First, the world of personal finance suffers from an odd sort of organizational failure. We tend to organize our thinking around products: retirement accounts, mortgages, long-term care insurance.

But in the real world, it’s a big life event that often governs our hunt for solutions. Sometimes, it’s a happy one, like getting married. But there are few ready-made tool kits like the one Ms. Reynolds has assembled for people considering the possibility of serious illness or death.
After his death, this much was clear: The family with the six-figure income and the four-bedroom house that they had bought in the Mount Baker neighborhood one year before had a will with no signature, little emergency savings and an unknown number of accounts with passwords that had been in Mr. Hernando’s head.
According to a survey that the legal services site Rocket Lawyer conducted in 2011, 57 percent of adults in the United States do not have a will. Of those 45 to 64 years of age, a shocking 44 percent still have not gotten it down.

People who get a fatal diagnosis from a doctor at least have a bit of time to sort things out. But Ms. Reynolds and her husband had made only a few plans.
There are a few things about Ms. Reynolds’s site that seem unique to me, though. The first is her raw insistence on considering what it means if you’re having trouble finding the right people to serve as your estate’s executor or to inherit prized possessions.

“If you are at a loss for whom to name, get out there and tighten up your friends and family relationships,” she writes on the site. “Find some better friends. Be a better friend. This is everything. This means everything.”

On her website is a maxim everyone should realize is true:  Life and Death Planning:  Low effort, high reward.
Posted by Jill Fallon at 8:34 PM | Permalink

September 27, 2012

'This kid is dead, you got that?'

Donor network 'pressured medics to declare patients dead so organs can be harvested'

New York hospitals are routinely 'harvesting' organs from patients before they're even dead, an explosive lawsuit is claiming.  The suit accuses transplant non-profit The New York Organ Donor Network of bullying doctors into declaring patients brain dead when they are still alive.

Plaintiff, Patrick McMahon, 50, reckons one in five patients is showing signs of brain activity when surgeons declare them dead and start hacking out their body parts. 'They're playing God,' McMahon, a former transplant coordinator who claims he was fired just four months into the role for speaking out about the practice, told The New York Post.

The lawsuit, filed in Manhattan Supreme Court yesterday, cites a 19-year-old car crash victim who was was still struggling to breathe and showing signs of brain activity when doctors gave the green light for his organs to be harvested.  Network officials including director Michael Goldstein allegedly bullied Nassau University Medical Center staff into declaring the teen dead, stating during a conference call: 'This kid is dead, you got that?'

McMahon, an Air Force Combat veteran, said he believed the 19-year-old could have recovered.  'I have been in Desert Storm, Iraq and Afghanistan in combat,' he said. 'I worked on massive brain injuries, trauma, gunshot wounds, IEDs. I have seen worse cases than this and the victims recover.

He said that the donor network makes 'millions and millions' from selling the organs they obtain to hospitals and to insurance companies for transplants.

'Hearts, lungs, kidneys, joints, bones, skin graphs, intestines, valves, eyes -- it's all big money,' he said.

The Air Force Combat veteran and former nurse added that financially strained hospitals are easily influenced to declare a patient brain dead because they're keen to free up bed space.

The lawsuit cites three other examples of patients who were still clinging to life when doctors gave a 'note' - an official declaration by a hospital that a patient is brain dead, which, as well as consent from next of kin, is required before a transplant can take place.
McMahon has accused the donor network of having a 'quota' system and hiring 'coaches' to teach staff how to be more persuasive in convincing family members to give consent to organ donation.

He said 'counseling' staff are like sales teams who are pressured to meet targets and threatened with the loss of their jobs if they fall short.

'If you don't meet the quotas then you'll get fired - that's a fact. I saw it happen,' he said.

'You're not there for grief counseling, you're there to get organs. It's all about sales -- and that's pretty much a direct quote from the organization. Counsellors are required to get a 30 per cent consent rate from families.'  McMahon added that staff members who collect the most organs throughout the year qualify for a Christmas bonus.

This is a total scandal.  I urge you to read Bleeding Heart Cadavers

The exam for brain death is simple. A doctor splashes ice water in your ears (to look for shivering in the eyes), pokes your eyes with a cotton swab and checks for any gag reflex, among other rudimentary tests. It takes less time than a standard eye exam. Finally, in what's called the apnea test, the ventilator is disconnected to see if you can breathe unassisted. If not, you are brain dead. (Some or all of the above tests are repeated hours later for confirmation.)

Here's the weird part. If you fail the apnea test, your respirator is reconnected. You will begin to breathe again, your heart pumping blood, keeping the organs fresh. Doctors like to say that, at this point, the "person" has departed the body. You will now be called a BHC, or beating-heart cadaver.
You might also be emitting brainwaves. Most people are surprised to learn that many people who are declared brain dead are never actually tested for higher-brain activity. The 1968 Harvard committee recommended that doctors use electroencephalography (EEG) to make sure the patient has flat brain waves. Today's tests concentrate on the stalk-like brain stem, in charge of basics such as breathing, sleeping and waking. The EEG would alert doctors if the cortex, the thinking part of your brain, is still active.

But various researchers decided that this test was unnecessary, so it was eliminated from the mandatory criteria in 1971.
And how about some anesthetic?
Although he doesn't believe the brain dead feel pain, Dr. Truog has used two light anesthetics, high-dose fentanyl and sufentanil, which won't harm organs, to quell high blood pressure or heart rate during harvesting operations. "If it were my family," he said, "I'd request them."
Posted by Jill Fallon at 3:38 PM | Permalink

September 18, 2012

He died with $200 in the bank and $7 million in gold coins in his garage

Recluse dies with just $200 in the bank… and $7million worth of GOLD COINS piled in his garage (and his cousin who hadn't spoken to him for a year will get the lot)

When 69-year-old Walter Samasko Jr died in May he left behind just $200 in the bank and no friends or family to lay claim to the meager inheritance.

He hadn't worked since 1968 and was living off stock accounts of $140,000 and $25,000.

But the real treasure was found at his Nevada home, along with his decaying body, one month later after neighbors complained of a foul smell.

There officials discovered box upon box of gold coins and bars stowed away in Samasko's garage, valued at a staggering $7million or more.

The 69-year-old had died from heart problems, a coroner found, at least one month before he was discovered.

Leaving no will, and with no known relatives, officials set about tracking down a list of people who had attended Samasko's mother's funeral after she died in 1992, the Las Vegas Sun reported.

They managed to identify a first cousin, Arlene Magdanz, a substitute teacher living in San Rafael, California.

Though Ms Magdanz declined to comment, her attorney said that the first words of of his client's mouth were: 'Oh my God, oh my God.'
Posted by Jill Fallon at 10:33 PM | Permalink

August 30, 2012

Neil Armstrong couldn't afford life insurance

So He Used A Creative Way To Provide For His Family If He Died

When Neil Armstrong and the rest of the crew of Apollo 11 piled atop that huge rocket packed full of fuel in 1969 they were under no illusions that it may have been the last thing they ever did. Unfortunately, neither was anyone who might have insured their lives, and helped provide security for the astronauts families in case they didn't come home.

Back then astronaut captains made about $17,000 a year, NPR reports and a life insurance policy for Neil Armstrong would have run about $50,000 a year, or more than $300,000 in 2012 dollars.
Because some guys from the prior Apollo missions had gotten colds, and mild bouts of queasiness on  their trips, NASA had implemented a quarantine procedure before liftoffs.

So about a month before they were set to go: Neil Armstrong, Michael Collins and Buzz Aldrin were locked into a Plexiglas room together and got busy providing for their families the only way the could — they signed hundreds of autographs.

In what would become a common practice, the guys signed their names on envelopes emblazoned with various space related images. The 'covers' would, of course, become intensely valuable should the trio perish on the mission. There now often referred to as " Apollo Insurance Covers."

And to ensure the covers would hold maximum value, the crew put stamps on them, and sent them in a package to a friend, who dumped them all in the mail so they would be postmarked July 16, 1969 — the day of the mission's success — or it's failure.

Fortunately, the trip went off without a hitch and all three men went on to live long, healthy lives and all remained alive until Neil Armstrong's death a few days ago.

The covers are still around, and not too hard to find. In 2011, Collectors Weekly pegged their average value at around $5,000.

-Neil Armstrong Postal Cover

Posted by Jill Fallon at 2:48 PM | Permalink

August 17, 2012

Do you want travel to be part of your legacy ?

A new car, or priceless memories?  How more parents are leaving behind travel trust funds instead of an inheritance

Instead of leaving behind a big inheritance, people are now choosing to create travel trusts, with their last wishes stipulated in geographical terms.  Whether it's parents wanting their offspring to connect with their heritage, culture or religion, people are increasingly deciding that travel should be a part of their legacy.

'You could give them money and they could go and buy a new car with it, or you could give them this and they can use it to create memories,' said Jim Bendt, president of Travel Beyond of Minneapolis.
Instead of leaving behind a big inheritance, people are now choosing to create travel trusts, with their last wishes stipulated in geographical terms.

Whether it's parents wanting their offspring to connect with their heritage, culture or religion, people are increasingly deciding that travel should be a part of their legacy.
At a family dinner in 2000, her father-in-law, an academic in his sixties, announced that once a year, he and his wife would pay up to $800 per passenger if one family visited the other.

Four years later, he died unexpectedly, and so far, the money has been used by his children for five family celebrations, three in Israel and two in the United States.
For Mrs Liebman, the money from her late father-in-law has had a very positive effect.

In the past dozen years, the family has expanded through weddings and babies, and the interaction and shared experiences at the family get-togethers means, 'there has been a new level of connection made.'

'It was really money well spent,' she said.
Posted by Jill Fallon at 11:56 AM | Permalink

August 9, 2012

"Yes, he got his lawyer to write in "killer party" into his will"

Military Members Explain Their Wills

Over at Reddit, a servicemember posted about how he and a buddy each bequeathed one another $2,000 in their wills.
Sounds standard. Except, this two grand is bequeathed so that his friend  — pardon the legalese — "can throw a killer party to celebrate my life."  Yes, he got his lawyer to write in "killer party" into his will.
One redditor said that his wife gets his full Servicemembers' Group Life Insurance, but with a stipulation. She has sixty days to leave the country, and is not allowed to return for nine months, and she's not allowed to stay in any one country for more than 30 days — in essence, forcing his widow to see the world after losing him.

Each member of the U.S. Armed Forces must write out a will prior to deployment. Each service member may also purchase into the Servicemember's Group Life Insurance, where a maximum $400,000 policy costs around $27 per month.  In the will, the service members indicate where they want all their worldly possessions to end up, as well as who benefits from the insurance payout.
Posted by Jill Fallon at 9:15 AM | Permalink

"86% of boomers named “family stories” as the most important part of their legacy—ahead of possessions and inheritance"

How to Give Heirs What They Most Want (It Won’t Cost Much)

An enduring legacy of the financial crisis has been a clear shift in personal values—away from materialism and toward relationships and experiences. Born out of need, this national (if not global) rethinking of what is most important has had remarkable staying power even as the economy has started to improve.

The latest bit of evidence comes from an Allianz Life survey, where 86% of boomers named “family stories” as the most important part of their legacy—ahead of possessions and inheritance. It appears that we care more about passing down our values and traditions than the contents of our Roth IRAs. Indeed, some 75% of boomers say it is not their duty to leave a financial legacy

That may be because boomers do not expect to have much of a nest egg to pass down–or that they believe they have lived such fabulous lives it would be a shame to go unremembered. But boomers also say they are not counting on an inheritance from their parents. Fewer than 5% say leaving money behind is their parents’ duty. This thinking has prompted Allianz to elevate “family stories” in the planning process, naming it as one of four pillars in a well-rounded legacy. The pillars:
  • Values and life lessons, including family stories
  • Instructions and wishes, including health directives and funeral arrangements
  • Personal possessions of emotional value, including pictures, scrapbooks and furniture
  • Financial assets, including real estate

This is precisely what what my upcoming book is designed to help you do.

It's called  Your Legacy Matters, 10 Steps to Taking Care of the Business of Your Life and Legacy in the Digital Age and Finding Yourself on a Mission of Love

Posted by Jill Fallon at 9:12 AM | Permalink

July 24, 2012

"Less than one in seven CPR recipients live to leave the hospital"

What is the goal of palliative care?

Most of us do not want to die in the ICU tethered to tubes — not the quality of life we expect. Yet only 30 percent of us have made arrangements to prevent this from happening. Death and dying is a tough subject for us to broach. Be aware that very few of us will die in our sleep — most have a slow sometimes excruciating decline to death.

As we get older it  becomes important to have a family discussion about what to do if you’re incapacitated in the hospital with not much hope of recovery. Advanced directives such as Do Not Resuscitate (DNR), a Living Will, or Durable Power of Attorney are important decisions to make. Providers are trained to go to heroic efforts to keep patients alive even when all hope is gone.  This often results in severe pain and suffering. There have been many horror stories of the pain and suffering from brittle ribs broken during CPR.

I bet you didn’t know that less than one in seven CPR recipients live to leave the hospital (don’t feel bad, many doctors don’t know this). Other studies show that few elderly patients or patients with cancer live to leave the hospital after CPR. Despite the fact that CPR was developed to resuscitate patients in cardiac arrest, CPR is mandatory to rescue the terminally and critically ill, unless there is an advanced DNR directive. One in five people die in intensive care with the last few months of life being expensive, painful, and futile exercises in medical care.

Thanks to palliative care medicine, doctors as well as medical students are being taught the importance of saying the ”D”-word.  Palliative (or comfort) care differs from hospice care in that it can happen along with aggressive life-sustaining treatments. Palliative care teams of doctors,  nurses, and social workers provide patients and families with the information they need to make painful choices, including decisions to avoid overly invasive care.  What patients and their families want is for doctors to be clearer and more realistic about what’s going on.

The aim of palliative care is for patients to live as well as long as possible while preparing them and their families for death.
Posted by Jill Fallon at 11:39 AM | Permalink

July 11, 2012

“You want to do major heart surgery on an 84-year-old woman showing progressive signs of dementia? What are you, nuts?”

A much discussed article A Life Worth Ending by Michael Wolff writes about his mother who suffering from dementia, "immobile and incoherent.  And filled with rage."

He loves his mother, but her increasing diminishment and the difficulties of finding her a place to live apart from the hospital,  has him pleading for euthanasia.

But within the article are important lessons of things not done.  He ignored his mother's wishes and was carried away by the doctor's plan.

My siblings and I must take the blame here. It did not once occur to us to say: “You want to do major heart surgery on an 84-year-old woman showing progressive signs of dementia? What are you, nuts?”

And my mother protested. Her wishes have always been properly expressed, volubly and in writing: She urgently did not want to end up where she ultimately has ended up. She had enough sense left to resist—sitting in the hospital writing panicky, beseeching, ­Herzog-like notes, to anyone who might listen—but of course who listens to a woman who scribbles such notes?

The truth is you’re so relieved that someone else has a plan, and that the professionals with the plan seem matter-of-fact and unconcerned, that you disregard even obvious fallacies of logic: that the choice is between life as it was before the operation and death, instead of between life after the operation and death.
Posted by Jill Fallon at 8:19 PM | Permalink

Nora Ephron's Funeral and Her Recipe for Coconut Macaroons

When you plan your own funeral in an Exit folder like Nora Ephron did, you can have the program include your favorite recipes.

Remembering Nora Ephron, Just as She Planned.

Of course there were recipes — different recipes in the programs the ushers handed out. One was for coconut macaroons. “Makes about 22,” it said.

Ms. Ephron had planned the memorial herself, filing the plans in a folder marked “exit.” The program turned out to be poignant at times and uproarious at times, and there were frequent food references — to her roast beef with Yorkshire pudding, for example, and to the collection of at least 10 kinds of jam that she kept in the refrigerator. And, according to her son Max, her resistance to having Thanksgiving dinner early in the day. “We always had it at 7, like civilized people,” he said.
The actor Martin Short called Nora Ephron “sudden, original and hilarious.”  And, he said, she was charmingly, disarmingly direct. He recalled her response when asked to do something she did not want to do — in this case, read a letter last year from the mayor at a Roundabout Theater Company tribute. “How could I ever say no to you,” Ms. Ephron told the person who had asked her to go onstage and read the letter, “and yet I am.”

Mr. Short also mentioned funny lines that Ms. Ephron dropped into conversation, like, “Hazelnuts are what’s wrong with Europe.”
A few minutes later, Delia Ephron said that line had originated with her.

She also said Nora Ephron had opinions. “Was there anyone in the world with more opinions?” Delia Ephron said. “The planet is practically opinion less now.”

Posted by Jill Fallon at 10:22 AM | Permalink

June 14, 2012

'Pillaging, plundering and looting' a $162 million estate in probate

Like the case of Jarndyce vs. Jarndyce in Charles Dickens' Bleak House, litigation over a will consumed years and exhausted its entire worth.

Entrepreneur's $162m estate 'entirely eaten up by lawyers' after 26-year court battle over his will

Mr D'Addario, from Trumbull, Connecticut left his estate to his wife, three daughters and two sons.

After more than a quarter of a century of legal tangles in the state's probate courts, it has been claimed that most of the wealth has disappeared, according to the Hartford Courant.

The businessman was head of D'Addario Industries in Connecticut and had been on his way to inspect an Illinois waste treatment plant when his twin-engine plane came down killing him and four others in icy weather conditions.

The Hartford Courant reports on this case that spent 25 years in probate.

D'Addario's oldest son David and the Cadle Corp, which has sought payment of about $3.1 million from the estate over the decades. The Cadle lawsuit seeks to settle some of that, charging that D'Addario's millions evaporated in years of "plundering, pillaging and looting.''
As recently as last fall, Probate Judge Joseph Egan, who took over the case in 2010 after a previous judged recused himself, declared that "this case should have been settled a long time ago,'' according to the Cadle Company lawsuit. Egan said it was "mind boggling" that the estate had remained open and unsettled for 26 years. Egan, through an aide, declined to comment for this column.

The Cadle suit alleges that "there has been no meaningful judicial review" of the case "for over 20 years."
The lack of oversight and attention by the probate court has allowed a $162 million estate to virtually disappear, according to lawyers for Cadle, which purchased some of the debt owed to a New Haven bank and has long sought payment from the D'Addario estate.

For years, the D'Addario file in probate was sealed, which prevented Cadle's lawyers from examining the estate. When it was opened last fall, lawyers for Cadle say they found it insolvent.

"What kind of country do we live in when you can't even look at a court file," said Ed Taiman, a Hartford lawyer for Cadle. "This has changed my whole opinion of the probate system. It makes me very wary of what goes on in probate courts."

No doubt many lawyers sent their kids to college and graduate school on the fees they earned.

Posted by Jill Fallon at 11:12 AM | Permalink

May 21, 2012

Losing sight of the fact that living a good life includes a good death

Let's not be afraid to talk about death writes the Archbishop of York.

In a society where people are living longer and medical science is enabling us to add more years to our span of life, we should not have to live in fear – we should celebrate and live life to the full. But in evading one of the most important discussions of our lives, we lose sight of the fact that a good death is also part of a good life.

Until this Monday morning you were probably not thinking about the meaning of life and the inevitability of death. Why would you? Even when there is time to sit back and consider the important things in life, we very rarely talk about death, even though sooner or later it catches up with all of us, regardless of our ethnic background or status. Death is the most democratic of all happenings.
I speak to you now not as an archbishop, but as a grieving son who nursed and watched his mother die a long and painful death from throat cancer. The surgeon did a marvelous operation. She was with us for two more years.  But then, after a week in Trinity Hospice, with me at her bedside, my mother gently passed from this life, through death, to be with Christ. This time, though difficult, was actually very important to us. Our two children, aged 15 and 10, said: “Grandma is so peaceful. We haven’t lost her: she has simply departed from us. We will see her.” The look on their faces was awe-inspiring.

Hospice care is about providing a good listening friend for the journey. It is help for our fears and feelings of uncertainty. It’s also about addressing our wholeness; we need spiritual, social and medical care. For the army of volunteers, the doctors, the nurses and for all those who share the benefit of their expertise to help alleviate pain and suffering of patients and their families, I give thanks today.

We all have to die, but we can go some way towards dying with dignity if we first articulate our choices, such as the place where we want to die, the kind of spiritual support we may want, how we wish to be cared for and what our funeral plans may be. The Book of Common Prayer includes the exhortation to make a will – we should take this seriously. This may include whether to be an organ donor. Even choosing hymns for the funeral, songs or readings can help family members already trying to come to terms with their loss.
Posted by Jill Fallon at 11:28 AM | Permalink

Bankrupt scoundrel lawyer

Lawyer plundered his ailing aunts' £400,000 estate by changing their wills and 'decimating' their bank accounts

A solicitor plundered the estate of his elderly aunts and changed their wills when they were in hospital, a court heard yesterday. Michael Harris took advantage of the poor health of Hannah Harris and Rosette Harris Emmanuel to claim a third of their £400,000 estate.  He is also accused of using the power of attorney the two women granted him to empty their bank accounts.  Both disliked him and wanted all their money to go to his niece and nephew.

Yesterday a judge at the High Court in London overturned both new wills, saying there was considerable doubt that either woman had the capacity to agree to the changes.  But the court heard that the siblings, Sara Cushway and Sebastian Elliot, are unlikely to receive any money because their uncle decimated the estate and is now bankrupt.  Instead, they will have to apply to a fund which compensates victims of dishonest solicitors.

The elderly sisters – both former nurses living together in Southsea, Hampshire – were in hospital in failing health in January 2006 when Harris drafted the new wills.  Rosette died of cancer just two weeks later at the age of 84, while her sister, who was showing signs of Alzheimer’s, died a year later at 91.

Their great-niece and great-nephew challenged the wills as well as Harris’s alleged frittering away of their two-thirds share….After giving judgment, the judge directed that the case papers be referred to the Director of Public Prosecutions.

Harris, who practised in Southsea, is bankrupt and was last year suspended for two years by the Solicitors Disciplinary Tribunal for breaching a series of rules relating to accounts, costs and professional conduct. Last night Mrs Cushway said she had no idea of her uncle’s involvement until after her aunts’ deaths.
Posted by Jill Fallon at 10:33 AM | Permalink

April 27, 2012

‘I feel so lucky that my parents wouldn’t take no for an answer.’

Dad rescues ‘brain dead’ son from doctors wishing to harvest his organs – boy recovers completely

LEICESTER, England, April 25, 2012 ( - According to the Daily Mail newspaper, a young British man owes his life to an insistent father who would not allow his son’s organs to be removed from his body, despite assurances from four doctors that his son could not recover from the wounds he had suffered in a recent car accident.

Here's the Daily Mail story:  The boy who came back from the dead: Experts said car crash teen was beyond hope. His parents disagreed

They were told there was no chance of their son surviving after he suffered devastating injuries in a car crash.
But Steven Thorpe’s parents refused to give up hope – despite four specialists declaring that the 17-year-old was brain dead.
Convinced they saw a ‘flicker’ of life as Steven lay in a coma, John and Janet Thorpe rejected advice to switch off his life support machine.
They begged for another opinion – and it was a decision that saved him.

A neurosurgeon found faint signs of brain activity and two weeks later, Steven woke from his coma. Within seven weeks, he had left hospital.
And four years on, the trainee accounts clerk says he owes everything to the persistence of his parents.
From his home in Kenilworth, Warwickshire, Steven, 21, said: ‘I feel so lucky that my parents wouldn’t take no for an answer.’

Ghoulish as it is, people in hospitals are looking for fresh organs to transplant.    If a loved one of yours is ever in this position, insist upon a brain wave test before agreeing with the person is brain dead.  Even then, insist on pain-killers to be administered during the harvesting.

You should put this in your end-of-life  instructions as well.

If you haven't read What You Lose When You Sign That Organ Donor Card, you should

Posted by Jill Fallon at 6:34 PM | Permalink

April 16, 2012

Four perfect questions for doctors when discussing the end of life

4 perfect questions when facing an end of life situation

She told Dr. Gawande that there are four questions she mentally carries around that guide her through the difficult but important conversations. And those conversations are not about sophisticated hard choices or last minute “epiphanies.” Instead, they are about the process of understanding hopes and fears.

Here are her four questions:

Do you understand your prognosis? What are your fears about what is to come? What are your goals as time runs out? What trade offs are you willing to make?
Posted by Jill Fallon at 2:20 PM | Permalink

March 23, 2012

Dying by Degrees

In  Dying by Degrees, Paula Span in The New Old Age reviews Dr. Ira Byock's new book, The Best Care Possible: A Physician's Quest to Transform Care Through the End of Life.

Ira Byock has been writing books about the way Americans die since 1998, when he published “Dying Well.” For most of that time, he has been appalled.

He still is. Dr. Byock, director of palliative medicine at the Dartmouth-Hitchcock Medical Center in Lebanon, N.H., pulls no punches in his new book, “The Best Care Possible: A Physician’s Quest to Transform Care Through the End of Life.”  The American way of dying, he points out, involves too much suffering for both patients and families, and routinized medical response with not enough individualized care. It means not enough listening, not enough support for families, way too much expense. “A national disgrace,” the author calls it in his introduction.
What makes Dr. Byock’s book particularly valuable is the chance to eavesdrop on the doctors we’re often quick to blame. He tells what it’s like on the other end of the stethoscope.

Physicians who comment here sometimes argue that they’re more than willing to stop futile treatments, to refer patients with advanced disease to hospice care so that they can die gently at home. It’s often families, they report, who angrily demand that patients remain in intensive care units, that doctors try one more procedure and then another, as though yielding to death were a moral failing.
Posted by Jill Fallon at 8:51 PM | Permalink

March 21, 2012

Beating Heart Cadavers

What You Lose When You Sign That Donor Card

The exam for brain death is simple. A doctor splashes ice water in your ears (to look for shivering in the eyes), pokes your eyes with a cotton swab and checks for any gag reflex, among other rudimentary tests. It takes less time than a standard eye exam. Finally, in what's called the apnea test, the ventilator is disconnected to see if you can breathe unassisted. If not, you are brain dead. (Some or all of the above tests are repeated hours later for confirmation.)

Here's the weird part. If you fail the apnea test, your respirator is reconnected. You will begin to breathe again, your heart pumping blood, keeping the organs fresh. Doctors like to say that, at this point, the "person" has departed the body. You will now be called a BHC, or beating-heart cadaver.

Still, you will have more in common biologically with a living person than with a person whose heart has stopped. Your vital organs will function, you'll maintain your body temperature, and your wounds will continue to heal. You can still get bedsores, have heart attacks and get fever from infections.

"I like my dead people cold, stiff, gray and not breathing," says Dr. Michael A. DeVita of the University of Pittsburgh Medical Center. "The brain dead are warm, pink and breathing."
But BHCs—who don't receive anesthetics during an organ harvest operation—react to the scalpel like inadequately anesthetized live patients, exhibiting high blood pressure and sometimes soaring heart rates. Doctors say these are simply reflexes.
You might also be emitting brainwaves. Most people are surprised to learn that many people who are declared brain dead are never actually tested for higher-brain activity. The 1968 Harvard committee recommended that doctors use electroencephalography (EEG) to make sure the patient has flat brain waves. Today's tests concentrate on the stalk-like brain stem, in charge of basics such as breathing, sleeping and waking. The EEG would alert doctors if the cortex, the thinking part of your brain, is still active.

But various researchers decided that this test was unnecessary, so it was eliminated from the mandatory criteria in 1971.
It is possible that not being a donor on your license can give you more bargaining power. If you leave instructions with your next of kin, they can perhaps negotiate a better deal. Instead of just the usual icewater-in-the-ears, why not ask for a blood-flow study to make sure your cortex is truly out of commission?

And how about some anesthetic? Although he doesn't believe the brain dead feel pain, Dr. Truog has used two light anesthetics, high-dose fentanyl and sufentanil, which won't harm organs, to quell high blood pressure or heart rate during harvesting operations. "If it were my family," he said, "I'd request them."

That's why the choice of you want to be your health care proxy is critical.  When you tell them want  what  you think about brain death and organ donation and why, it will be easier for them to do what you would want them to do.

Posted by Jill Fallon at 7:46 PM | Permalink

March 5, 2012

Facebook banned me from my dead daughter's page

Facebook banned me from my dead daughter's page... to protect her privacy: Mother's anguish after teenager dies of brain tumour

A grieving mother has branded Facebook ‘heartless’ after it stopped her logging into her dead daughter’s page.

When Louise Palmer’s 19-year-old daughter died from a brain tumour, she was devastated. But at her lowest points, she found comfort by logging into Becky's Facebook page and reading her old messages.

However, four weeks ago Mrs Palmer discovered the log in details had been changed. And when she challenged Facebook
they told her she could no longer login – due to fears it could invade Becky’s privacy.
However at the end of January Mrs Palmer went to log into the page as usual to find the log in details had been changed with a strange message that the page had been ‘memorialized’.

At the same time the page was made only visible to confirmed Facebook friends.

She says: 'I felt there must be some mistake as a request for something such as this could only come from the next of kin and I hadn’t asked for it.'

However, when she contacted Facebook they replied in an email: ‘unfortunately for privacy reasons, we cannot make changes to the profile or provide login information for the account.'
'People who did not have a Facebook account or who weren’t friends on Facebook can now no longer even see the page even though they might want to leave a message of condolence on the Wall.'
Posted by Jill Fallon at 10:10 AM | Permalink

February 14, 2012

"You saved his death"

Jordan Grument, an internal medicine physician writes about the challenge of creating a palliative care program

A transformation occurred during our fourth meeting. We had ten people in the program. As Nancy presented each patient, I could sense a difference in the tone of her voice. She was now approaching the project with a new sense of zest and zeal.

At the end of the meeting, I asked her what was going on.

Well, you know Mr. Smith? He passed yesterday.

Mr. Smith had end stage dementia. He was in the process of dying for months, but his physician had not bothered to talk to the family about end of life care.

His daughters and I completed the POLST form a few weeks ago. So when he started to die, we were all on the same page. He passed quietly in bed without ambulances, IVs, or CPR.

I could see the change in her posture. She got it. She now saw how powerful these conversations could be. I smiled and congratulated her on how well she was doing such an important job. She looked down embarrassed.

It’s not like I saved his life.

Our eyes met.

No, you did something most doctors have forgotten how to do.

You saved his death.
Posted by Jill Fallon at 11:08 PM | Permalink

December 3, 2011

Mystery of reclusive heiress's TWO wills:

Lawyers are salivating over the Mystery of reclusive heiress's TWO wills: How copper magnate's daughter signed one document leaving her family $400m... and another bequeathing her fortune to her NURSE

The family of Huguette Clark have launched a legal battle for her vast fortune after it was revealed the reclusive heiress had signed two wills.

The first document left her estimated $400 million to relatives - while the second cuts them out completely.

The two wills were signed within six weeks of each other while Miss Clark was in a New York hospital in 2005.
Posted by Jill Fallon at 1:30 PM | Permalink

October 8, 2011

"I wanted my kids to know me"

No public service is planned for Steve Jobs.  A small private one was held Friday.

According to this article Steve Jobs's secret legacy: plans for four years of new products.

Also coming is an authorized biography by Walter Isaacson, due out Oct 24    Why did this famously private man decide to cooperate with Mr. Isaacson?

Isaacson reported in a posthumous tribute to be published in Time this week

"I wanted my kids to know me," Mr Isaacson recalled Mr Jobs saying, in a posthumous tribute the biographer wrote for Time magazine. "I wasn't always there for them, and I wanted them to know why and to understand what I did."


Isaacson said he visited Jobs for the last time a few weeks ago and found him curled up in some pain in a downstairs bedroom. Jobs had moved there because he was too weak to go up and down stairs, “but his mind was still sharp and his humor vibrant,”

Steve Jobs' final wish: to get to know his children before it was too late

Mr Jobs, who was 56, is survived by his wife, Laurene Powell Jobs, their three children, Eve, Erin and Reed and his sisters Patti Jobs and Mona Simpson. He also has a 33-year-old daughter, Lisa Brennan-Jobs, whose mother was a high-school girlfriend, Chris-Ann Brennan.
Friends say that he spent recent weeks at home in Palo Alto, California, with his immediate family, who will now oversee the fate of his $6.5 billion fortune. Though many potential visitors were rebuffed, he found time to say farewell to a handful of close friends.

One of his final outings was to Jin Sho, a favourite sushi restaurant, where he dined with Dean Omish, a physician and friend. "He was aware that his time on earth was limited. He wanted control of what he did with the choices that were left," Mr Omish told the New York Times.

"He was very human. He was so much more of a real person than most people know. That's what made him so great," he added. "Steve made choices. I asked him if he was glad that he had kids, and he said, 'It's 10,000 times better than anything I've ever done'."
Mr Jobs died from pancreatic cancer. He had recently started a new drug regime and told friends that there was some cause for hope. But his sister, Mona Simpson, said he was resigned to his fate, adding: "His tone was tenderly apologetic at the end. He felt terrible that he would have to leave us."
Posted by Jill Fallon at 12:17 PM | Permalink

September 14, 2011

"We were like 'wow'"

Many baby boomers don't plan to leave their children an inheritance
Unlike previous generations, some baby boomers believe they've already given their children enough, and they plan to spend the money they've saved on themselves.

Upending the conventional notion of parents carefully tending their financial estates to be passed down at the reading of their wills, many baby boomers say they instead plan to spend the money on themselves while they're alive.

In a survey of millionaire boomers by investment firm U.S. Trust, only 49% said it was important to leave money to their children when they die. The low rate was a big surprise for a company that for decades has advised wealthy people how to leave money to their heirs.

"We were like 'wow,'" said Keith Banks, U.S. Trust president.
Posted by Jill Fallon at 11:06 PM | Permalink

August 6, 2011

The grace of a happy death

The Secret of True Happiness

Yet the phrase “a happy death” is for most people today a contradiction in terms. For the Church, it is the most desirable conclusion to a good life. The Catholic tradition has for centuries encouraged us to pray for that grace and the Roman Missal has a set of prayers “for the grace of a happy death”. What we are praying for is that at the hour of our death we may be reconciled with God and at peace with our neighbor, strengthened by the sacraments of the Church to pass into everlasting life. In addition to that, each of us will have a particular desire for the time of our death: that an estranged relative might be reconciled or that our country might have made peace with its enemies. Taking all of these together is the happy death for which we pray.

We know that in general we must pray as if everything depended on God and work as if everything depended on us. A happy death, however, seems an exception to this because we cannot control our death. People can, however, take steps to make death happy by means of what project managers call “back-planning”. Starting at the end point (the ideal state at the time of death) people need to ask: in order to be in that state, what needs to be done the day before, the week before, the month before and so on, right up until the present moment. Then people can discover what they need to do today in order to prepare for a happy death.

Back-planning from our death bed will include making sure we give time every day to what matters: the classic virtues of justice and courage, prudence and temperance; the theological virtues of faith, hope and love; daily prayer and regular participation in the sacraments. This is the happiness that we are celebrating in this year’s Day for Life. It is a happiness that all can find in riches and in poverty, in sickness and in health, in death and in life.

Momento Mori.

-Memento Mori

Count no man happy until he is dead -Euripides 

Posted by Jill Fallon at 11:18 AM | Permalink

July 6, 2011

The Complicated Family Tree

Can a child enforce a claim against the estate of a sperm or egg donor?

Who’s on the Family Tree? Now It’s Complicated

Many families are grappling with similar questions as a family tree today is beginning to look more like a tangled forest. Genealogists have long defined familial relations along bloodlines or marriage. But as the composition of families changes, so too has the notion of who gets a branch on the family tree.
Tracing a family tree, though, is more than just an intellectual exercise. There are medical and legal implications, particularly when it comes to death and inheritance. Families, said Melinde Lutz Byrne, president of the American Society of Genealogists, are mostly concerned with who inherits property when a biological relative dies.

When Ms. Ashmore and her husband, Lee, learned a few years ago that they could not conceive a child, Ms. Williams stepped in and offered to become pregnant with a donor’s sperm on behalf of the couple, and give birth to the child. The baby, Mallory, was born in September 2007 and adopted by Ms. Ashmore and her husband.

Then the sisters began to ponder: where would the little girl sit on the family tree?

“For medical purposes I am her mother,” Ms. Williams said. “But I am also her aunt.”
Posted by Jill Fallon at 9:13 AM | Permalink

May 18, 2011

"I'm a Catholic - I believe in miracles"

Why you want to wait a bit before you pull the plug.

“Brain dead” woman awakes in Australian hospital.

“Hopeless” and “brain dead” are expressions which have to be used with great caution, it seems, judging from the experience of an Australian woman.

Gloria Cruz, 56, had a stroke in her sleep and was operated on at a Darwin hospital. Doctors told her husband, Tani, that her case was “hopeless” and that she would probably die in 48 hours. They wanted to turn the ventilator off, but Mr Cruz asked for a 48-hour reprieve. "I'm a Catholic - I believe in miracles," he pleaded.

Later a doctor, social worker and patient advocate all rang him and once again insisted that the ventilator should be turned off.

After two weeks it was turned off. And three days later Mrs Cruz awoke, to the astonishment of the hospital staff. Now she is alert and in a wheelchair at the hospital. Her husband told the Northern Territory News: "She's well on the way to recovery.
Posted by Jill Fallon at 8:38 AM | Permalink

May 5, 2011

"I'm dead, and this is my last post to my blog"

A blogger publishes his own last words and turns his blog into an archive.

"I'm dead, and this is my last post to my blog" wrote Derek Miller of Vancouver, Canada.

In advance, I asked that once my body finally shut down from the punishments of my cancer, then my family and friends publish this prepared message I wrote—the first part of the process of turning this from an active website to an archive.

If you knew me at all in real life, you probably heard the news already from another source, but however you found out, consider this a confirmation: I was born on June 30, 1969 in Vancouver, Canada, and I died in Burnaby on May 3, 2011, age 41, of complications from stage 4 metastatic colorectal cancer. We all knew this was coming.

It turns out that no one can imagine what's really coming in our lives. We can plan, and do what we enjoy, but we can't expect our plans to work out. Some of them might, while most probably won't. Inventions and ideas will appear, and events will occur, that we could never foresee. That's neither bad nor good, but it is real.

I think and hope that's what my daughters can take from my disease and death. And that my wonderful, amazing wife Airdrie can see too. Not that they could die any day, but that they should pursue what they enjoy, and what stimulates their minds, as much as possible—so they can be ready for opportunities, as well as not disappointed when things go sideways, as they inevitably do.
The world, indeed the whole universe, is a beautiful, astonishing, wondrous place. There is always more to find out. I don't look back and regret anything, and I hope my family can find a way to do the same.

What is true is that I loved them. Lauren and Marina, as you mature and become yourselves over the years, know that I loved you and did my best to be a good father.

Airdrie, you were my best friend and my closest connection. I don't know what we'd have been like without each other, but I think the world would be a poorer place. I loved you deeply, I loved you, I loved you, I loved you.
Posted by Jill Fallon at 4:24 PM | Permalink

May 3, 2011

What should medicine do when it can't save your life

Atul Gawande on Letting Go or Why hospice care for dying patients.

People have concerns besides simply prolonging their lives. Surveys of patients with terminal illness find that their top priorities include, in addition to avoiding suffering, being with family, having the touch of others, being mentally aware, and not becoming a burden to others. Our system of technological medical care has utterly failed to meet these needs, and the cost of this failure is measured in far more than dollars. The hard question we face, then, is not how we can afford this system’s expense. It is how we can build a health-care system that will actually help dying patients achieve what’s most important to them at the end of their lives.
“Is she dying?” one of the sisters asked me. I didn’t know how to answer the question. I wasn’t even sure what the word “dying” meant anymore. In the past few decades, medical science has rendered obsolete centuries of experience, tradition, and language about our mortality, and created a new difficulty for mankind: how to die.
Hospice has tried to offer a new ideal for how we die. Although not everyone has embraced its rituals, those who have are helping to negotiate an ars moriendi for our age. But doing so represents a struggle—not only against suffering but also against the seemingly unstoppable momentum of medical treatment.
This is a modern tragedy, replayed millions of times over. When there is no way of knowing exactly how long our skeins will run—and when we imagine ourselves to have much more time than we do—our every impulse is to fight, to die with chemo in our veins or a tube in our throats or fresh sutures in our flesh. The fact that we may be shortening or worsening the time we have left hardly seems to register.

We imagine that we can wait until the doctors tell us that there is nothing more they can do. But rarely is there nothing more that doctors can do. They can give toxic drugs of unknown efficacy, operate to try to remove part of the tumor, put in a feeding tube if a person can’t eat: there’s always something. We want these choices. We don’t want anyone—certainly not bureaucrats or the marketplace—to limit them. But that doesn’t mean we are eager to make the choices ourselves. Instead, most often, we make no choice at all. We fall back on the default, and the default is: Do Something. Is there any way out of this?
Posted by Jill Fallon at 4:25 PM | Permalink

April 11, 2011

The doctor who changed her mind

From an interview of Dr. Diane Meier MD

winner of a McArthur (genius) Fellowship and Director of the Center to Advance Palliative Care (CAPC), Director of the Lilian and Benjamin Hertzberg Palliative Care Institute; Professor of Geriatrics and Internal Medicine in the Brookdale Department of Geriatrics and Palliative Medicine; and Catherine Gaisman Professor of Medical Ethics in the Department of Medicine at Mount Sinai School of Medicine in New York City.

Dr. Diane Meier: I, as a young person, was strongly in favor of legalization of assisted suicide. I think I was somewhat naïve at the time, you know, kind of doctrinaire about my commitment to patient self-determination and patient autonomy. And as I got a bit older and had more experience taking care of patients and families, and realizing that autonomy was not really relevant to the human condition – We are all parts of families and parts of communities and critically dependent on one another in ways that notions of self-determination and autonomy pretend don’t exist –

...there’s an old Chinese proverb that: “Suicide reverberates for seven generations.” The harm to families when someone decides to leave, rather than having to leave, is substantial and has been understudied.
What’s also very interesting is that the movement to legalize assisted suicide is overwhelmingly driven by the ‘worried well’ – by people who are so terrified of the loss of control that illness and death, dying and death bring – that there’s a sort of reaction formation: “Damn it, I’m gonna take control back” over something that’s so terrifying. But, for millions of years, humans have lived and died in their families. And it’s not that scary. It’s pretty natural, like birth.

And when you look at – “What do sick people want?” – Sick people almost always want to continue to live. And it took my experience with sick people who, if it were me, I’d say, “I want assisted suicide,” and they still want to live. Overwhelmingly, people want to live, in spite of conditions that the “worried well” would think are intolerable.
Posted by Jill Fallon at 10:24 AM | Permalink

March 10, 2011

Don't die of starvation and dehydration

Don't die of starvation and dehydration.  Make sure your advance health care directive allows food and water unlike this one. 

Advance Health Care Directive

If the extension of my life would result in an existence devoid of cognitive function, with no reasonable hope for normal functioning, then
I do not desire any form of life-sustaining procedures, including nutrition and hydration, unless necessary for my comfort or alleviation of pain.

My agent shall consent to and arrange for the administration of any type of pain relief, even though its use may lead to permanent damage, addiction or even hasten the moment of, but not intentionally cause, my death…

That's the document Zombie had to contend with as his uncle lay dying. Death Channels.

There were now frequent hushed conversations in Tagalog and Spanish in the hallways between the upset orderlies. They were concerned about possibly losing their hospice license and their jobs, but it was more than that. Some confided in me that they felt very uncomfortable about being forced to “kill” the patients this way. When I pointed out that the patients had all signed directives to withhold life-extending care and for pain relief, one orderly shook his head, explaining, “The hospital wants to keep them unconscious on morphine so they don’t wake up and change their minds!”

I might have thought this accusation was a little over-the-top had it not been for the attitude of the nurses themselves, in particular the main daytime chief nurse who also confided in me and whom I eventually nicknamed “Nurse Kevorkian.” She flew into a rage whenever she found a hospice worker sneaking food to a patient, going so far as to clean the food out of one patient’s mouth to make sure no more got swallowed. As we sat by Larry’s bed together now and then, she expressed enthusiasm when his vital signs continued to drop, but became annoyed if he seemed to rally with a stronger pulse and more vigorous breathing. She assumed that I too was hoping for as rapid a death as possible for Larry, and complained bitterly about the crazy Filipinos and their weird attitude.

One night, I was alone with Larry in his room, while the night nurse was elsewhere in the building. He was due for another morphine dose in a few hours, so the previous dose was probably starting to wear off. For the first time in days, Larry stirred, and seemed to wake up. He made a faint moaning noise. I got up and leaned closer, and for the only time during the last month of his life, he spoke. It was just two raspy words: “Help me!”

I ran into the hallway and got the nurse, describing to her what had happened. Her response? “He must be in pain!” She came in and quickly gave him another dose of morphine. Before he faded back to sleep Larry made one last gesture: He shook his head, as if to say “No no no.” And then he went unconscious again. He never woke up after that, the nurses ensuring that he was drugged up at all times. He died three days later without saying another word or regaining consciousness.

What killed him? Well, the doctors would likely say he died of AIDS. But the direct cause of his death was, basically, starvation and dehydration. Which, I later learned, is what actually kills many patients in hospice care, who often die from the withholding of nutrition rather than from the more slow-moving effects of their terminal illnesses.

You can still have a natural death just not a grotesque one. 

Posted by Jill Fallon at 8:19 AM | Permalink

January 28, 2011

"Grabbed by the lapels, shaken loose from mundane and secular preoccupations"

Just in Case

The last thing I wanted to do on a Saturday morning was discuss my husband’s death with 20 women. Not that he had died; neither had theirs. But, encouraged by him, I signed up for a workshop on what to do if suddenly widowed. Leading this sobering examination was a woman whose fate had been exactly that.

Faced with making responsible decisions and meeting challenges in the throes of unexpected grief, she determined to assemble vital material to ease the path of women who would follow her. The terrible truth is that so many do; the average age of widows in the United States is 56, one-third of women are widowed under the age of 50, and, on average, wives outlive husbands by ten to 15 years.

--Predictably, the workshop was full of nuts and bolts about taxes, budgets, and yes, funerals. We were given blue workbooks whose pages were a primer for widows. Categories concerned myths about money, developing self-reliance, mistakes widows make....Overshadowing the pragmatic agenda came an extraordinary bonus relating to matters of the heart.


After hours of exploring practical necessities, our widow redirected us to examinations of conscience. Visibly moved, she noted that we were going home to waiting husbands, no longer her blessing. She invited us to mull over, on that drive, a few questions. These she delivered slowly, long pauses between each. “Why,” she began, “do you think your husband married you? What attracted him? Why did he fall in love with you, and not others? If asked today, do you think he would say those same reasons remain? Is his life better, is it happier, for having married you?”

Her carefully chosen words inspired reflection. It was like the aftermath of a penetrating sermon, the inescapable recognition of having been grabbed by the lapels, shaken loose from mundane and secular preoccupations. Minutes passed. No one budged.

Posted by Jill Fallon at 9:29 AM | Permalink

January 6, 2011

Cut out

Elizabeth Edwards's revenge from beyond the grave after she cut cheating husband John out of will days before death

The final will and testament of Elizabeth Edwards shows she left nothing to her cheating husband, former presidential candidate John Edwards.

She cut her estranged husband out - instead leaving everything to her three children.

The couple's eldest daughter, lawyer Cate, was named as the executor of the will, which Elizabeth, 61, signed on December 1 - just six days before she lost her battle to breast cancer.

-- The couple announced last January that they had separated after 32 years of marriage.

Posted by Jill Fallon at 9:38 AM | Permalink

December 16, 2010

Remains of Amelia Earhart Found?

A lingering death on a tiny island and then eaten by crabs: Will bone fragment finally solve mystery of what happened to aviator Amelia Earhart?


A tiny bone found on a tropical island could finally solve the riddle of what happened to aviator Amelia Earhart.

Researchers found the fragment - which is believed to come from a finger - alongside pieces of a pocket knife, pre-war American bottles and makeup from a woman's compact.

The remains of small fires as well as bird and fish bones and empty oyster shells laid in rows as if to catch water were also recovered.

The discovery raises the possibility that Earhart died a lingering death as a castaway on the island before her remains were eaten by crabs.

Earhart, 41, the most famous female aviator of all time, disappeared in 1937 while attempting to fly round the world. She was last heard from while heading towards tiny Howland island in the south Pacific when her twin-engine Lockheed Electra crashed in the ocean after running out of fuel on July 2, 1937.

The tiny bone fragment, believed to be from a human finger, was found on Nikumaroro, an uninhabited island in the southwest Pacific.

Investigators also recovered two other bones, one believed to be from the neck. Members of Earhart's family have provided DNA to be tested against the remains.

The claims about Earhart's final resting place were made in a documentary on the Discovery Channel that was screened over the weekend.

'After 22 years of rigorous research and 10 gruelling expeditions, we can say that all of the evidence we have found on Nikumaroro is consistent with the hypothesis that Earhart and her navigator Fred Noonan landed and eventually died there as castaways,' said Ric Gillespie, executive director of The International Group for Historic Aircraft Recovery (TIGHAR).

Posted by Jill Fallon at 8:18 AM | Permalink

December 8, 2010

A.N.D. Allow Natural Death

Will a change in language make a difference for those making painful end-of-life decisions?

D.N.R. by Another Name

The key question: Should your parent have a D.N.R. order, meaning “do not resuscitate”?

Before you answer, another key question: Would that decision be any clearer, easier or less painful if the order was instead called A.N.D., for “allow natural death”?

Some health care professionals think it might be. Even if the staff’s subsequent actions were exactly the same, if in either case a patient would receive comfort care to relieve pain but wouldn’t undergo cardiopulmonary resuscitation, nomenclature might make a difference.


Posted by Jill Fallon at 11:00 AM | Permalink

November 26, 2010

"A new ideal for how we die"

I don't know how I missed this when it came out in August. It's a great piece. A must-read.

Atul Gawande explores what medicine should do when it can't save your life in Letting Go

Almost all these patients had known, for some time, that they had a terminal condition. Yet they—along with their families and doctors—were unprepared for the final stage. “We are having more conversation now about what patients want for the end of their life, by far, than they have had in all their lives to this point,” my friend said. “The problem is that’s way too late.” In 2008, the national Coping with Cancer project published a study showing that terminally ill cancer patients who were put on a mechanical ventilator, given electrical defibrillation or chest compressions, or admitted, near death, to intensive care had a substantially worse quality of life in their last week than those who received no such interventions. And, six months after their death, their caregivers were three times as likely to suffer major depression. Spending one’s final days in an I.C.U. because of terminal illness is for most people a kind of failure. You lie on a ventilator, your every organ shutting down, your mind teetering on delirium and permanently beyond realizing that you will never leave this borrowed, fluorescent place. The end comes with no chance for you to have said goodbye or “It’s O.K.” or “I’m sorry” or “I love you.”

People have concerns besides simply prolonging their lives. Surveys of patients with terminal illness find that their top priorities include, in addition to avoiding suffering, being with family, having the touch of others, being mentally aware, and not becoming a burden to others. Our system of technological medical care has utterly failed to meet these needs, and the cost of this failure is measured in far more than dollars. The hard question we face, then, is not how we can afford this system’s expense. It is how we can build a health-care system that will actually help dying patients achieve what’s most important to them at the end of their lives.

Read Gawande encounters hospice for the first time with one of his two dying patients and what hospice nurse Lee Creed has to say about the difference between hospice care and ordinary medical care for a dying patient.

The difference between standard medical care and hospice is not the difference between treating and doing nothing, she explained. The difference was in your priorities. In ordinary medicine, the goal is to extend life. We’ll sacrifice the quality of your existence now—by performing surgery, providing chemotherapy, putting you in intensive care—for the chance of gaining time later. Hospice deploys nurses, doctors, and social workers to help people with a fatal illness have the fullest possible lives right now. That means focussing on objectives like freedom from pain and discomfort, or maintaining mental awareness for as long as possible, or getting out with family once in a while. Hospice and palliative-care specialists aren’t much concerned about whether that makes people’s lives longer or shorter.
In comparing the deaths of his two patients Gawande writes:
Dave Galloway died one week later—at home, at peace, and surrounded by family. A week after that, Lee Cox died, too. But, as if to show just how resistant to formula human lives are, Cox had never reconciled herself to the incurability of her illnesses. So when her family found her in cardiac arrest one morning they followed her wishes and called 911 instead of the hospice service. The emergency medical technicians and firefighters and police rushed in. They pulled off her clothes and pumped her chest, put a tube in her airway and forced oxygen into her lungs, and tried to see if they could shock her heart back. But such efforts rarely succeed with terminal patients, and they did not succeed with her. Hospice has tried to offer a new ideal for how we die.
People who had substantive discussions with their doctor about their end-of-life preferences were far more likely to die at peace and in control of their situation, and to spare their family anguish.
Posted by Jill Fallon at 10:45 PM | Permalink

October 12, 2010

Ethical will to communicate what we think is important to those we love

You leave your family more than an estate. An ethical will, an extralegal, nonbinding document, is meant to communicate values and family feelings.

Bequeathing Smart Strategies in Barron's

TOM ROGERSON, director of family wealth services at BNY Mellon Wealth Management in Boston, keeps a copy of a handwritten, 10-page document on his desk. When he first saw it, he says, it made him weep.

The letter, from a father to his son, is nearly 25 years old. It describes the impact of his conversion to Christianity late in life, and outlines his hopes for his son.

"That was my first experience, before I knew the term," Rogerson says. "But it turns out this was an ethical will. It is a great example of what an ethical will is designed to do."

My  colleague Susan Turnbull at Personal Legacy Advisors is interviewed

"The impulse to communicate what we think is important to those we love is as old as the human race," says Susan Turnbull, founder and principal of Personal Legacy Advisors, a firm that advocates nonbinding personal-legacy documents as a component of estate and philanthropic planning.

"What struck me was that it was the missing piece of estate planning," she says. "A will is written in formal legalese that is very limited in scope. It has no personality, and there is no life or warmth in it. Love and affection and gratitude may be implied by the document, but are never stated."

"An ethical will takes a 30,000-foot view of your life," Turnbull adds, "and tries to capture the essence of what has been important to you, and the lasting messages you want to leave."
"The ethical will is written to help other people, for the benefit of the heirs, but the process the author goes through to create it is as valuable as the document itself," Turnbull says. "The author has the opportunity to pause and reflect on his life in ways he might otherwise never do."
Posted by Jill Fallon at 10:20 PM | Permalink

October 5, 2010

Hearing her dead daughter's heart beat

Extraordinary moment a mother hears her dead 13-year-old daughter's heart beat again...  inside chest of transplant patient

Taylor Storch, 13, died in a skiing accident on the last day of a family holiday in Colorado in March this year.

Her organs were donated - and through an extraordinary series of events - six months her parents Todd and Tara Storch found themselves face to face with the woman who was alive only because she had received their daughter's heart.

At the link, scroll to the very bottom to see the video.

 Dead-Daughter's Heart Beating

Posted by Jill Fallon at 5:15 PM | Permalink

July 27, 2010

What should medicine do when it can't save your life?

Atul Gawande on Letting Go.  A must read especially for those who have a loved one with a terminal illness.

Almost all these patients had known, for some time, that they had a terminal condition. Yet they—along with their families and doctors—were unprepared for the final stage. “We are having more conversation now about what patients want for the end of their life, by far, than they have had in all their lives to this point,” my friend said. “The problem is that’s way too late.” In 2008, the national Coping with Cancer project published a study showing that terminally ill cancer patients who were put on a mechanical ventilator, given electrical defibrillation or chest compressions, or admitted, near death, to intensive care had a substantially worse quality of life in their last week than those who received no such interventions. And, six months after their death, their caregivers were three times as likely to suffer major depression. Spending one’s final days in an I.C.U. because of terminal illness is for most people a kind of failure. You lie on a ventilator, your every organ shutting down, your mind teetering on delirium and permanently beyond realizing that you will never leave this borrowed, fluorescent place. The end comes with no chance for you to have said goodbye or “It’s O.K.” or “I’m sorry” or “I love you.”

The difference between hospice and standard medical care.

The difference between standard medical care and hospice is not the difference between treating and doing nothing, she explained. The difference was in your priorities. In ordinary medicine, the goal is to extend life. We’ll sacrifice the quality of your existence now—by performing surgery, providing chemotherapy, putting you in intensive care—for the chance of gaining time later. Hospice deploys nurses, doctors, and social workers to help people with a fatal illness have the fullest possible lives right now. That means focussing on objectives like freedom from pain and discomfort, or maintaining mental awareness for as long as possible, or getting out with family once in a while. Hospice and palliative-care specialists aren’t much concerned about whether that makes people’s lives longer or shorter.

Like many people, I had believed that hospice care hastens death, because patients forgo hospital treatments and are allowed high-dose narcotics to combat pain. But studies suggest otherwise. In one, researchers followed 4,493 Medicare patients with either terminal cancer or congestive heart failure. They found no difference in survival time between hospice and non-hospice patients with breast cancer, prostate cancer, and colon cancer. Curiously, hospice care seemed to extend survival for some patients; those with pancreatic cancer gained an average of three weeks, those with lung cancer gained six weeks, and those with congestive heart failure gained three months. The lesson seems almost Zen: you live longer only when you stop trying to live longer.

This is not just a Zen, Christians hold the same.  Life is not and can never be a possession.  Attempting to grasp life and hold on it in fact diminishes your life.  "For whosoever will save his life shall lose it; but whosoever shall lose his life for my sake and the gospel’s, the same shall save it.” (Mark 8:34-5).

The simple view is that medicine exists to fight death and disease, and that is, of course, its most basic task. Death is the enemy. But the enemy has superior forces. Eventually, it wins. And, in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You don’t want Custer. You want Robert E. Lee, someone who knew how to fight for territory when he could and how to surrender when he couldn’t, someone who understood that the damage is greatest if all you do is fight to the bitter end.
Posted by Jill Fallon at 5:33 PM | Permalink

July 20, 2010

Widow of firefighter killed in blaze was a man. Suit filed.

Here's a new one for estate lawyers

  Suit claims widow of Wharton firefighter was born a man

The family of a Wharton firefighter who died battling a massive egg farm blaze is fighting to keep his widow from receiving death benefits, arguing that the 37-year-old had found out his bride of two years was born a man.

Thomas Araguz III separated from his wife after learning her history two months prior to being trapped in the fatal July 3 fire, according to attorney Chad Ellis, who is representing Araguz's parents in the lawsuit.

"He was distraught. It was extremely difficult and embarrassing for Tommy," said Ellis, who added that there is no will for the estate, which will be substantial since the fire captain died in the line of duty.

Thomas Araguz learned during a custody dispute with his ex-wife last spring that 35-year-old Nikki Araguz, whom he married in August 2008, was allegedly born as Justin Graham Purdue. Ellis said he was unsure when Nikki Araguz may have undergone a sex-change operation, but the lawsuit claims she changed her name in the mid-1990s to Nikki Paige Araguz.

Nikki Araguz has been court-ordered not to remove any property from their home, withdraw funds from any account or receive any death benefits, as part of the lawsuit filed last week in state district court by the firefighter's mother, Simona Longoria.

Among the issues: Who will be the administrator of the estate and whether Nikki Araguz was Thomas Araguz' lawful wife. The family wants all the death benefits to go to the two young sons that Araguz had with ex-wife Heather Delgado.

Posted by Jill Fallon at 8:52 PM | Permalink

Family secrets, sibling fury and an apartment to die for

The best precis of the Nightmare in Apt 9B is from The Browser

Hitchcock film in the form of a newspaper story. Dying widow, sex-change daughter, idle son battle for ownership of apartment on Central Park West. Ends with jail sentences, hired killer

The struggle over Apartment 9B is one of those real-estate fights that is about far more than real estate — although it may reveal in spectacular terms the lengths that some people will go for a great apartment. Brimming with claims about abuse and inheritance, the battle is about family secrets and sibling fury as much as it is about co-op shares.

It even made public a private gender switch. Mrs. Cheney’s daughter, Ms. Wells, was her first son, Jonathan, before a sex-change operation in the 1970s. The morning that the housekeeper found Mrs. Cheney on the couch was just two days after she had met with lawyers to reconsider her will. Ms. Gordon soon had an ambulance crew wheeling its stretcher across the hardwood floors that are a selling point in the El Dorado’s $4 million co-ops.
The Cheney family battle over whether she can remain is now headed toward a courtroom finale at a trial this fall in Manhattan Surrogate’s Court. Family members declined to be interviewed. But cartons of court documents include diaries, letters, transcripts and reports that detail the battle for Apartment 9B, a family fight that defies real resolution, like thousands of family struggles with bottomless emotions that occupy the courts every year.

Posted by Jill Fallon at 6:32 AM | Permalink

May 13, 2010

‘She just left me there to die,’

The difficulties involved when one doesn't agree with the person one has  designated as their health care proxy

Fighting Over the Living Will of J. Bruce Llewellyn

ALMOST everyone who visited J. Bruce Llewellyn three years ago in the Mary Manning Walsh nursing home in Manhattan heard the same refrain: Get me out of here.

A fall and other ailments had forced Mr. Llewellyn into rehabilitation, and after several months, his doctors said he was well enough to return to his Central Park West apartment. But his wife of nearly 30 years disagreed, saying he was too ill.

Finally, he persuaded three longtime friends to supersede his wife’s authority over his affairs. They became his court-appointed guardians, assumed control of his bank accounts, found him a new apartment, hired staff members and brought in flowers, artwork and musicians to brighten his days.

Mr. Mederos testified that Mr. Llewellyn felt abandoned, wanted his friends to take over his affairs and was upset at his wife’s refusal to let him leave the nursing home.

“His words at one point were, ‘She just left me there to die,’ ” Mr. Mederos testified.

Posted by Jill Fallon at 8:20 AM | Permalink

October 13, 2009

The frontier of law

With the rapid changes in technology and life, there are issues now before courts that could never have been imagined 25 years ago.

Two British-born orphans adopted by regal Italian family in legal battle over £1bn fortune

The pair – who are not real siblings – have fallen out over who will one day inherit the billion-pound estate of the family that took them in 40 years ago.
But 45-year- old Princess Gesine is unhappy about her adoptive brother’s offspring being named as heirs. Prince Jonathan is gay and had a son and daughter by surrogate mothers.
Under Italian law Emily, three, and Filippo Andrea, two, have no legal rights to the family fortune, despite Jonathan’s British civil partnership with Brazilian lover Elson Edeno Braga.

In addition, staunchly Roman Catholic Princess Gesine disapproves of Jonathan’s lifestyle and says she fears that the children’s surrogate mothers could try to claim part of the fortune if they were

For last two years the dispute has been fought out in the Italian courts – a bitter ending to that fairytale beginning. A decision is expected next week.

'The funniest thing out of all of this is that Jonathan and Gesine call themselves prince and princess but they don't have a drop of real blue blood between them

How can you plan for what you can't even imagine?

Posted by Jill Fallon at 11:30 AM | Permalink

October 9, 2009

The never-ending litigation over the Astor estate

Brooke Astor's son Anthony Marshall, 85, was found guilty on charges that he defrauded his mother and stole tens of millions of dollars from her as she suffered from Alzheimer's disease in the twilight of her life.

So just what happens to the $180 million estate?  More litigation.

At the core of this issue is whether Mrs. Astor was mentally competent when she signed the 2002 will, which was amended in late 2003 and again in early 2004. Those revisions gave her son more control over her estate and, in the process, reduced the amount of money she left to the New York universities, libraries, parks and museums she spent so much of her life supporting.

The sweeping verdict against Mr. Marshall may provide a significant boost to their push to have the recent will thrown out as invalid, lawyers say. “It’s very unusual and directly relevant to the issues before the surrogate because both cases concern her mental capacity,” said Paul C. Saunders, a lawyer for Annette de la Renta, who was Mrs. Astor’s court-appointed guardian and is a party in the Surrogate’s Court case. “Clearly the jury believes she didn’t have the capacity to understand what she was doing.”

The maneuvering began almost immediately after Mrs. Astor’s death on Aug. 13, 2007, with a dispute over who should be named administrators of the estate (the court eventually named JPMorgan Chase & Company and a retired judge). The case began to move quickly toward a will battle, though no formal objection has yet been filed.

If the most recent will is upheld, many charities will lose millions of dollars, with the Met and the library — both of which declined to comment — losing out on an estimated $10 million each. The Surrogate’s Court case was postponed pending the resolution of the criminal case, and it remained unclear whether it would resume if Mr. Marshall appealed his conviction. The court is scheduled to discuss the civil case again on Nov. 4.
One complicating factor is that Mrs. Astor included a provision aimed at discouraging any challenge to her will. It states that anyone who contests the will and loses will receive nothing.

Posted by Jill Fallon at 7:49 PM | Permalink

May 16, 2009

"Warning signs on one hand and dollar signs on the other"

You're the director of a non-profit that operates an alternative school and runs programs for people with developmental disabilities when you get a call from someone you never met who says he plans to leave your organization his entire estate.  Of course, you'll meet with him and together you set a date.   

But there's a death in your family and you have to leave town.  You tried to cancel and reschedule but you couldn't reach him.  The caller comes by anyway and leaves a large white envelope for you.  Scrawled on the bank in large capital letters are the words:

When you get back, did you open the envelope?

Of course you do.  Annie Green did.

Inside she found the last will and testament of John Francis Beech and yes, indeed Beech left Laradon Hall, the non-profit  in question, all his estate.  Beech also left the keys to his house, instructions and $100,000 check, post-dated for two weeks, for Laradon Hall.

  Beech And Mom
John Beech and his mother

If you couldn't surmise from the writing outside the envelope that this man was contemplating suicide, surely you could by what was inside.

What would you do?

Annie Green put the check into a safe until she could deposit it. 

Where would you take a $100,000 check that is also a suicide note - to the cops or the bank?

Beech had a mother, three sisters and a brother. The news of his death left them and other relatives reeling in shock and bewilderment. Jack, as he was known to his younger siblings, had always been the family's pillar of strength — the oldest, the most confident, the one who was the life of the party. He collected beautiful cars and performed magic tricks in bars; he had money, globe-trotting adventures and lots of girlfriends. He'd never shown signs of depression and, as far as they knew, had never been treated for mental illness. He'd never talked about suicide around them — except to express outrage when an old friend took his own life in 2007. Why, Jack had seethed, didn't the guy come to him for help?  But Jack was also an extremely private person. He'd disappear for weeks on a trip or something, then abruptly resurface. The family knew there were parts of his life he simply didn't share with them, and maybe not with anyone. "If you needed help, he'd give you the shirt off his back," says his brother, David Beech, a news director for a television station in Reno, Nevada. "But if you tried to help him with anything, he'd refuse. He was like a father; he was our father.


Now the family is suing on pubic policy grounds so that the non-profit can not benefit from its failure to take action to prevent the suicide.

But Malonson's attorney, Susan Harris, says the message Beech left for Green was unmistakable. "The only people he revealed his suicide plan to was Laradon Hall," she says. "There's no note that says, 'I'm going to commit suicide,' but there's a lot of indications. Who gives their house keys and financial information to a perfect stranger? He writes about the coroner, about where to find his car titles — and here's a postdated check for $100,000. One of the classic signs of impending suicide is the property giveaway.

"Laradon Hall deals with the mental-health issues of the clients it serves," Harris continues. "They have psychologists on board, all kinds of mental-health professionals. They do assessment; they do treatment. But they never tried to save him. They didn't contact him. They didn't call a hotline. They didn't talk to one of their own psychologists. They stuck the check in their safe."

A fascinating story by Allan Prendergast, you have to read.

Posted by Jill Fallon at 3:42 PM | Permalink

April 4, 2009

The terrible costs of not discussing end-of-life care

If doctors and families don't talk about end-of-life care, the dying patient will endure more misery, physical distress and suffering as costs
mounts up.

At the end of life, denial comes at a price

A team of investigators, lead by researchers at the Dana-Farber Cancer Institute in Boston, interviewed 603 patients with advanced cancer. They asked the patients, who had about six months left to live, whether their doctors had discussed their wishes for end-of-life care. The majority — 69 percent — said those conversations had not taken place. And in their last weeks of life, those patients who had talked with their doctors wound up with medical bills that were on average 36 percent lower — $1,876 compared to $2,917 — than those of patients who did not have end-of-life conversations with their doctors.
Why such a big difference? Dr. Holly Prigerson, a professor of psychiatry at Harvard Medical School and an author of the study, explained that the patients who never talked about their end-of-life wishes were more likely to be resuscitated, intubated or put in intensive care — or all of the above. Patients who had had those conversations generally opted for comfort, or palliative, care at home or in a hospice at much lower cost.
Why should doctors be so reluctant to talk about dying when patients are terminally ill? Dr. Susan Dale Block, chair of the department of psychosocial oncology and palliative care at Brigham and Women’s Hospital in Boston, noted that oncologists don’t want to appear to be giving up on patients by discussing plans for dying. At the same time, family members and loved ones worry that such conversations might upset an already vulnerable patient. And patients themselves often feel their role is to be heroic and to soldier on, against the odds, with yet another treatment or intervention.
As this blog has noted, Compassion & Choices offers free consultations to families and patients through its End-of-Life Consultation Program (800-247-7421). The program’s counselors help patients make decisions about continuing treatment and provide advice on asking health care providers some of the tough questions. The counselors also offer tips on how to speak to providers if the patient’s needs and wishes are not being met.
Posted by Jill Fallon at 10:54 AM | Permalink

March 30, 2009

The conspiracy to deny two sisters their inheritance

A twenty-five-year battle over an estate ends. 

The “conspiracy to deny us our inheritance destroyed my family, broke my heart and left me with scars that I have painfully struggled with and have not fully overcome even now, after all these years,” Diana, 68, said in a recent affidavit.
Evelyn and Diana, who both live in New Rochelle, recall their father as a charming man who sang opera in their home, one of six adjoining houses he built in Pelham Parkway, a Bronx neighborhood of small brick houses and apartment buildings.
After their father died, their brother returned from the Army to help sort out his affairs. “We were told we were impoverished and my father died without a will,” Diana said. “I supported myself basically, from the time my father died.”

But, in fact, their father did write a single-page will leaving one-third of his estate to his wife, Rose, and equally dividing the remaining two-thirds among Walter, Evelyn and Diana. The will, a copy of which was obtained by The New York Times, instructed that a trust fund be established for his daughters until they turned 23. That never happened.

After discovering the will in 1983, Diana and Evelyn confronted their mother, who initially denied any knowledge of the will. But she later gave the girls the deed to her house and a 10 percent stake in Rose Gardens.

The sisters also went to Walter’s house in Kings Point to confront him. He called the police to have them removed, they said.

Posted by Jill Fallon at 9:02 AM | Permalink

March 16, 2009

Michael Jackson to be 'plastinized'

Michael Jackson plans to have his body 'plastinized' by Dr. Death

MICHAEL Jackson will achieve his dream of immortality by being stuffed with plastic by Dr Death.

The King Of Pop, who calls himself Peter Pan, has had a string of cosmetic surgery ops to try to defy the ageing process.

But he is now preparing to strike the ultimate blow against death and decay by having his whole body “plastinated” by controversial doctor Gunther von Hagens.

Jacko, who is a fan of the German anatomist, was said to be thrilled his Body Worlds exhibition would be on at the O2 Arena during his This Is It concerts, which start in July.

The exhibition showcases Von Hagens’ groundbreaking corpse preservation technique which earned him the nickname Dr Death.

Creepy as this is at least Jackson is giving his consent unlike the Chinese prisoners who were used for the first  Body Worlds exhibition

Posted by Jill Fallon at 3:22 PM | Permalink

March 9, 2009

Suit says teen was 'killed' for organs

Suit says Teen was 'killed' for organs

The parents of an 18-year-old who suffered a brain injury in a 2007 snowboarding accident say his doctors "intentionally killed" him to harvest his organs.

In the lawsuit filed this week in the U.S. District Court of Western Pennsylvania, Michael and Teresa Jacobs claim that doctors "hastened" their son Gregory Jacobs' death by delaying treatment and ultimately pulling his breathing tube, causing him to suffocate.

The couple said their son had not been formally declared brain dead when surgeons began the transplant procedure. They are seeking $5 million in damages.
According to the plaintiffs, brain death was recorded the next day, "retroactively" as life support was being withdrawn in preparation for organ removal.


In an interview with media in 2007, hospital officials acknowledged that the recorded time of death was a mistake.

Posted by Jill Fallon at 5:29 PM | Permalink

March 1, 2009

Making Sure of His Last Word

There's nothing wrong with 84-year-old Ed Koch, so it's quite strange to hear he's erected an already engraved tombstone for himself in a Manhattan cemetery. 

Ed's Grave Situation

The unadorned tombstone, planted firmly on a hill at Trinity Church Cemetery in Washington Heights, carries an inscription that hails his Jewish heritage, as well as his life in public service.

"He was fiercely proud of his Jewish faith. He fiercely defended the City of New York, and he fiercely loved its people," the headstone reads.

"Above all, he loved his country, the United States of America, in whose armed forces he served in World War II."

 Edkoch Tombstone

Also carved into the stone is a common Jewish prayer as well as the last words of Wall Street Journal reporter Daniel Pearl, who was beheaded by Muslim terrorists in 2002: "My father is Jewish, my mother is Jewish, I am Jewish."

Neighbors in the three-term mayor's apartment building in Greenwich Village said the move was just an example of Koch's out-sized personality.

"He's a bigger-than-life character and I guess he wants to be bigger than death," one female resident quipped.

Another tenant added: "He's accustomed to having the last word, so this doesn't surprise me."

Posted by Jill Fallon at 8:01 PM | Permalink

September 29, 2008

Ledger family gives everything to Mathilda

It's rare to read in the news about a family that does the right thing and avoids all litigation

Heath Ledger's family give his millions to his two-year-old daughter

Every penny of Heath Ledger's fortune will go to his daughter, Matilda Rose, the dead star's father has revealed.

In Ledger's will, which has been probated behind closed doors at the Australian Supreme Court in Perth, the 28-year-old actor left everything to his parents and three sisters. But the will was signed by the actor on April 12, 2003 - two years before Matilda was born

It was expected that Ledger's former partner, Michelle Williams, would lodge a claim on the will on behalf of their daughter. But Ledger's father, Kim, instead told Australia's Herald Sun that the family had decided to give everything to Matilda.

Posted by Jill Fallon at 9:41 AM | Permalink

September 10, 2008

Uneven Shares

THE day will come, or may have already, when your children think of your money as theirs.

Learning to Share

Putting off discussion and then springing an unwelcome surprise in a will can poison the reservoir of family joy that parents want to bequeath to the next generation, resurrecting or exacerbating sibling rivalries, especially in blended families created through divorce or remarriage after the death of a spouse.

Succession is a natural progression, as old as the concept of private property, yet many parents never bother to tell their children about plans for their estate.

David Cay Johnston in the New York Times lays out the costs of not telling your children about uneven shares in your will.

Mitchell Gans, a law professor at Hofstra University in Hempstead, N.Y., who has helped develop some of the most complex estate plans in the country, recommends that in such cases you should prepare the will and then notify “the kids that you are cutting out — or who are getting less than the others.”

“If you have the courage to do that,” Professor Gans said, “you cut down significantly the chance of litigation after death.”

Posted by Jill Fallon at 9:34 AM | Permalink

September 6, 2008

Pope's organ card an 'act of love'

He signed up as an organ donor when he was a cardinal.

Pope Benedict carries organ donor card as "an act of love'.

Pope Benedict XVI is a card-carrying organ donor, it emerged today. The disclosure that the pontiff is prepared to donate organs for transplants after his death follows a front page article in the Vatican newspaper, L'Osservatore Romano, calling into question the concept of brain death as the end of life rather than cardio-circulatory arrest.

The modern Catechism of the Catholic Church
"Donation of organs after death is a noble and meritorious act and is to be encouraged as a manifestation of generous solidarity. It is not morally acceptable if the donor or those who legitimately speak for him have not given their explicit consent."

Posted by Jill Fallon at 10:35 AM | Permalink

April 16, 2008

Adamant that she would not 'die rich'

Body shop founder Anita Roddick gave away her fortune to charity and  the tax man and left nothing to her daughters.

She described leaving money to your family as "obscene" and cut her two daughters Sam and Justine out of her will in 2005 soon after making a fortune from the sale of The Body Shop.

French cosmetics firm L'Oreal paid £625million for the company, paying Dame Anita and her husband Gordon more than £100million for their 18 per cent share in the business.

Her half of the profit from the eco-friendly, ethical business which she and her husband built up from one shop was donated to the Roddick Foundation, which supports charity causes she espoused.
Mr Roddick and his family were yesterday away on holiday but the couple's daughters have publicly supported their mother's decision to disinherit them.

Remember husband and father still has half the fortune.

Posted by Jill Fallon at 12:07 AM | Permalink

March 8, 2008

Custody Battle over Aging Priest

In January Father Brian Gallagher was visiting the Kowalczyk family Arizona in January when he fell and broke his arm.  What the doctors also found when they treated him was a stage IV brain tumor.

A so-called friend saw the opportunity for money to made if only she kept control of him. 

Custody Battle Threatens Health and Life of Aging Priest

A terminally ill Roman Catholic priest is the center of a tempestuous legal battle between a court-appointed temporary guardian - who has demanded his return to an Arizona care center - and family and friends - who believe such a move could kill him.

Documents obtained by show that Kowalczyk seized emergency legal guardianship of Fr. Gallagher shortly after learning that the priest, dissatisfied with her unwillingness to return him to California, relieved her of her power of attorney and reassigned any health-care directive and legal control over his finances to his cousin James Logsdon.
The priest also expressed his wish to return to San Juan Capistrano or live in a religious institute, "so that I may be with the Blessed Sacrament daily as well as receive the sacraments daily till the end of my days."

"When Fr. Gallagher was moved [from Arizona to California] he was very happy, smiling from ear to ear, saying 'I'm home now, even though I'm in the hospital, I'm in California now,'" said Denise Riggio, a long-time friend of Fr. Gallagher's who visited him earlier this week. "He is in a comfortable room, being monitored, has an IV, and is open to all visitors. The change was from bad to wonderful."

Posted by Jill Fallon at 8:51 PM | Permalink

February 28, 2008

Your Intellectual Property

Know those organ stickers you put on your driver's license?

Now there's one for you can affix to the same license that expresses your desire to become an intellectual property donor.   

         Intellectual Propety Donor

Using such a sticker will not comply with the laws of any state, if any survivor  wishes to challenge it, so I expect legal contests in the future. 

via Kottke

Posted by Jill Fallon at 4:15 PM | Permalink

February 18, 2008

The Queen of Mean's $4B

Leona Helmsley.

Her obituary here
Her will here
Her bequest here
The four very big ones (nearly quadruple the giving of any other American last year) will go to the Leona M and Harry B Helmsley Charitable Trust.

Among good causes and works it supports are: Greenwich Hospital, the Helen Keller National Center for Deaf-Blind Youths and Adults, and the Alzheimer's Association. She also gave $5m to the families of New York firefighters in the wake of 9/11.

The year's other big givers are Baron Hilton of hotels fame – $1.2bn; George Soros, the financial wizard – $474.6m; and Michael Bloomberg, the media magnate and residing mayor of New York – $205m.

And so Leona will go down to posterity in rather better odour than she lived, ever demandingly, among us. She was hard, tyrannical to staff (she once made a waiter in one of her hotels beg on his knees for his job after serving a cup of tea with a smidgen of water in the saucer), and petulantly fired one man when she discovered he was gay. But, in the years to come, thousands of Americans will owe their lives to the medical facilities her billions will provide. Why, the woman's very nearly a saint.

Posted by Jill Fallon at 5:02 PM | Permalink

February 17, 2008

When a King doesn't leave a will

When someone dies without leaving a will, their family can be split apart in acrimony.  When a king doesn't leave a will, a country can.

When King Pakubuwono XII died four years ago, he left six mistresses with 35 children, but no wife, no heir and no instructions about the succession here in this city in central Java.

He might have guessed what would happen. Two half brothers each claimed the ancient crown, and the family split into two bitterly feuding factions.
Shortly after their father died, on June 12, 2004, each contending brother had himself crowned King Pakubuwono XIII. One coronation was held inside the palace, one outside, at the mansion of a friend.

When the time came to commemorate their father’s death, palace insiders say, the princes carried out separate tomb-sealing rituals: two teams of masons, two teams mixing cement, two solemn ceremonies.

In a Sultanate Known as Solo, One Too  Many Kings.

Posted by Jill Fallon at 8:18 AM | Permalink

January 26, 2008

"He took pretty much all she had"

A doctor who works at Columbia Presbyterian scammed his 92-year-old mother out of nearly $1 million.

Minnie Motz, the mother who worked her whole life as a librarian never thought her Jewish doctor son would leave her virtually penniless and on the brink of eviction.


Dr. Robin Motz, an internist took control of his mother's finances in 2003 because she was failing physically.

In 2004, when her husband, Lloyd Motz, died, Robin Motz moved his mother's investments from her Oppenheimer account to a Merrill Lynch account in his name, prosecutors said. He liquidated the investments, which had been in tax-free municipal bonds, and began writing checks to cover his credit-card bills, the Manhattan DA's Office charged.

He's now under indictment and faces 15 years in jail.

A woman with a West-Indian accent who picked up the phone at Minnie Motz's apartment would only say, "How would you feel? That's exactly how she feels!"

Posted by Jill Fallon at 1:50 PM | Permalink

January 23, 2008

Will of the Queen Mother sealed in secret

A longstanding convention has kept royal wills secret, but Queen Elizabeth codified that convention into law when she had the wills of Princess Margaret and her mother sealed in secret.

Only the appearance of Robert Brown who claims to be the illegitimate son of Princess Margaret and her one time lover Group Captain Peter Townsend brought the secret law to light.

Queen 'had her mother's will sealed in secret'

The 52-year-old accountant from Jersey was challenging the claim that "the privacy interests of the Royal family outweigh any public interest in unsealing royal wills," he said.

Mr Hinks said the executors of the royal wills were opposing the application because Mr Brown had no right to see them. "It is a fraudulent claim. It is a scandalous claim that he is the son of the sister of the sovereign without any factual basis," he said.

Posted by Jill Fallon at 9:05 AM | Permalink

January 22, 2008

Opting In or Out

In England the plan is to take dead patients' organs without their consent to cover a shortfall in organ donations which leads to more than a 1000 people each year dying before they can receive life-saving transplants. 

Prime Minister Gordon Brown supports a system of 'presumed consent' whereby a dead person's organs are automatically available unless they opted out earlier or family members object.

I predict it won't be long before there is similar pressure here for 'presumed consent.' 

Posted by Jill Fallon at 8:16 AM | Permalink

November 28, 2007

Bad Heir Day

Details about the charges against Anthony Marshall, son of Brook Astor, are catnip for the tabloids.

 Bad Heir Day

DA's Kick in the Astor
He tried to appear stoic, but Brooke Astor's son had a difficult time keeping a stiff upper lip yesterday as he was arraigned on charges of swindling his Alzheimer's-stricken mother out of millions in cash, property and artwork.

Anthony Marshall had to wipe away tears when his wife, Charlene, ran into his arms in Manhattan Supreme Court, where he was about to be slammed with charges over his handling of his mother's affairs, including grand larceny, criminal possession of stolen property and conspiracy.

If convicted at trial of the top count, Marshall, 83, would face up to 25 years in prison and would likely die behind bars.

Posted by Jill Fallon at 9:28 AM | Permalink

November 27, 2007

Brooke Astor's Son Indicted

Brooke Astor's son and one of her former lawyers have been indicted on criminal charges.

The charges stem from their stewardship of her financial affairs and the handling of her will.

Prosecutors were believed to be investigating millions of dollars in cash, property and stocks that Mr. Marshall obtained over the years in his role as steward of his mother’s finances.
The district attorney’s office was also informed by Mrs. Astor’s court-appointed lawyer, who had retained a nationally known handwriting expert, that the signature on the third amendment, which was made in March 2004, was possibly forged

Over a year ago I wrote about Brooke Astor and Elder Abuse

It appears the brouhaha over the way she was treated and her money spent caught the attention not only of the press but also the prosecutor's office.

Posted by Jill Fallon at 9:53 AM | Permalink

October 18, 2007

Bury Me Naked with My Mobile Phone

According to recent survey in England some of the most popular requests by people planning their funerals are

BURY me naked.
Put a mobile phone in the coffin.
Cremate me with my pet's ashes.
Bury me with my teeth in.
And do make sure I'm actually dead.

The most common request is to have a beloved pet cremated with them.  Of course, the pet has to be dead before it can be cremated.

Posted by Jill Fallon at 11:16 PM | Permalink

September 28, 2007

Why you should review your will

Seventeen years is too long to go without reviewing your will.
Siblings in noted Cape family clash over will.

When their mother made a will in 1990, no doubt she thought  circumstances  were quite different.

But in a painful split within the well-known clan, three of Thomas Cahir's sisters allege that the young man who followed faithfully in his father's political footsteps also deceived and improperly pressured his widowed mother, Edith, to write a will that left the family business, worth hundreds of thousands of dollars, solely to him.

Said one lawyer disputes will continue to multiply as the assets held by older generations grow in value.

"It's unbelievably common.  The ones that make it to court are just the tip of the iceberg."

Posted by Jill Fallon at 8:48 AM | Permalink

September 4, 2007

The Wills of Leona Helmsley and Arthur Miller

Not all wills are dry, legal documents.  Leona Helmsley solidified her reputation as the 'Queen of Mean'  with hers.

With an estate valued at between  4 billion and 8 billion dollars, she left $12 million in trust for her dog, a white Maltese named Trouble,  yet nothing to her 12 great grandchildren.  To two of her grandsons, she left $5 million each and another $5 million in trust so long as they visited their father's grave once a year.  To the other two of her grandchildren, she left nothing "for reasons that are known to them".

In her will, Leona asked her brother to care for the dog, but her brother doesn't want anything to do with the pooch who's more trouble than it's worth.

Other Wills of the Rich and Vengeful

Meanwhile, the reputed greatest American playwright of the 20th century, Arthur Miller whose most line "Attention must be paid" in Death of the Salesman pointed to the intrinsic value of every human life abandoned his own son at birth.

Daniel was born with Down's syndrome and was almost immediately institutionalized.  It's speculated that such a son did not fit into the successful narrative Miller wanted for his life who never mentioned him again.

Daniel's mother, Inge Morath, visited him every Sunday.  By all accounts, Daniel has overcome his challenges spectacularly, competing in the Special Olympics and now lives independently, much loved and admired by those who know him.

Miller's son-in-law Daniel Day-Lewis, the actor who played a disabled person in My Left Foot apparently was appalled at Miller's treatment of his son. Together with his wife Rebecca Miller, they must have had some influence.  Six weeks before his death, Miller made a new will leaving his son Daniel a share in his estate equal to his siblings.  Attention paid and redemption of a sort, Miller gained with his will.

The Son who didn't fit into the plot of Arthur Miller's life

Posted by Jill Fallon at 11:17 AM | Permalink

April 13, 2007

2007 Estate Planning Survey

According to the latest survey on estate planning by Martindale Hubbell, the percentage of people without a will remains the same, 55% while the number of Americans with living will or advance directives has increased to 41%

Among non-white adults, the lack of wills is even more pronounced. Only one in three African American adults (32 percent) and one in four Hispanic American adults (26 percent) have wills, compared to more than half (52 percent) of white American adults.

Additionally, two in five (38 percent) American adults report assigning a power of attorney for healthcare purposes, compared to 27 percent in 2004. A power of attorney for healthcare legally delegates authority to another to make medical decisions for that individual, if he or she is incapacitated.

One in ten say they don't have any elements of an estate plan because they don't want to think about dying or becoming incapacitated.

Nearly one in ten say they don't know who to talk to about creating such documents.

And one in four say they don't have an estate plan because they have insufficient assets.

Posted by Jill Fallon at 7:18 PM | Permalink | TrackBack

March 1, 2007

Last Wish Can't Be Granted

"When you die and you don't have any relatives, they just kick you to the side," Fouty said. "And now she's frozen. That just makes me cringe. That's not what she wanted at all. I'm just scared to death they're going to cremate her and stick her in a cemetery where she doesn't know anyone."

Deceased woman's last wish can't be granted.

Williams-Martin did not have the proper paperwork or the relatives to claim her, so her body could not be donated to science. Now, Fouty hopes her ashes can be placed on her father's grave, but first a relative must come forward.

People living alone need wills too.

Posted by Jill Fallon at 5:51 AM | Permalink | TrackBack

February 27, 2007

Adopting an Older, Sexual Partner

Can you adopt someone older than you are?  Olive Watson did.
A lesbian, she 'adopted' her partner Patricia Spado in Maine where they summered.  Their 14 year relationship ended in 1992 but the adoption didn't.

At stake now is her share as a "grandchild" of Thomas Watson, who set up trusts for his grandchildren.  He never knew of the adoption.

Also at issue is the validity of the adoption of a sexual partner.

Family of IBM Pioneer Seeks to Exclude Heir's Adopted Lesbian Lover from Inheritance.

Posted by Jill Fallon at 7:55 AM | Permalink | TrackBack

February 26, 2007

Deconstruct this

The late philosopher Jacques Derrida was considered the father of deconstruction which, to greatly oversimplify, holds that the meaning of words depends on the assumptions of the people who wrote them.  I find the theory impossible to understand, others have called it bewildering, but it has been exceptionally influential in this post-modern age because it questions the concept of universal truth and whether anyone can know anything for sure.

At the end of his career, Derrida was a professor at the University of California at Irvine, and signed an agreement in 1990  to donate his  archives to them.

Shortly before his death, he threatened to pull the plug on his agreement because he didn't like the way the University was investigating a Russian studies professor who was accused of sexually harassing a graduate student.  The professor was a vampire expert who taught a popular class on vampires and signed his e-mails with a colon to symbolize Dracula bite marks, used his position as the student's advisor to manipulate her into a series of sexual encounters...invited the woman to his apartment to view photos of Moscow.. plied the student with Transylvanian wine and opera music

So when Derrida's heirs didn't turn over the archives, the university sued his widow.

A Philosophical View of Sex from the LA Times is all about the contest between the widow and the university.

My second favorite line after  "he signed his emails with a colon to symbolize Dracula bite marks"  is a quotation from an unnamed blogger Given that Derrida's philosophical legacy is the notion that words have no meaning, shouldn't the bright minds at UC Irvine have realized that 'an agreement he signed' might not be worth much?"

I just googled the entire quote and found the John Miller, the national political reporter for the National Review said it. No wonder the LA Times didn't name him.

Posted by Jill Fallon at 2:52 PM | Permalink | TrackBack

February 22, 2007

Trump wedding chapel to mausoleum

Donald Trump is eyeing N.J golf course for his grave site.

First though, he has to get approval to build a wedding chapel on the golf course he built on the  former estate of the late automaker John DeLorean.

Then, he plans to convert it to a mausoleum for himself and his family.

I guess he plans to see his children married and hear wedding bells first.

Posted by Jill Fallon at 10:10 PM | Permalink | TrackBack

February 14, 2007

More Anna Nicole

Sadly, Anna Nicole Smith is not resting in peace.

There is a Tug of War over Anna's Body among her mother who wants to bury her, her putative husband Howard Stern and Larry Birkhead who per court order has a legal hold on her body until a DNA sample is forthcoming.

Not to mention the possibility that the father of her baby is her dead husband via his frozen sperm.

Or is it the bodyguard?

Here's a lovely reminiscence by Larry Miller

I liked her, and so did you, even if you didn't. No one in the public eye dies without making us stop and think. Shall we turn up our noses at her because she wasn't Katharine Hepburn? She did pretty well with what she was given, so let's not scoff because she wasn't a great poet or leader. Will I mourn more deeply, say, when the sad day comes and Jimmy Carter passes away? Less, I think.

Posted by Jill Fallon at 9:55 AM | Permalink

February 9, 2007

Anna Nicole Smith Dies and The Mother of All Estate Battles Begins

Anna Nicole Smith, dead at 39  as reported by The New York Times
a former Playboy centerfold, actress and television personality who was famous, above all, for being famous, but also for being sporadically rich and chronically litigious, was found dead on Thursday in her suite at the Seminole Hard Rock Cafe Hotel and Casino in Hollywood, Fla.

They also call her
obtrusively voluptuous and almost preternaturally blonde.

One of six children born to a single mother, Vickie Hogan dropped out of high school, married a chicken fry cook she met at Jim's Krispy Fried Chicken in Mexia, Texas, gave birth to son Daniel and separated from his father, all before she was 20.

She left her son with her mother to seek her fortune as a topless dancer. With her extraordinary body and beauty,  fortune she found.

   Anna Nicole Smith

She was on the cover of Playboy magazine as Playmate of the Year, took the name of Anne Nicole Smith when she signed a contract to model Guess Jeans.  She became the most famous gold digger in America when married an 89-year-old oil tycoon J Howard Marshall.    When her husband died 14 months later,  her legal battles began.

J.Howard Marshall's estate was worth $1.4 billion.
There was no pre-nuptial agreement

Anna Nicole Smith battled Marshall's stepson Pierce for her share in the estate.
She filed for bankruptcy in 1999.

In 2000, she won a $474 million judgment in a California court that was thrown out by a Texas state court.

She appealed to a federal court, took her battle to the U.S. Supreme Court and won a unanimous decision that allowed her to continue her legal battle in federal court.

In 2006, Pierce Marshall died at 67.  His widow continues the legal case in his place.

Anna Nicole gave birth in September, 2006 to a baby girl, and did not name the biological father.

Her son Daniel died 3 days later while visiting his mother and newborn sister in the hospital from a toxic combination of Zoloft, Lexapro and methadone.

Later that month, Anna Nicole and her lawyer Howard Stern exchanged commitment vows aboard a catamaran off the coast of the Bahamas.  No marriage certificate was issued.

Howard Stern's name appears on the birth certificate issued in the Bahamas.

Her former boyfriend photojournalist Larry Birkhead claims he is the biological father and has filed suit to claim paternity.

Last Wednesday, a class action suit was filed against  her and Trimspa for false and misleading marketing.  She became the spokesman for the weight loss supplement after she lost 69 pounds.

The little baby, Dannielynn Hope Marshall Stern, is the sole heir-at-law.
Whoever is judged her father stands to control whatever the estate of Anna Nicole wins.

It will be a gargantuan battle of estate vs estate, that will take years to unravel.  I expect it to be  the mother of all estate battles saving Jarndyce vs. Jarndyce

Christopher Cline of the law firm Holland and Knight, who is an estate planning specialist,
he has never seen a case “with more moving parts.”

Outstanding questions include not only the paternity of her daughter, but if she died with a will and how her death will affect the lawsuit pending against the Marshall estate. It also wasn't clear where she legally lived when she died.

“It's a really large legal quagmire,” Cline said.

More in the you-can't-make-this-stuff-up department - her dead husband, over whose money everyone is fighting, was a former professor of trusts and estates at Yale Law School.

Update to more stuff you couldn't make up.  The husband of Zsa Zsa Gabor said he had a 10 year long affair with Anna Nicole and could be the father of the baby girl.  He with the title of Prince Frederick von Anhalt said Anna Nicole wanted to be a princess like Zsa Zsa.  He offered to adopt her but Gabor wouldn't sign the papers!

Update 2 -comments from around the web.

What Drew Us to Anna Nicole?

many people were hard pressed to describe what exactly Anna Nicole Smith was. Actress? Model? Reality star? Rich widow? ''I don't know exactly what she did,'' said talk show host Joy Behar, hearing the news over the phone. And yet, trying to put her finger on why we watched this strange woman over the years, she came up with two things: Dysfunction. And beauty.

''With Anna Nicole, she was pathetic but at the same time you thought, 'Gosh, if I could just scoop you up and fix things, it would be OK,''' said Jerry Herron, a professor of American culture at Wayne State University. ''You wouldn't want to scoop up Paris Hilton.'''

Ann Althouse
Ah, yes. The classic two types of hyper-sexualized women -- the kind you think you can help, who just really need you, and the ones who seem ready to crush you if you came anywhere near. Anna Nicole is to Paris Hilton as Marilyn Monroe is to Madonna.

Update 3
Her body will be preserved for 10 days ordered the judge in the hearing today on the request by putative dad Larry Birkhead for an emergency DNA Test "so no one could switch the baby."

Posted by Jill Fallon at 9:06 AM | Permalink | TrackBack

January 26, 2007

Man Leaves Money to Strangers

If you don't have any family, you could do what Luis da Camera did and pick names from the phone book.

Portuguese man left money in his will to 70 strangers

Luis da Camara made his will at the age of 29 by picking names out of the Lisbon telephone directory.

He had no family, reports the Mirror.

Luis died earlier this month, aged just 42, leaving two houses, a car and £17,000 in cash.

The 70 strangers will each get around £6,000.

One beneficiary Helena Suares, 76, said: "At first I thought it was a hoax, but I need the money and I am very grateful to him."

Posted by Jill Fallon at 10:07 AM | Permalink | TrackBack

November 26, 2006

Jack Kerouac

Jack Kerouac lived and wrote before my time, still when I finally read Dharma Bums.   I was as entranced with the sweetness of the man as I was with his zest for life and search for truth, not to mention his sheer good looks.

Dharma Bums is an autobiographical novel, set in California, following the publication and amazing success of On the Road of which he said, "I wrote the book because we're all going to die."

Here's a video of Jack  reading from On the Road.

But the best place to see that sweetness is in Steve Allen's interview of Jack on YouTube

via Boing Boing

Some of my favorite Kerouac quotes.

“All of life is a foreign country.”

“I hope it is true that a man can die and yet not only live in others but give them life, and not only life, but that great consciousness of life.”

Dean took out other pictures. I realized these were all the snapshots which our children would look at someday with wonder, thinking their parents had lived smooth, well-ordered, estabilished-within-the-photo lives and got up in the morning to walk proudly on the sidewalks of life, never dreaming the raggedy madness and riot of our actual lives, our actual night, the hell of it, the senseless nightmare road.

“Write in recollection and amazement for yourself”

His estate on his death in 1969 was worth $91.  By 2004, it was worth an estimated $20 million.

Jack Boulware writes about the unbelievable complexities of his literary estate  in The Kerouac Obssession

The legal situation surrounding the Kerouac estate is so mysterious and confusing as to be almost impenetrable. These, however, are the basic facts: When Jack Kerouac died, he left everything to his mother, Gabrielle. When she died, her will left her entire estate, including Jack Kerouac’s literary materials, to Stella Sampas, Jack’s third wife. In 1994, Kerouac’s only daughter, Jan, contended this will was a forgery, and filed an action in Florida, the state in which Gabrielle died, contesting the probate of her grandmother’s will. This is the action that Nicosia has championed, as an heir and literary representative of Jan Kerouac, even after her death. 

Jan met her father for the first time in 1962, when her mother’s efforts to gain child support finally forced Kerouac to take a paternity blood test. (The result was positive.) As a 9-year-old, she nervously accompanied him to the liquor store for a bottle of Harveys Bristol Cream sherry, and saved the cork as a reminder that she did indeed have a father.
Johnny Depp's purchase invoice of Kerouac memorabilia

The Kerouac raincoat, $15,000; suitcase, $10,000; travel bag, $5,000; sweat shirt, $2,000; rain hat, $3,000; tweed coat, $10,000; a letter to fellow road-tripper Neal Cassady, $5,000; and a canceled check to a liquor store, $350.

The total is $50,640, including tax.

Posted by Jill Fallon at 5:26 PM | Permalink | TrackBack

August 25, 2006

New Law Eases Taxes on Inherited 401(k)s

A big problem with inherited 401(k)s has just been solved with legislation signed yesterday by President Bush.

Heirs who aren't spouses can now roll over retirement accounts into their IRAs.

Wall St Journal Tax Report

Congress's Joint Committee on Taxation estimates the change will save taxpayers about $291 million over the next decade alone. But be careful: The new law is effective only for distributions made after the end of this year.

"In my 20 years of practice, I have seen dozens of families and tax advisers who would have benefited" from the new provision, says Robert S. Keebler, a certified public accountant at Virchow Krause & Co. in Green Bay, Wis. In most of those cases, a parent died, leaving retirement-plan money to a child who was forced, under the plan's rules, to withdraw money from the plan within five years -- and, in some cases, immediately, Mr. Keebler says in a new book from CCH, a Riverwoods, Ill., publisher of tax information.

Posted by Jill Fallon at 3:30 PM | Permalink | TrackBack

June 26, 2006

Dividing an Estate Among Half Siblings

The minefields of dividing an estate among different siblings.

"If you're not careful, it can cause people to be bitter for decades, it can ruin relationships," says Chris Dardaman, chief executive officer of Brightworth LLC, a financial advisory firm in Atlanta.

Tips on Dividing an Estate Among Half Siblings by Bridget O'Brian in the Wall Stree Journal

• Sit down with the entire family to discuss the estate plans. Each family needs to determine how specific to get on the topic of numbers, but at the very least such a confab can eliminate negative surprises. "You want, to the extent you can, to remove the emotional powder kegs," says Mr. Dardaman.

• Consider providing for each of your children -- from all marriages -- in your will. Such a move could eliminate or reduce the chance that one or more of the children would contest your will, says Mr. Nass. It's also helpful to write a side letter, or a note to your children, explaining why you've structured things the way you have and, perhaps, to assuage bruised feelings.

• You don't want bitterness between the families to turn into the adult kids fighting the widowed spouse, says Ms. Vasileff. Be sure the second spouse understands and is supportive of your plans.

• Consider an irrevocable insurance trust, a move that can help to avoid probate altogether.

Posted by Jill Fallon at 11:50 PM | Permalink | TrackBack

June 3, 2006

The Red Will

When times change, it's time to review your will unlike the Frenchman, Albert Le Roy, a hardline Marxist, who left his money to his small village council "to prepare for communism."

It's quite split the small village who don't know what to do.

Village red-faced at butcher's late call to revolution.

Posted by Jill Fallon at 11:37 PM | Permalink

May 15, 2006

Weekend Joke

From Happy Catholic comes this weekend joke.

An elderly gentleman had serious hearing problems for a number of years.

He went to the doctor and the doctor was able to have him fitted for a set of hearing aids that allowed the gentleman to hear 100%.

The elderly gentleman went back in a month to the doctor and the doctor said, "Your hearing is perfect. Your family must be really pleased that you can hear again."

The gentleman replied, "Oh, I haven't told my family yet. I just sit around and listen to the conversations. I've changed my will three times!"

Posted by Jill Fallon at 1:05 AM | Permalink

May 10, 2006

Art Honoring Life

Funeria, an arts agency, is leading the emerging funerary arts movement.

Funeria offers a portfolio of some 70 designs, of hand-made, museum-quality, artist-made funerary vessels.

  Ashes To Art

It's certainly time for more thought and beauty for the urns, vessels and reliquaries for cremated remains. As one wag said, "You've urned it!"

If you are an artist, you may be interested in their call for entries 2006 in the Ashes to Art collection.

The deadline is August 19, 2006. The Ashes to Art exhibition will be in Philadelphia in October.

Posted by Jill Fallon at 9:22 PM | Permalink

Art Honoring Life

Funeria, an arts agency, is leading the emerging funerary arts movement.

Funeria offers a portfolio of some 70 designs, of hand-made, museum-quality, artist-made funerary vessels.

  Ashes To Art

It's certainly time for more thought and beauty for the urns, vessels and reliquaries for cremated remains.  As one wag said, "You've urned it!"

If you are an artist, you may be interested in their call for entries 2006 in the Ashes to Art collection. 

The deadline is August 19, 2006.  The Ashes to Art exhibition will be in Philadelphia in October.

Posted by Jill Fallon at 6:22 PM | Permalink | TrackBack

May 4, 2006

The Ashes of Kirby Puckett

Leaving no written directions about how he wanted to be buried or who should have his ashes, Baseball Hall of Famer Kirby Puckett left plenty of work for the lawyers for his children and his fiancee.

Posted by Jill Fallon at 9:55 PM | Permalink

April 3, 2006

Blue Light Coffins

Helen Baxter in North Scituate, R.I. makes coffins that are not only beautiful, but can be used as furniture until the last day comes.

Her creations make an eternal impression.

Baxter points to the eye-grabber in the store, a tall lavender bookshelf with a delicate design of lilacs painted behind the single shelf. Around the sides of the recently-finished piece are tiny green willow leaves, and the strong arms of an oak tree wrap around the outside frame, as though protecting it. The only giveaway that this is an antique-style coffin, standing upright, is its hexagonal shape. The coffin lid, which Baxter says is usually stowed away while the coffin is being used as furniture, has birch tree branches painted on it. The woman who commissioned the coffin, she explains, is a perfectly healthy 61-year-old nurse named Helen Busby. ''She said she liked birches, oaks, and willows," Baxter says. ''When she's laid out it will be really beautiful."

The Blue Light Coffin Co.

My coffins are handcrafted and handpainted. Many people order them early in life so that they may serve more than their final intended purpose. My coffins are designed to be practical and beautiful in a home for years in advance of need, serving as blanket chests, window seats, coffee tables and more.

Posted by Jill Fallon at 1:10 PM | Permalink

March 17, 2006

Body $natcher

When a tragic, horrific death becomes a battle over money.

The first time he ever saw his daughter, she was laid out in a coffin.

But now, the biological father of Nixzmary Brown wants control of her estate - which could reap millions from lawsuits against the city.

The NY Post calls him a Body $natcher

Posted by Jill Fallon at 2:00 PM | Permalink

February 28, 2006

Students thank cadavers

First year medical students paid homage to those who had donated their bodies to science and education. Students thank cadavers for 'gift'

During the brief memorial service, humble observations and boundless gratitude spilled from students who'd learned much about the human body through six months of dissection.


Erica Moyer brushed away tears while she reflected on the sacrifice of the individual whose body was donated for her education.

"This was pretty intense for me. I'm pretty sensitive toward death anyway," the 24-year-old said. "I have a deep respect for these people that would do that."

Posted by Jill Fallon at 1:44 PM | Permalink

February 6, 2006

Life Support - A Passalong

Someone sent me this a while ago. With the Superbowl just over, it seems timely

Life Support

A man and his wife were sitting in the living room and he said to her,

"Just so you know, I never want to live in a vegetative state, dependent on some machine and fluids from a bottle. If that ever happens, just pull the plug."

His wife got up, turned off the football game, unplugged the TV and threw out all of his beer.

Posted by Jill Fallon at 6:01 PM | Permalink

January 27, 2006

Charlie plays

Charles Krauthammer pens a moving tribute to his brother in today's Washington Post.

Whenever I look at that picture, I know what we were thinking at the moment it was taken: It will forever be thus. Ever brothers. Ever young. Ever summer.

Sadly, it's never "forever thus" however timeless the moment.

Posted by Jill Fallon at 8:12 PM | Permalink

January 24, 2006

Too Cold

What Ted Williams and Walt Disney have in common is the belief that they can be revived years after death when medicine has advanced sufficiently to cure whatever caused their deaths.

There are some 1000 people in the cryonics movement who have arranged to have their bodies frozen in liquid nitrogen until the time is right to thaw them out. Some 142 human bodies or heads are already so frozen.

I always thought it was nuts myself, but never more so than when I read in the Wall Street Journal that they are leaving their money to themselves! A Cold Calculus Leads Cryonauts to Put Assets on Ice.

With the help of an estate planner, Mr. Pizer has created legal arrangements for a financial trust that will manage his roughly $10 million in land and stock holdings until he is re-animated. Mr. Pizer says that with his money earning interest while he is frozen, he could wake up in 100 years the "richest man in the world."
At least a dozen wealthy American and foreign businessmen are testing unfamiliar legal territory by creating so-called personal revival trusts designed to allow them to reclaim their riches hundreds, or even thousands, of years into the future.
Such financial arrangements, which tie up money that might otherwise go to heirs or charities, are "more widespread than I originally thought," says A. Christopher Sega, an adjunct professor of law at Georgetown University and a trusts and estates attorney at Venable LLP, in Washington. Mr. Sega says he's created three revival trusts in the last year.

On Personal Revival Trusts

Ashes to ashes, dust to dust, leaving money to yourself is nothing but nuts.

Posted by Jill Fallon at 4:37 AM | Permalink

November 7, 2005

Blessing Ahmed

A rose amidst the ashes. A beautiful story of the family of a 13 year old Palestinian boy who had been shot dead by IDF soldiers who mistook his toy gun for a real one.

The parents decided to donate the organs "for the sake of peace between the two people". Ariel Sharon invited the father to meet with him and accept his apology and his gratitude.

Ahmed's heart has been transplanted into the body of a 12 year old girl.
Ahmed's liver was donated to a six month old baby and a 66 year old woman.
Ahmed's lungs will be donated to a 14 year old Cystic Fibrosis patient.
Ahmed's kidneys will be donated to a 5 year old boy and 4 girl.

An exceptional deed indeed and a Great Legacy. Many people are blessing Ahmed and his family today. You too will be blessed if you ...Donate Life. Hat Tip, Charles Johnson at LGF

  Donate Life-2

Posted by Jill Fallon at 2:39 AM | Permalink

October 1, 2005

$50 million Jennings' Estate

ABC News reports that Peter Jenning left an estate worth over $50 million.

The New York Daily News got the first look at Peter Jenning's will which was filed Wednesday in the New York's Surrogate Court in Manhattan.

Jennings, 67, left the bulk of his estate in trust for his two children, Elizabeth, 25, and Christopher, 23, from his marriage to writer Kati Marton, according to the will, filed Wednesday in Manhattan Surrogate's Court.
He left his Central Park West apartment to his widow, Kayce Freed, whom he wed in 1997, as well as a portion of his estate, as laid out in a prenuptial agreement the couple signed before their wedding.
Jennings, who died last month after battling lung cancer, reportedly earned as much as $10 million a year during part of his tenure at ABC. His will lists $50 million in personal property and $3.5 million in real property in New York.

Posted by Jill Fallon at 12:39 AM | Permalink

September 20, 2005

Bob Dylan's Legacy

Bob Dylan is looking to control his own legacy reports the Wall St. Journal. If Dylan's taking care to choose how he wants to be remembered, shouldn't you be thinking about the same thing?

With a torrent of new projects focusing on his most-revered period, from 1961 to 1966, the singer is pre-empting the posthumous image-massaging that has confronted many rock estates by dealing with his own legacy now, while the 64-year-old is still very much alive.

The DVD release today of the 3½-hour, Martin Scorsese-directed documentary "No Direction Home: Bob Dylan" is part of a multipronged project in which Mr. Dylan has aggressively focused attention on his transformation from baby-faced folk singer to rock 'n' roll icon.

In that way, Mr. Dylan is staking out unusual ground for a rock star. The process of picking through an artist's archives for clues about his or her creative evolution is often left to heirs and others after the musician's death. The estates of Jimi Hendrix, Mr. Cobain and Tupac Shakur all have made cottage industries of issuing rarities, album outtakes, obscure live recordings, and the like. But that process is often contentious, like the long legal battle among Mr. Hendrix's heirs, record labels and producers. The fights frequently lead to cheap repackagings of old material, designed more to make heirs a quick buck than to craft a lasting legacy.

Posted by Jill Fallon at 6:21 PM | Permalink

September 8, 2005

Guidance for Mourners

Tom Peters reports in Nice! on an obituary he chanced upon in the Vineyard Gazette.  The deceased was Stanley Murray and the guidance to mourners was as follows:

"In lieu of flowers, please buy some coffee for the person behind you in line at Dippin' Donuts or Espresso Love and tell them it's from Stan."

Posted by Jill Fallon at 4:08 PM | Permalink

August 20, 2005

Do Not Open Until My Death

If you have a deep dark secret that implicates yourself or someone in your family as an accomplice in a murder, a secret that might solve a mystery that has puzzled the nation for years, then writing what you know down and sealing it in an envelope marked Do Not Open Until My Death is the way to go.

After 73 years, the mystery of what happened to Judge Crater, "the most missingest man in America" may be solved because one woman left such a letter in her safety deposit box.

From ABC News

On Aug. 6, 1930, Judge Joseph F. Crater stepped off a midtown Manhattan curb and into a cab after seeing a Broadway play with his showgirl girlfriend. He was never heard from again.
The possible break in the case came after the death a little more than two months ago of an elderly woman, whose name is being withheld by detectives at this time.

The woman's death prompted her family to open a safe-deposit box where they discovered a letter labeled "Do Not Open Until My Death." In the letter, the woman recounted her own father's deathbed statements to her, statements which, if true, could bring to a close one of the oldest enduring mysteries in America. And so far, detectives say, everything the woman wrote has been corroborated.

The letter contained the names of cab driver Frank Burn, and his brother, a police officer named Charles. The letter claimed that Frank Burn had killed Crater and buried the body under the boardwalk at New York's Coney Island. Charles Burn was named as the killer in another notorious homicide.

Posted by Jill Fallon at 5:48 PM | Permalink

August 2, 2005

Starving the Dying

In England, the terminally ill can be starved to death.  So ruled an appeal court in the U.K.

No longer must doctors follow a patient's wishes, even if clearly stated by a mentally competent patient who is terminally ill. 

Doctors  get the final say once a patient can no longer communicate.  They can withdraw artificial nutrition and hydration (ANH) if they consider it 'overly burdensome'.

I find this a very troubling ruling because it seems to draw the line between those worth feeding and those you can starve solely on their ability to communicate.

It's not our ability to communicate that's distinguishes humans from other species, but our consciousness.

Those who are in a "locked in" state are alert and wakeful even if they are paralyzed and unable to speak.  One of them, Jean-Dominque Bauby, even wrote a book about it .


"The Diving Bell and the Butterfly : A Memoir of Life in Death"

Posted by Jill Fallon at 2:08 PM | Permalink

July 29, 2005

Stud farm legacy

A racehouse trainer, Neil Adam, won the Prix de l'Abbaye at Longchamp two years running.  He built up a stud farm, Collin Stud,  near Newmarket, which he left to his two daughters in 1997, one of whom is a qualified veterinarian.

By 2001, Neil Adam was paralysed with multiple sclerosis  and could only communicate by nodding, winking and shaking his head.  Still he made out a second will leaving the stud farm to its manager and head groom.

The two sisters  succeeded in overturning their father's last will.  The deputy High Court judge said,

"In my judgment, it is likely that there was a temporary poisoning of his natural affection for his daughters, or a perversion of his sense of right, the nature of which nobody can satisfactorily explain," said the judge.

He added that he realised his decision would be hard on Mr Sharp, 44, and Mr Bryson, 39, both of whom worked for Mr Adam since leaving school.

"There is every likelihood that the decision to benefit them resulted from rational thought, in which Mr Adam recognised his considerable debt of gratitude to them," said the judge.

"Nevertheless, I cannot conclude that the will as a whole was rationally made, or that Mr Adam's natural feelings for his daughters, or his sense of right, were unaffected by disorder of the mind."

The judge granted permission for the case to be appealed and said,

"I have been struck throughout the case by the great affection everyone had for Mr Adam and the extremely kind way in which everybody treated him. If that could result in some resolution of the issues between the parties, it might be a fitting tribute to him."

Good legal advice would have obviated this "awful business."

Posted by Jill Fallon at 3:49 PM | Permalink

July 13, 2005

Cash at the Grave

If you want your family to visit your grave, you have to pay them, or at least that's what Morris Gorski thought.

Gorski, a popular businessman who owned a number of properties, got permission before his death to have a cash machine installed in his tombstone at the Chester Jewish Cemetery.

Now when any one of his 25 heirs turn up at the gravestone, they can collect up to 750 pounds.  No more than once a week though.

According to the Board of Guardians of British Jews, other people will be able to do the same if Gorski's incentive proves popular.

HT Hanan Levin

UPDATE:  It took Richard, a commenter, to point out to me that the site I  linked to is a "satire" site based on real life.  Is my face ever red, taken in by a too-good-to-be true story.

Posted by Jill Fallon at 3:25 PM | Permalink

July 1, 2005

After the Brando Auction

His biographer Peter Manso said

I think the whole auction is creepy and I can tell you I'm not the only one who thinks so after spending two days with (Brando's son) Christian."
"The auction borders on complete tastelessness and Brando would never, ever, ever have wanted this," the author of "Brando: The Biography" told Reuters by telephone.
According to Manso, Brando left instructions that his bedroom be sealed with a padlock after his death.
"I can assure you Marlon is turning over in his grave to think that someone has his driver's license."

The sale of Brando's personal effects raised more than $2.4 million to be divided among his nine children.

Posted by Jill Fallon at 2:39 PM | Permalink

June 1, 2005

Widow can't use husband's sperm

In Australia, a widow can not impregnate herself with her dead husband's sperm without his written consent.

The 36-year-old woman had been married to her husband for more than eight years when he was killed in a car accident in July 1998.

Within 24 hours of his death, the woman, who can only be identified as AB, received permission from the Victorian Supreme Court - and the consent of the dead man's parents - to have his sperm taken and stored at a Melbourne hospital.

But yesterday, Justice Hargrave said the law did not allow the taking of sperm or ova from the dead for the purpose of reproduction if the person had not consented in writing to the procedure before their death.

In this case, the man, who was 29 when he died, had not given written consent for the posthumous removal and use of his sperm

Widow can't use husband's sperm

Yet another thing for young couples to think about before they visit their lawyer to make their wills.    Probably a good idea for American couples as well.

Posted by Jill Fallon at 2:01 PM | Permalink

May 24, 2005

Joan Didion on Schiavo

A very even-handed fair look at the Case of Theresa Schiavo by Joan Didion, one of our greatest living writers, in the New York Review of Books.

HT Amy Welborn

Posted by Jill Fallon at 1:38 PM | Permalink

May 16, 2005

Never Say Never

In talking about end of life issues,  there's one phrase you hear over and over, it's I don't want to be a burden.   

Can someone who's a "burden" also serve, even give?  Who measures the quality of life anyway?  Mary Beth McCauley writes in the Christian Science Monitor on The issues beyond right-to-die.

This is surely the most loathed condition in our era of the fit, beautiful, and self-sufficient. Who could ever submit voluntarily to an existence that's all take and no give? And so it has evolved, almost without question, that we've embraced this "don't want to be a burden" idea as valid - that if you're potentially needy you want to make your exit posthaste.....
But few who have gone the distance with serious illness would say that the experience didn't open them to a quality of relationship they never knew existed. Few haven't found themselves changed on the most basic level by the process, haven't become different - a better person, if you will - than they'd thought possible previously. And who, exactly, is the "giver" in such situations anyhow? Don't those who do the burdening themselves serve by allowing another the opportunity to give?
To expect anyone to embrace such a situation trivializes the excruciating pain that comes with lost dreams and intolerable demands. That said, people who've been there know well that the burdenhood model misrepresents a reality that often allows - if fleetingly - for physical and spiritual .

That debate shouldn't end privately, in the lawyer's office.....  Do we continue in lock step behind the convenient premise that the sick are a burden?...
.... there is shortsightedness in expecting the healthcare industry to make end-of-life policy. Thus the need to press the debate. After all, most of us have seen too many modern-day Lazaruses, watched too many lives made great by impossible medical challenges, to believe that "protocol" should measure the quality of our lives, or, finally, dictate the number of our days

Posted by Jill Fallon at 2:18 AM | Permalink

May 15, 2005

The Dead Don't Talk

Because celebrity spokesmen often get into trouble, advertisers like dead people, especially the certainty they won't talk says Truman Taylor

That's why Marilyn Monroe earned $7 million last year,  Elvis earned $40 million.  Even Einstein pulled in $1 million last year, appearing in ads for Apple computers, Fuji film and Chrysler cars.

  Elvis, Mm And Einstein

Happy heirs.

Posted by Jill Fallon at 5:42 AM | Permalink

May 9, 2005

Your Digital Assets

People are finally coming to realize that they have "digital assets" and they are real assets, something of value and valuable for many reasons.  So just what happens to your digital assets when you die or if you become incapacitated?

What do you want done with your blog? 
Who knows how to get to your photos posted on the Kodak Gallery or Flickr? 
Do you want your family to read your email?
Do you have address books that are only available online?
What are the usernames and passwords to your online accounts?
Do you have any files that exist only online with a third party?
Do you have work files on your computer that should be returned to your employer?
Who gets to go through your computer and clean out any files you don't want anyone to see like a porn collection?
Who gets your iPod and the music on it?

These issues are attracting increasing attention.  The Christian Science Monitor asks Who Gets to see the email of the deceased?    Darren Barefoot wonders if it isn't time for  Digital Morticians .  Joel Schoenmeyer, a Chicago area estate planning lawyer writes about the need for a Technology Inventory as does law professor Gerry Beyer.  Darren Rowse in Problogger wonders what would happen to his blog which happens to be an income-producing asset in Blogging Fears - Death.

Just where should you put all those bits and pieces about your digital assets and your online life?  Is it your will?

Your will is not the only way or the document with which you can direct how you want things to be done after your death.  There are a lot of things that you want someone to know and a will is not necessarily the best place to tell him or her.  After all, a will is a public document.  And you certainly don't want to go to your attorney to add a new codicil every time you change a user name or password to an online account.

There is a vehicle, too little used, called “Letter to your Executor”.  It's the ultimate in do-it-yourself.  Since it is only a letter and not a will, it is not legally binding, but it is morally binding.  And it’s just the place to leave directions of how you want certain things handled after your death.  I call it the “Gift of Good Directions,” a fine complement to the Gift of Good Records, your master list of what and where everything is and who to contact. 

A digression here, to talk about the third in this trio- the Gift of a Lifetime, your Personal Legacy Archives.  Few of us will have biographers, all of us are archivists of our own lives.  Lost among the ephemera, files and shoeboxes filled with photos we all have are the stories and the meaning.  What were the top ten highlights of your life?  What did you love and why?  Where were the "choice-points" in your life, where you could have gone either way, but chose one? And how did it turn out?  What do you regret?  What are your proudest achievements?  What's your favorite music, the moments you'll never forget?  What do you want your children to know about you?  What have you left unsaid that you want said? 

While there are few Mount Rushmore lives, Joseph Cooper says, each of us carves out a bit of history that should be put down for our own edification and for our families and friends.  For his son, he's set down his own Monuments to a Decent Life.  Ronni Bennett calls them Stories for the Infinite Future.  As one who spent much of her professional life with celebrities, she says with great authority, No Lives Are Ordinary.   

Time was when people kept journals and wrote letters  They were just like bloggers. Take Henry Thoreau.  Or Samuel Pepys.  Some, like Mark Twain, kept scrapbooks.  Others were just ordinary people, like these emigrants and pioneers, or these diarists in Britain during World War II.   

Ordinary letters to a new grandson written in 1918 are a precious family heirloom 90 years later.  Such journals and letters preserve personal and family memories as well as the sense of times gone by by people long gone, but not forgotten.  Some rise to become societal memories.  We can understand better what things were like for the Jews during World War II because we've read the Diary of Anne Frank.   

Human nature is constant, it doesn't change over time.  We experience the same emotions love and fear, gratitude and shame, as people did a thousand years ago.  It's only the people, the details and the stories that change.  But those details and those stories are what we want to pass on into the future.  It's what you want your loved ones to know.  It's what they want to know.  Only we no longer keep journals or write many letters. 

That's why many of us write blogs - to keep a record of where we were and what we thought.  The more we write, the more valuable the blog becomes and not just for its "long tail".    Some bloggers show us the way of suffering with illness and facing death and they are Truly Noble and their work deserves to be preserved.  For most of us, we'd like our families or friends to have our blog after we're gone;  we don't want our blog to  just disappear into the ether.  The world will go on after you die, but not your blog unless someone pays the hosting fees.  You are the one that can decide whether your blog will have an afterlife.  Thinking ahead, Ronni Bennett has set aside money to pay for her blog host for at least a year and to download her blog to CDs for whoever wants a copy. 

Details like what you want done about your blog and your other digital assets are the sort of directions you leave in your Letter to your Executor. With a Letter to your Executor, you can update it and revise it as often as you want.  Just be sure to date it so it doesn't get confused with earlier letters.  I recommend printing it out as well to file with your other important papers.  Copies of all important papers should be kept in a steel box so that it can be grabbed in a moment if you must leave your house in an emergency.  The steel should protect your files against fires and you may want to get one with a key so you can keep it locked and safe from prying eyes.

Because it's so easily revised and costs nothing to revise, your Letter to your Executor is also the ideal document for other directions that may change on a fairly frequent basis, like the music you want played at your funeral or what you want engraved on your tombstone, how to take care of your pets, or the small sentimental gifts you want distributed to friends.   

Once you get into it, you realize there's a whole lot of context that doesn't and will never appear in the legal documents of your estate plan.
Everyone should have a will, a durable power of attorney, and a health care proxy or power of attorney first, but once that's done, spend some time to think about the context, those details that express who you are. 

Once you've formalized who you want as guardians for your children, what do you want them to pay particular attention to.  Helen Harcombe was dying of cancer, so she composed a detailed mommy manual to tell her husband things he wouldn't think about in raising their seven year old daughter alone.  No will is ever going to contain the phrase, "Bath and hair every other night, AT LEAST.  No child of mine to be smelly."  For her husband, it was "great comfort."  Her daughter Ffion said when she saw the manual, "That makes me feel a lot better, Daddy." 

Any guardian, any child will be happier if they knew what you wanted them to do and pay special attention to.  A letter to the guardians of your children will be invaluable guidance.  Now this may seem a whole lot of trouble to write directions for something that will likely never happen.  So think of it as an on-going letter about what you want for your children and what you think is important at different stages in their lives.  It could be a letter you write each year on their birthdays or on Mother's Day.    That way, you are creating something valuable for them after you're gone, something they'll treasure as part of your personal legacy, the gift of who you are.  Such a letter becomes a chronological record of how you saw your children as they grew up.  What grist for the mill when they start therapy or have children of their own!

Directions are important too for your health care agent.  So write a letter to your health care agent  describing how you would like to be taken care of should you fall ill and be unable to communicate. 

(If you haven't executed a health care proxy, otherwise known as a power of attorney for health care, and of course you know you should, you haven't faced the grid many lawyers will present you of the almost limitless health care decisions your health care agent could be asked to make.) 

A living will is almost useless because it can't anticipate the circumstances or the complicated decisions that will have to be made in your future.  That's why choosing one person you trust to act in your stead is Better than a Living Will

More important for your comfort and quality of life are the directions you leave for your health care agent.  There's a lot of room between "doing everything" and "doing nothing." 

What you consider a "quality of life" you want to hold on to is quite likely is not the same as someone else's.  But if you don't give your health care agent a clue as to what you want or just how far you want to go, you are just making it harder for them.    Again, you will never find such guidance in a legal document.  Mystic Knight wrote his directions the night before he faced an operation.  I've done mine in Living the Way Terri Was and my health care agent says she definitely wants my playlist.  You will not find playlists in legal documents.

I expect to change my mind about these things almost as often as I redecorate, not a constant pre-occupation, but a periodic one.  So will you. Think of your estate plan as the architecture.  The furnishings, the little details you want to add or subtract or update will change periodically, but  they don't require an architect or a builder  - or a lawyer.  They just require your keeping a Letter to Your Executor - changing it as often as you want - in a safe place.

Posted by Jill Fallon at 2:29 PM | Permalink

April 30, 2005

Cancer mother's legacy to her family

Here's a wonderful example of how good directions can make a great legacy.

Even while she lay dying from breast cancer in Wales, Helen Harcombe left instructions to her husband from raising her seven year old daughter, Ffion.

  Helen Harcombe And FfionHere's some of Helen's to do list for her husband.

Uniform bought every September. Check hair for nits regularly.
• Bath and hair every other night, AT LEAST. No child of mine to be smelly.
• Make sure you serve food with veg/peas. Get fruit down her. Don't let her live out of cans, noodles and toast etc.
• At Christmas time don't forget the smaller things like stocking fillers to make it look more and fill up the stocking - chocolates, bobbles, clips, make up, fun stuff etc.
• Bedding should be changed once a fortnight, more if sweaty.
• Flowers to me at least Mothers' Day, my birthday, Ffion's birthday, our anniversary, Christmas etc (in between would be nice!)
• Keep in touch witFi's godparents and my friends and especially Mam and Dad or ... I'll haunt you!

"It did bring a smile to a lot of people's faces and the pointers I am sure will be with us forever probably."

Ms Raybould said it was also important to have left something for Ffion.  "It does show that even though her mother was going through a difficult illness, that the focus was on the family and on her," she said.

Jill Templeman, a family support team leader for Marie Curie Cancer Care in Wales, said the list was "a lovely and invaluable thing.  We do encourage and try to support families to be open and prepare for death in lots of different ways with memory boxes and photo projects."

Cancer specialist Baroness Ilora Finlay, professor of palliative medicine and vice dean in the School of Medicine at Cardiff University, said Mrs Harcombe had left "a tremendous legacy".

"Helen died tragically young, leaving a young daughter and I really hope for her daughter that that list and that letter will become indeed more treasured with time," she said.   
Posted by Jill Fallon at 4:39 PM | Permalink

April 25, 2005

Are we burying answers?

We may be burying our best medical lessons by not doing enough autopsies writes David Dobbs in Buried Answers in the New York Times magazine.

Autopsy is the most powerful tool in medicine, responsible for most of our knowledge of anatomy and disease says Alan Schiller, chairman of pathology at Mt Sinai School of Medicine in New York.

Neglecting the autopsy is anathema to the whole practice of medicine.

In the 1960s, almost 50% of all deaths were autopsied, today the number is less than 5%.  Dr. George Lundberg, a pathologist who edits the online medical journal Medscape says nothing can reveal error like an autopsy and by revealing mistakes, help doctors learn and advance the cause of medicine.

Only an autopsy can reveal whether a patient died of Alzheimer's, or multi-infarct dementia or encephalitis or even a variant Creutzfeldt-Jakob prion killing disease.  What a patient really died of has enormous significance for their survivors.  The real cause of death can reveal what the surviving family can take preventative action against.  In many cases, an autopsy can provide the family with a "welcome sense of resolution.... ease anguish about things done or not done"

Reliance on diagnostic tools before death like CAT scans and MRI's instead of autopsies only buries the real answers.

One of my own family doctors told me that he rarely asks for an autopsy because ''with M.R.I.'s and CAT scans and everything else, we usually know why they died.''

This sense of omniscience, Lundberg says, is part of ''a vast cultural delusion.'' At his most incensed, Lundberg says he feels that his fellow doctors simply don't want to face their own fallibility. But Lundberg's indictment is even broader. The autopsy's decline reflects not just individual arrogance, but also the general state of health care: the increasing distance and unease between doctors and patients and their families, a pervasive fear of lawsuits, our denial of age and death and, especially, our credulous infatuation with technology. Our doctors' overconfidence, less bigheaded than blithe, is part of the medicine we've come to expect.

So there's one more thing you can do for your family - insist on an autopsy as part of your last wishes.    You'll be advancing the cause of medicine at the same time.

Posted by Jill Fallon at 7:25 PM | Permalink

April 13, 2005

Advance Medical Directives

Attorney Rita Marker clarifies many misconceptions about living wills and the traps for the unwary in Be Prepared.

The most protective and the most flexible type of advance directive is the "Durable Power of Attorney for Health Care." With this type of document you designate someone else to make health-care decisions on your behalf if you are ever temporarily or permanently unable to make those decisions for yourself. The person you name is usually called an agent, although some states call this individual a health-care proxy, health-care representative or health-care surrogate.

When you are able to make your own decisions, it is the responsibility of your health-care providers to let your know your diagnosis, to give you information about possible treatments, as well as the risks and benefits associated with those treatments. Then, it is up to you to give or withhold consent based on that information. If you have named an agent to make decisions for you that person stands in your shoes. The doctor gives your agent the same information that would have been given to you and then, based on prior discussions you and your agent have had and with the knowledge of your values, your agent gives or withholds consent for treatment.

You can, but need not, name a family member as your agent. In addition to selecting an agent who agrees with you, it is important that that person has the ability to be assertive when necessary. He should be a person who will be open to receiving necessary information and who will not be intimidated by a physician or ethics committee who may hold different views. .

Because the Durable Power of Attorney for Health Care is a legal document, it is important that you have one that is carefully drafted. It is not necessary, advisable, or even possible to write everything down about your wishes. There is no way you can envision every possible condition, treatment, or situation you could face at any time. The most important thing is to maintain communication with your agent about your wishes as they change from time to time. (Sometimes what we want now may be different than what we wanted five years ago.)

Posted by Jill Fallon at 3:09 PM | Permalink

Joan Kennedy battles her children

Joan Kennedy is not very pleased with her children who became her legal guardians last year to see that she received treatment for alcoholism and to take care of her financial affairs.  In retaliation, she put up for sale her summer house on Squaw Island for $6.5 million.  Her children object to the sale and it is unlikely the house will be sold given the cloud on the title.

The battle of children to retain control over one or another parent or elderly relative is on the rise with no end in sight.  Half the guardianship cases heard in Barnstable Family and Probate Court were filed by family or friends seeking control over another adult's life according to the Cape Cod Times.

The most difficult cases where the prospective ward contests the proposed guardianship usually involve  substance abuse  - drugs or alcohol.  I have nothing but sympathy for these families dealing with such difficult issues; however, I can not help but believe that advance planning in the form of a durable power of attorney would have saved these families a lot of grief.

Posted by Jill Fallon at 1:39 PM | Permalink

April 9, 2005

Living Will didn't Help

Those of us who are worried about the rush to euthanize now have the case of Mae Magouirk to show us how right we were to worry. 

Another woman, 81,  lies in a hospice without food or water since March 28.  Another family dispute  - this time between Mae's granddaughter and Mae's brother and sister.  Brother and sister want a temporary feeding tube inserted and Mae evaluated for treatment at the University of Alabama Medical Center.  Granddaughter, Gaddy,  has been appointed emergency guardian and has stated.

"Grandmama is old and I think it is time she went home to Jesus. She has glaucoma and now this heart problem, and who would want to live with disabilities like these?

At a follow-up hearing in Troup County Probate Court, a settlement has been reached that allows awards guardianship to the granddaughter Gaddy provided three cardiologists evaluate the patient who would receive whatever treatment two of the three recommended.

Mae has a living will that states nourishment  is to be withheld only if she were in a coma or vegetative state with no hope of recovery.  Apparently, she did not have a health care proxy

Is this woman is being denied food and water even as the evaluation is going on? I don't know. Her granddaughter testified according to the local paper linked above that she feeds her grandmother Jello and chips of ice.

Is this case part of the hurry up and die syndrome? I don't know but I will follow it.  I'm afraid we'll see many more of these cases, some genuinely a dispute over what the patient wanted, others with far more base motives.  I don't think "quality of life" is the standard.  None of us know with appreciation we can live even if from the outside the "quality" seems poor or what we would endure for just a little more life.  I am reminded of the Zen strawberry story

One day while walking through the wilderness a man stumbled upon a vicious tiger. He ran but soon came to the edge of a high cliff. Desperate to save himself, he climbed down a vine and dangled over the fatal precipice. As he hung there, two mice appeared from a hole in the cliff and began gnawing on the vine. Suddenly, he noticed on the vine a plump wild strawberry. He plucked it and popped it in his mouth. It was incredibly delicious!

Wizbang has a number of links and continually updates Mae's story.

Hyscience has a long and excellent post that asks whether hospices are enabling euthanasia.

UPDATE: On Friday, the three doctors determined that Mae's heart condition was treatable.  She
was airlifted to the University of Alabama Medical Center.  Her nephew Kenneth Mullinax of Birmingham is quoted as saying, "Hospice is only for the dying and my aunt has many more years to live.  A crime was being committed by having a person in a hospice who was not terminally ill.  I hope that this never ever happens again."

The questions that remain are

1. Why was she in a hospice?
2. Why did her doctor order her feeding tube removed?
3. Why did neither her doctor or her granddaughter abide by the conditions listed in Mae's living will?

Posted by Jill Fallon at 11:44 PM | Permalink

April 5, 2005

CBS and ABC give false impression

Shortly before Terri Schiavo died, both CBS and ABC published polls that showed 68% of Americans were "in favor of letting Terri Schiavo die..."

Pat Cadell, a leading Democratic pollster, an expert on the use and abuse of polls, said essentially this poll was designed to achieve a certain result.

But what's being presented in these polls, particularly with CBS when it's so disturbing to me because it's being cited everywhere, and it's not being cited accurately. .......

only once [before], --have I seen a survey that made me wonder whether or not the results were prejudged before they were written. This poll is so basically designed to produce certain results, and then is being reported as such, makes me very concerned. Now it could be just pure incompetence, however I suspect that there's more here than that.

The Anchoress paraphased the questions CBS asked:

""Terri Schiavo is in a persistent vegatative state, and has been for 15 years, she is in a coma and will never recover, should she be taken off life support?" ask a question like'll get a number like 68% saying, "yes, let the poor woman die..."

A Zogby poll rephrased the question more accurately,

"If a disabled person is not terminally ill, not in a coma, and not being kept alive on life support, and they have no written directive, should or should they not be denied food and water,"

The response to the Zogby poll:  79% said the patient should not have food and water taken away while just 9% said yes.   

Let me know if you hear this reported anywhere but in blogs.

Hat tip
The Anchoress

Posted by Jill Fallon at 5:35 PM | Permalink

April 1, 2005

Theresa Maria Schiavo, R.I.P.

Saddened by the spectacle Terri's death became, horrified by the manner of her dying where the judge forbade even ice chips to ease her suffering, I haven't reflected sufficiently on her legacy to write about, so I offer you these links.

From the Washington Post

THE DEATH yesterday of Terri Schiavo concludes a legal battle, but its moral quandaries live on. The Schiavo case gripped the nation because of the lines drawn between life and death, and the middle ground of dementia or coma, agonizingly hard areas to delineate. In addition, because of a mute understanding that this subject is too awful to contemplate, a discussion of Schiavo-like choices has not fully penetrated the public square. It will be a healthy thing if this taboo is permanently shattered. We may not want to discuss death, but it will come to all of us. And, because of medical technology, more people will be empowered, or perhaps some would say condemned, to make judgments about when life is worth living, and when not.

A century ago, death usually came abruptly; the most frequent causes were pneumonia, tuberculosis, diarrhea and injuries, sudden killers all. Today, the average American spends two years disabled enough to need help with the routine activities of living; and growing numbers survive to be 85 and older, at which point they have a 50 percent chance of suffering dementia before they die. In 2000, there were 4.2 million Americans in the 85-plus cohort, but by 2030 there will be nearly 9 million, according to a paper for the Rand institute by Joanne Lynn and David M. Adamson. We speak of people being "snatched from life." Death, for more and more Americans, however, is the final stumble in a slow decline.

We have not adjusted to this transformation, in emotional, moral or economic terms. .......Many Americans, and not just social conservatives, feel that life is always worth preserving and that wavering from this principle opens the door to selfish relatives who don't want the burden of caring for the vulnerable. It's an honorable outlook -- also a natural one. Many believe on religious grounds that life is sacrosanct. With the survival instinct hard-wired into human nature, others find it difficult to contemplate the extinction of the self. Yet there has to be space in a free society for others to differ: to draw up living wills that specify limits to life-prolonging medical interventions, and perhaps also to opt for assisted suicide........Thanks to Terri Schiavo, a national conversation is, we hope, beginning.

From the New York Times

One of the most astonishing things about the human experience is the realization that loved ones die. The first time it happens, we are invariably amazed that nearly everyone who has ever lived has weathered an experience so wrenching. We see other humans on the street and in the shops and marvel that they manage to simply go about their business - that there is no constant, universal primal scream in the face of such an awful fact.

That level of grief seldom brings out the noblest emotions. The sufferers can barely make their way through the day, let alone summon their best reserves of patience and compassion for the lucky people who continue to live. In the case of Terri Schiavo, the whole world witnessed what happens when that natural emotional frailty is taken captive by politics.

It was awful, and according to the polls, the American public shrank from the sight of it.

From Ellen Goodman, The Boston Globe

It's why we need a healthcare proxy as well as a living will. We need someone we can trust and burden with the authority to make decisions for us when we are unable.

But this too will require some deeper, bolder, tough talk: If we don't want to live ''like that," how do we want to live? Like what?

A Wellesley College bioethicist, Adrienne Asch, says: ''The typical advance directive or living will does not ask the right questions. It asks what sort of medical intervention we want or don't want. The question that we ought to be asked is what am I experiencing? What will make me feel that I have something to live for? What is enough?"

Asch, who is blind and very conscious of societal attitudes toward disabilities, says that if she wrote the living will form, it would ask people to imagine themselves in a range of scenarios. When would we want our lives prolonged by medicine? In her own advance directive she has written that ''as long as the people who know me believe that I recognize them and can differentiate them from strangers, I want to be alive." After that, enough.

People on all sides share a moral obligation. We need to let the people we leave behind mourn with the clear conscience that, as much as possible, they did what we wanted.

Terri Schiavo was only 25 when this tragedy began. Her family has been, simply, devastated. We owe our own families much, much more than that.

From It is Ended by William Anderson, senior psychiatrist at Mass General Hospital.

SO IT HAS ENDED. The nightmare of judicial execution by dehydration is finally over. How could such a thing have happened? Students of law, medicine, and ethics will examine this tragedy for decades to come.
To withhold minimal comfort measures such as water is gratuitous cruelty. But the judge must be convinced of his probity and rectitude, for he alerted every sheriff in Florida to be vigilant in preventing a chip of ice from entering Terri's mouth. And appellate courts declined to interfere with this travesty of justice on the grounds that proper procedures were followed. Thus they became complicit in the evolving tragedy.

Much mischief is set loose when the uncertain judgments of medical diagnosis are conflated with the rigid categories of the law. Unlike coma or brain death, persistent vegetative state is a diagnosis that depends on subjective judgment. It requires a finding of unresponsiveness in an awake and alert person. Even skilled diagnosticians may disagree on this assessment. It does not necessarily preclude the possibility of improvement. It has no definitive laboratory tests.

Thus the diagnosis of PVS is not reliable in a forensic sense, and should not be used in life and death decisions. It is a
clinical diagnosis, which prescribes treatment measures in normative medical practice

Posted by Jill Fallon at 5:52 PM | Permalink

March 30, 2005

Music stirred her damaged brain

A professor of neurology and neurophysiology at Harvard Medical School describes how a 32 year old woman, born with hydranencephaly, and thought to have been in a persistent vegetative state reacted with joy and delight to music.

I immediately brought her other doctors back into the room, where they began to interact with her in a totally different manner, in some cases holding her hand and trying to speak with her, and treating her more like a normally functioning human being. I was so emotionally moved by her struggle for human definition through the single modality of hearing that I went down to a local electronics shop and bought her an audio cassette player, and some modern and classical music. 

She continued to appear to enjoy the audio cassette player and her music until her death some years later. 

This patient demonstrated the dilemma we face in determining whether people in an apparent persistent vegetative state, who by all objective measure have little or no function in the cerebral hemispheres, have any residual human capacity that would persuade us to sustain their lives, even by artificial means. 

Her case was a reminder of how much we do not understand about the brain, and that even people in an apparent vegetative state may have ways of connecting to the world around them.
Posted by Jill Fallon at 1:55 AM | Permalink

March 26, 2005

There's more 'there' there.

A few years ago, unresponsive patients  were classified as comatose (eyes closed and responses limited to basic reflexes) or vegetative (eyes opening and closing in a cycle of sleeping and waking but without any sign of awareness).

That began to change when Danny Rios, a 24 year old with a severe brain injury, unable to speak or move his body, was taken to Sloan Kettering Institute on Manhattan's East Side.    Danny was placed in an MRI machine and a recording by his sister saying she was there and she loved him was played over his earphones.

The doctors didn't know what to expect when they looked at the images from the scan. They certainly did not expect to see Danny's brain to fire its neurons in a way virtually identical to a healthy subject.  Even the visual centers of his brain lit up as "if his sister's words awakened his mind's eye," in the words of researcher Joy Hirsch, an expert in brain imaging at Columbia University.  "There didn't seem to be anything missing, " said Nicholas Schiff, an expert in consciousness disorders at Weill Medical College of Cornell University.

Even with a brain injury,  neural networks can reorganize themselves into something closer to full consciousness.  One doctor said of Danny ""He's aware of himself, he's happy, but it took a lot of skill to see it. If he ended up in a nursing home and started doing things like this, no one would have noticed."

The whole fascinating story
- What if There is Something Going On in There by Carl Zimmer  - can be read in the New York Times magazine, September 28, 2003.  It can be accessed for free here.   

These researchers proposed a new category of consciousness  - the minimally conscious state -  in the Journal of Neurology  in 2002, a call endorsed by a string of medical societies and academies.

These researchers think it's likely that a vast number of people who might otherwise be classified as vegetative actually have hidden reserves of mental activity.   
It may well be that we have given up too soon on many people they think.

As we learn that different parts of the brain regenerate and reorganize even as other parts go missing, if we knew say, that someone who appears locked in a persistent vegetative state, understands who she is, appreciates music, recognizes people and feels emotion, then many of us have to reconsider what we want to do with the 100,000 - 300,000 people in a minimally conscious state. 

If thousands of brain-damaged people are treated as if they are unaware, but in fact hear and register what's going on but are unable to respond, how do we care for them?  Listen to what one doctor had to say in
Signs of Awareness Seen in Brain-Injured Patients, a New York Times article, sated February 8, 2005.  Free link here

This study gave me goose bumps, because it shows this possibility of this profound isolation, that these people are there, that they've been there all along, even though we've been treating them as if they're not," said Dr. Joseph Fins, chief of the medical ethics division of New York Presbyterian Hospital-Weill Cornell Medical Center. Dr. Fins was not involved in the study but collaborates with its authors on other projects.
A better understanding of brain patterns in minimally conscious patients should also help cut down on misdiagnosis by doctors, Dr. Fins said. He said one study had found that as many as 30 percent of patients identified as being unaware, in a persistently vegetative state, were not. They were minimally conscious.

The findings, if repeated in follow-up experiments, could have sweeping implications for how to care best for these patients. Some experts said the study, which appeared yesterday in the journal Neurology, could also have consequences for legal cases in which parties dispute the mental state of an unresponsive patient.

"The most consequential thing about this is that we have opened a door, we have found an objective voice for these patients, which tells us they have some cognitive ability in a way they cannot tell us themselves," Dr. Hirsch said.
The patients are, she added, "more human than we imagined in the past, and it is unconscionable not to aggressively pursue research efforts to evaluate them and develop therapeutic techniques."
Posted by Jill Fallon at 10:55 PM | Permalink

Lessons for Living from the Dying

Lessons for Living from the Dying by Jeanne McManus in the Washington Post

The first time I sat by the side of a deathbed and watched the life drain from a loved one, it changed me forever.
I continue to fine-tune my final scene. The more of life that I am given, the more I value it.  But the more I value it, the more I think about losing it and the more I try to direct the terms of my departure. I use flip and cynical comments to friends and family about what to do with me, most of my directives involving a wheelbarrow and a steep cliff.  On the more serious side, I use the wisdom of lawyers and estate planners to lock my wishes into place.
Time spent watching someone die is painful, agonizing and transforming.

Though it would be noble to say otherwise, it's not what you learn about death or about your friend or your parent or your sibling as the life drains from them. It's what you learn about you.

I would only add that failure to plan for the inevitable also says a lot about you.

Posted by Jill Fallon at 1:25 PM | Permalink

Most tsunami dead female

Far more women than men were killed by the Asian tsunami, in some areas four times as many, according to Oxfam.

This hugely disproportionate impact will have effects for generations to come.

Posted by Jill Fallon at 12:06 PM | Permalink

March 21, 2005

The Twilight Zone

The final vote in the House was 203 yeah and 58 nay.  The familiar saying that hard cases make bad law may be true in Terri's case. 

While I am pleased that the President has signed the emergency legislation that allows a federal court to review Terri's case,  I don't think that an extraordinary appeal to Congress is the way to handle such cases. 

I  hope that this Congress seriously debates and considers how to provide the incapacitated with rights that insure the same due process if they have left no written directives that we accord convicted criminals.    "The facts of this case suggest that existing safeguards are dangerously inadequate" the editors of the National Review write. Democrat Michael Totten writes To Save or Not to Save and questions what the White House will do about people who are taken off life support because their families have run out of money.

I hope every adult appoints a health care proxy first, or at minimum, leaves advance medical directives.
There is no excuse for a competent adult American to leave their families clueless as to what to do.

Because absent a health care proxy, absent a living will, we have entered the twilight zone.

The debate on the right to live,  the right to die and the right to euthanize has begun. 

Whatever your opinion is on the Terri Schiavo case, there is no debate that the issue touches all of us.

No doubt we can keep bodies alive almost forever.  With oodles of money, Sunny von Bulow is still alive after 20 years in a coma.  While the battle for Terri raged on, a baby born with a fatal defect died after the removal of life support against the mother's wishes.  Does Spiro Nikolouzos meet the criteria for brain dead?  If his family can not find an institution who will take him, his life support will be cut off in 10 days.  In both cases, the hospitals were concerned about the rising costs of what they considered futile care. 

We're hearing about the rising costs of supporting aging boomers in their retirement.  What about the costs of keeping boomers alive through tax-supported Medicare?    The costs of end of life care can be extraordinary, a fact which prompted former Colorado Governor Richard Lamm to say in 1984 that "we have a duty to die" and get out of the way of younger generations.  He was often misquoted as saying the elderly have a duty to die. 

"I am fairly sure that the young generation and the baby boomers are going to demand more control over life and death," said Lamm. "I think they're going to demand physician-assisted suicide. We have some of these ethical issues that lie in our future, and we just have no idea of how tough they're going to be."

I don't have all the answers.    I do have some sense of how tough these issues are and will increasingly be.  I am concerned about the rights of the disabled and incapacitated.  I  think a lethal injection or increasing doses of morphine is far more humane than starving people to death.
I hope people think of the costs of futile care.  I  hope people think of themselves as part of a great continuum and face the prospect of death bravely.    I hope that people will decide for themselves and spare their families.

UPDATE: These women are yeoman -  doing the research and finding the facts and not just spouting opinions.  See What Bush Did in Texas by the Anchoress and Katherine Lopez at the Corner

Posted by Jill Fallon at 6:45 PM | Permalink

Better than a Living Will

I have written in the past about living wills Is the Living Will Dead? 

1.Most people don't really know what they want, apart from the general statement that they don't want to live like a vegetable.
2.People can't articulate what they want, apart from the general statement that they don't want to live like a vegetable.
3. Living wills  often can't be found. It's a long way from executing a living will to getting it on the hospital charts.

James Q. Wilson points out the problem in today's Wall Street Journal (subscription only)

[S]cholars have shown that we have greatly exaggerated the benefits of living wills. Studies by University of Michigan Professor Carl Schneider and others have shown that living wills rarely make any difference. People with them are likely to get exactly the same treatment as people without them, possibly because doctors and family members ignore the wills. And ignoring them is often the right thing to do because it is virtually impossible to write a living will that anticipates and makes decisions about all of the many, complicated, and hard to foresee illnesses you may face.

We both come to the same conclusion.  You are far better off with a health care proxy or durable power of attorney for health care that authorizes one person you know and trust to make the end-of-life decisions for you. 

The most difficult decision is who do you want to make those decisions.  It doesn't have to be a relative.  Pick one person and an alternate in case the person you've chosen can't serve.  You want to avoid family fights, so don't pick a committee.  It's simple, straightfoward and not expensive.  You don't have to anticipate every possible circumstance which you can't in event.  You just have to choose one person you trust. 

Get thee to thy lawyer.

Posted by Jill Fallon at 6:45 PM | Permalink

March 19, 2005

Removing Terri's feeding tube

Imagine Terri were your sister, your daughter, your aunt.  Could you bear it knowing that she would be starved to death over a period of two weeks.

When her attorney Barbara Weller told Terri what was happening, that the Judge had ordered the removal of her feeding tube,  "Terri cried and could not be quieted"

Peggy Noonan writes a special piece, If Terri Schiavo is killed, Republicans will pay a political price.

There is a passionate, highly motivated and sincere group of voters and activists who care deeply about whether Terri Schiavo is allowed to live. Their reasoning, ultimately, is this: Be on the side of life.
On the other side of this debate, one would assume there is an equally well organized and passionate group of organizations deeply committed to removing Terri Schiavo's feeding tube. But that's not true. There's just about no one on the other side. Or rather there is one person, a disaffected husband who insists Terri once told him she didn't want to be kept alive by extraordinary measures.

He has fought the battle to kill her with a determination that at this point seems not single-minded or passionate but strange. His former wife's parents and family are eager to care for her and do care for her, every day. He doesn't have to do a thing. His wife is not kept alive by extraordinary measures--she breathes on her own, is not on a respirator. All she needs to continue existing--and to continue being alive so that life can produce whatever miracle it may produce--is a feeding tube. 

But in the end, it comes down to this: Why kill her? What is gained? What is good about it?   

This case is being too quickly labeled as a conservative issue, which it is not.  It is a very difficult case that will impact all families who have a loved one who did not leave a written directive and who will die if a feeding tube is removed. 

Most families in these agonizing situations will grapple and find some sort of resolution but not without a lot of pain and agonizing.  Some families will be split irrevocably.     

Of course, the biggest lesson here is that every adult should have advance medical directives or a health care proxy.   

The most difficult area, the grey area is when families are split.  When one side wants to "do everything they can" and the other wants to "let them go" and there is no medical directive. 

Except in this case, "letting Terri go" requires her to be starved to death.  She is alive, conscious, interacts with her family and the people around her, requires no life support and is not brain dead in any way.    We don't allow dogs, convicted murderers or terrorists to be starved to death.  Why ever should we countenance starvation of an innocent woman. 

Katherine Lopez writes

A lot of folks who consider themselves "pro-life"--get worked up about abortion--want Schiavo protected. Those who are indifferent to or support legal abortion aren't particularly interested in hearing about the case--or assume her husband knows best. 

I think the key in this case are these fact questions. This woman has not gotten a fair shake in the judicial process. And medically, she may not have gotten what she could--like the chance at rehab. If more people knew some of these basic facts of unfairness, and could see some of these videos ..., I think this "issue" would transcend labels and things.
Posted by Jill Fallon at 4:58 AM | Permalink

March 16, 2005

Habeas Corpus Protection for Terri

You would think that having your own blog means that you can post your own comments.  But not so, it was rejected for "questionable content."!

So here is my fairly long response to "Buckhead" whose comments you can read at One Settlement, Another Judicial Homicide

I disagree.  We do not execute murderers without due process. What we are facing with Terri is judicial homicide without due process. I believe that the courts must allow due process when it comes to withholding food or water from a patient who is not terminal and who has not left a written directive. 17 doctors have filed affidavits saying that Terri is not even in a persistent vegetative state.  I do not believe that a conscious, but disabled woman should be allowed to starve to death, an action which amounts to torture.

Of course, people should have the right to refuse medical care. It's the family first or one member of that family and not the courts who decide to do when a medical directive is lacking.  Power has never been extended to courts to decide for themselves who lives and who dies. What they do is rule in favor, Here we have a spouse who has a severe conflict of interest and has not complied with state law regarding his guardianship of Terri.  When a guardian is a guardian only because of a default provision under state law, great care must be taken if there is an apparent conflict of interest especially when the rest of the family disagrees and has brought judicial proceedings contesting the default guardianship. 

Habeas corpus protection is guaranteed under the US constitution and there is a settled body of law that allows federal courts to review whether state court proceedings have violated a person’s
rights under the 14th amendment 
No State ...  shall deprive any person of life ... without due process of law...nor deny to any person within its jurisdiction the equal protection of the laws.  I believe that habeas corpus protection should be extended to those whose life support may be withdrawn pursuant to court order. Such an extension of habeas corpus protection will allow federal courts to review state family and probate court rulings where judges have extraordinary powers and discretion. I support the proposed Incapacitated Persons Legal Protection Act recently introduced in Congress.

There must be some collateral review of state court proceedings, particularly in cases like these where the judge’s conduct is so outrageous that people are now calling for his impeachment.  The realities of life in the 21st century are that such situations will arise often.  Terri Schiavo is a landmark case because she stands for all profoundly disabled people and for the millions of Americans who will get sick without ever executing an advance medical directive or appointing a health care agent.

Posted by Jill Fallon at 5:35 PM | Permalink

Motivating Procrastinating Clients

Financial Advisor News has a short article about Dealing with procrastinating clients.  Seems as if their high net worth clients put off making major financial decisions - especially when it comes to estate planning -  for as long as nine or ten years, a major problem for financial planners.

Motivating clients to do what everyone should do is their biggest challenge. So why do people procrastinate?  Yes, they're busy and yes they have limited time.  Who doesn't? 

Dealing with the fact of mortality is very difficult for some people.  For high net worth people ceding control of a business they started and grown can be "shocking" says Richard Peterson, a managing partner at Market Psychology Consulting in San Francisco.  Some people identify themselves with their wealth and the idea of giving it up can be akin to losing their identity.

Peterson puts his clients at ease by talking about their legacies, what they want to leave to the world.

Fear of death is so uncomfortable, many people can't even begin to think about what they will leave behind.  The only way to face fear is with courage. And courage means action of some sort.  The real antidote to fear is love.    The medieval mystic Meister Eickhart wrote a poem that included the thought, If you are afraid, imagine holding the hand of a small child and then you will become brave.  You protect your family and you protect the young.  People who love their families, who love themselves, have the self-regard and self-worth to plan for what is, after all, inevitable.

Financial advisors often talk only about the money that can be saved on taxes when they discuss estate planning, when that's not what people are concerned about. 

Unpleasant as the task may seem to some clients, neglecting to put one in place could end up being even worse. It could unintentionally hurt survivors financially and emotionally, costing millions of dollars in taxes, leaving assets tied up, putting a business at risk or inadvertently shortchanging some heirs.

People are concerned about their legacies, their reputation, their families.  No one really wants to leave this world leaving a mess behind and their families and employees angry and upset. Financial planners should be asking their procrastinating clients what really matters.  You do what really matters first.

Posted by Jill Fallon at 3:33 AM | Permalink

February 28, 2005

The Resistance: Not Dead Yet

I was unprepared at the power of disability advocates who speak from the authority of their own experience to say they are not dead yet .  They are leading a resistance and opposition to those who too blithely dismiss life in a wheelchair, or blind, or brain-damaged as not worth living.

Maybe this is the beginning of a real debate in America's marketplace of ideas over the value of a human life and it's taking place in the context of the Oscar win of Million Dollar Baby (M$B) and in the case of Terry Schiavo. 

Here are what some cripples say about Million Dollar Baby with its "better dead than disabled" message.
John Hockenberry asks whether suicide is the only option available to someone with a spinal cord injury and are they going to tell that to the wounded soldiers at Walter Reed hospital.
Mary Johnson says don't confuse the disability rights opposition with either conservatives or the Christian right, don't dismiss it as part of the left-right culture debate and don't ignore it.
Diane Coleman, an attorney in a wheelchair,  wished she had brought a sign to M$B saying, "I Am Not Better Off Dead."

Disability advocates are shocked by Judge Greer's recent order which they call an order of execution because it requires Michael Schiavo to begin starving and dehydrating Terri Schiavo on March 18, 2005 absent a stay from the appellate courts.

"Ordered and Adjudged that absent a stay from the appellate courts, the guardian, Michael Schiavo, shall cause the removal of nutrition and hydration from the ward, Theresa Marie Schiavo, at 1:00 pm on Friday, March 18, 2005."

Disclosure: I've not yet seen Million Dollar Baby and plan to do so;  I have a disabled sister; I've great admiration for Clint Eastwood; and I believe that we all have the right to forego extraordinary means to keep us alive if we have executed a proper health care proxy or living will.  I'm not against the right to die, I am against euthanasia and murder.  I am for the right to live for the old, the retarded and the disabled.  Inconvenience, unattractiveness, and expense are not reasons to put them to death.

UPDATE:  Wesley Smith writes about the Million Dollar Missed Opportunity Clint Eastwood missed.

[T]he bigger sin of the movie is its peddling of dangerous ignorance. For example, the movie depicts Maggie as a mere slave to medical protocols. In reality, she would have had the legal right to refuse medical treatment--even if it meant that she would die. Thus, she could have ordered her respirator turned off. Indeed, given today's increasing utilitarianist tendencies in health care, bioethicists, social workers, and doctors involved with her care might well have repeatedly reminded her of that fact (hint, hint).
Secondly, while it is true that many people who become quadriplegic later in life become very depressed and suicidal--like Maggie in the movie--studies show that such existential despair is not usually permanent. Indeed, one medical report published several years ago found that the level of depression in people disabled later in life to be no different five years post-injury than that found among the able bodied. Moreover, people suffering the emotional agony that Maggie experienced in the film can be treated for their depression and their suicides prevented--without being force-sedated.

The most important point omitted from the film is that people with quadriplegia, when they are not merely warehoused in a nursing home, live very rich and satisfying lives. That Eastwood never seems to have given this matter any thought is odd, given that Christopher Reeve demonstrated famously that becoming quadriplegic does not mean that meaningful life ends. Similarly, Joni Erickson Tada became a world famous artist, disability rights activist, and Christian apologist after becoming near-quadriplegic. Meanwhile, every day tens of thousands of our disabled brothers and sisters lead meritorious and productive lives, aided by respirators and wheelchairs that come to be seen not as dignity-robbing impediments, but facilitators and tools of independent living.

UPDATE 2  I failed to say that YOU have the responsibility to execute a health care proxy and appoint someone you trust to make the life and death decisions in the event you cannot.  No one else can do it for you.  I wish Terry Schiavo had done so. 

UPDATE 3 Gerald Vanderleun writes on The Passion of the Pope about what we are learning from the Pope as he shows us how to die.

Posted by Jill Fallon at 9:00 PM | Permalink

February 27, 2005

Let Terri Schiavo Live

The failure to execute a health care proxy, a simple thing to do, can break families apart, cause long-lasting feuds, cost hundreds of thousands of dollars,  involve legal wrangles that last for years and mean quite literally  the difference between life and death. 

Without a health care proxy designating someone you trust to make life and death decisions for you, you may be done in by someone, like a disgruntled spouse, who looks forward to your death as a way of inheriting your money. 

That's what's happening to Terri Schiavo in what most of the media refer to as a right-to-die case, like the Karen Quinlan case.  To me, it is more a right-to-live case.  It shows, in all its legal twists and tangles, just who realizes what a terrible precedent this case sets.    I tremble at the anxiety the infirm, disabled and elderly must feel as they follow what happens to Terri.  We have reached the line between letting people die naturally and killing them. 

Terry has severe brain damage since suffering cardiac arrest in 1990.  Michael Schiavo, as her husband, is the default person under Florida law, absent a written health care proxy, to decide what his wife would have wanted.    He insists that Terry never wanted to live as a "vegetable", in the state she now is in.  He wants the feeding tubes removed so that she can die slowly by starvation.  There is no corroborative evidence concerning Terri's wishes.  Since Terri was considering divorce before her cardiac arrest, since a bone scan in 1991 show numerous injuries including a head injury suggestive of a history of physical abuse before and perhaps after her cardiac arrest, since Michael has moved in with his mistress by whom he has two children,  Michael's motives in wanting to disconnect the feeding tubes are suspect.

Nor is Terri in a persistent vegetative state.  She is not hooked up to any life support equipment. She is alert, makes direct eye contact with visitors, and responds to and interacts  with her parents and others.  Because she can not swallow, she does require feeding and hydration tubes.  Twelve doctors have testified in court that Terri is not in a persistent vegetative state and with proper therapy could improve significantly, be taught to speak and learn to eat food again

After Terry's cardiac arrest, her husband won an award for medical malpractice amounting to over $2 million which he stands to inherit if she dies.  He will receive nothing if he divorces her. 

Although he swore under oath at trial in 1992 that he would take care of his wife for the rest of her life, once he received the settlement totaling some $1.7 million, he ordered all rehabilitative services for her be stopped

Heidi Law, a certified nursing assistant who took care of Terri in 1997  sworn in an affidavit: 

• Terri has spoken words, 'Hi', 'Momma', and 'Help Me'.
• Terri, was often in a "cold sweat" and silent for hours after visits by her husband
• Terri was denied rehabilitation by her husband who intimidated staff at the nursing home.
• Michael limited the radio stations Terri could listen to only one.
• Terri would chuckle or laugh as she listened to stories.
• Terri adored baths, having her hair combed, enjoyed sweet-smelling lotions and soft nightgowns.
• It was obvious that her mother was Terri's favorite person in the whole world. 

Terry's parents have been utterly devoted to her and want to take care of her for the rest of her natural life.  Since 1993, Michael Schiavo has ordered information about her condition to be withheld from her family, according to her brother who also says,

When we visit with Terri she is always happy to see us. She lights up when she hears my mom's voice, beginning with a huge grin and laugh, then by trying so hard to talk. No doctor in the world can ever convince my family that Terri isn't resonding to us when we visit her and that Terri isn't trying to communicate with us. It is sad that we are unable to understand what she is trying to say as she desperately needs speech therapy. She has not had any speech therapy in over twelve years. She usually gets tired and then just listens as we tell her about the latest family events. She sometimes cries when we say we are leaving.

Who decides whether Terri lives or dies? Her husband who wants her to die, her parents who want her to live or the judge who is also acting as Terri's guardian ad litem is ruling for the husband.

Terri is not brain dead, she is not on life support, so pulling the plug is not an option.  She is not a terminal cancer patient, weak and gaunt.  She lives brain-damaged in a healthy body and weighs 138 pounds.  If her feeding tubes are removed, Terri faces a slow, extended death of starvation.  Starvation to kill people was used in Auschwitz, Bergen-Belsen, Treblinka and in the countless Stalinist gulags. 

We don't allow people to starve dogs.  Or convicted felons on death row.  Why would we allow a vulnerable person to be deliberately starved when her parents and siblings want to take care of her?

Will her family be allowed to see Terri as she is starved which might take two weeks? 

Is this not torture of the cruelest kind?  By what authority does any U.S. Court have to allow this?
Convicted murderers who are sentenced to death, have years to make legal appeals, and, if their sentence is affirmed, get lethal gas that kills them real quick in the end.  For the love of God or the love of humanity, if Terri is to die legally, can't it be done more mercifully.

I had written this post before I came across "What if This was Our Daughter or Sister or Wife?  What If It Was 'Only' A Stranger's Life which details far better the background with links to court affidavits.  I can only echo Donald Hawthorne's conclusion.

As observers from afar, we cannot independently confirm the veracity of all of the information described above. But reasonable people must admit that the information pattern raises enough material questions about the behavior of Terri’s husband and the judge to have concerns.

And that leads us back to the more fundamental question about what value we will place on human life, including that of an ill woman. If we begin to say it is okay to kill off "weak" human beings, think where that will take us over time. It will take us to a place where certain people will seek to play "God" so they can set the criteria for who lives and who dies. Why not then an elderly parent or a young child, should either become a financial or emotional burden? The freedom to do such great evil will only invite more profound evil over time.

Holocausts do not begin with operational concentration camps; they start on a smaller scale and steadily break down our resistance while many people plead that they are "too busy" to pay attention and get involved.

The stakes are enormous here and there is no neutral ground. Not to decide is to decide. The fight for Terri’s life is another battle to determine whether we are to live in a culture of life or a culture of death.

More Links

Terry Schindler-Schiavo Foundation  to see documents, the latest information and videos of Terri.  With so much demand on this website, it may be down or slow to load.
Hospice Patients Alliance has many of the documents online as well
John Grogan, a newspaper columnist changes his mind

Blogs that are following the Terri Schiavo case
Blogs for Terri has an aggregator,  a growing blogroll of supporters and copies of documents and affidavits
Interview of Bobbi Schindler, her brother on February 18, 2005
A certain slant of light
Anchor Rising
The Anchoress

UPDATE: Settlement offer rejected
I just learned that Terri's parents sent a letter to Michael Schiavo in October, 2004 in which they offer to

  • Take Terri home and care for her at their own expense.
  • Never to seek money from her husband, Michael, including from past malpractice awards. He would also be able to keep all assets from their married life.
  • Sign any legal documents allowing her husband to divorce her, should he desire that, while still allowing him to retain all rights to her estate upon her natural death in the future as if he was still married to her.
  • Allow Michael to retain visitation rights, if he so wished.
  • Forgo any and all future financial claims against Michael.

Michael has refused the settlement.  Apparently, nothing less than Terri's death will satisfy him.

UPDATE -2 -Status Feb 25
Judge Greer has ruled that the husband may remove the feeding tube on March 18.  The New York Times reports.

He is "no longer comfortable" granting stays.  He said that the Schindlers would have to take any further motions to appellate courts before March 18, the date he chose "so that last rites and other similar matters can be addressed in an orderly manner."

UPDATE -3 -What death by starvation is like

Dr. William Burke, a neurologist in St. Louis describes the process: "A conscious person would feel it [dehydration] just as you and I would. They will go into seizures. Their skin cracks, their tongue cracks, their lips crack. They may have nosebleeds because of the drying of the mucous membranes, and heaving and vomiting might ensue because of the drying out of the stomach lining . . . death by dehydration takes 10 to 14 days. It is an extremely agonizing death."
Posted by Jill Fallon at 12:19 AM | Permalink

February 25, 2005

Guardianship for Joan Kennedy

Joan  Kennedy's three children sought and were granted legal control of her day-to-day affairs last spring amid her continued struggle with alcoholism

reports the Boston Globe after her son U.S. Representative Patrick Kennedy revealed the legal steps taken yesterday in a statement issued on behalf of all three children.

My brother, sister and I love our mother very much," Patrick Kennedy, 37, said in a statement issued on behalf of him, his 43-year-old brother, Edward Kennedy Jr., and his sister, Kara Kennedy Allen, 44.

''She has done so much for us throughout our lives, and we will take whatever steps necessary to ensure she gets the medical treatment and care she needs and deserves. Families across this country struggle to make decisions for the long-term care of their parents each and every day. These decisions are never easy, and in our case, all too early in our mother's life. . . . We will continue to do whatever is necessary to protect our mother and make certain she receives the necessary treatment for her disease, and hope that others will join us in praying for her well-being," the statement said.
Posted by Jill Fallon at 5:01 PM | Permalink

February 22, 2005

Boomer Burials and Scatterings

I never cease to be amazed at the variety of burial and cremation choices now available  for aging boomers as they plan their last wave out.

I've already written about creative cremains, fantasy coffins, rocket rides for remains to rest in space, green burials, dust to mulch, and in boomer remains  how diamonds are forever, silk urns get through airport security, and the promessa process to turn your body into compost. 

But I never knew about harleycaskets where you can choose the "custom casket built for bikers" with a velvet interior and custom "highway to heaven panel and decals"

Or the DNA Genome Vault to preserve your genetic strands inside a miniature pyramid with a 3-D memorial bust on the top.

Golfers  - and some golf widows - should know that cremated remains can be poured down one of two putting-green holes that lead into two large ossuraries or containers, underneath the putting green for eternity on the greens at Catawba Memorial Park  in North Carolina.

If you love parties and fireworks, why not go out with a bang with the help of Angels Flight for a "scattering from within a beautiful fireworks display".

The Eternal Ascent Company is offering franchise opportunities to join their growing business  - and the patented process of sending cremated remains on their "final flight to the heavens in a giant balloon."

If you want to make a statement and an environmental tribute at the same time, consider Sea Services for burial in a bio-degradable "Ocean Urn that gently cradles remains at the ocean's depths than safely dissolves".

Sea lovers or scuba divers might really like the idea of eternal reefs where your ashes are mixed with concrete and buried at sea, part of an artificial reef where you sleep forever with the fishes. 

Or, in Italian style, you can become one with nature again, buried in Mother Earth, naked and in the fetal position,  all tight and cozy in a biodegradable pod from capsulamundi with a tree planted as your marker.

And this is only the beginning of the Long GoodBye.

UPDATE:  Just one day after I posted this, I learn that Hunter Thompson is going to have his remains fired from a cannon.

If you hear of any more, let me know.


Posted by Jill Fallon at 10:30 PM | Permalink

February 16, 2005

Dynasty Trusts are the Opposite of Great Legacies

When I was in law school, the rule against perpetuities was something everyone had to learn and had to explain.  Think of it as a rule against dynasties, against a family or a group maintaining economic power for several generations.

The rule against perpetuities comes from the common law and prevents property from being held perpetually in trust by voiding any agreement (which varies from state to state) which does not end twenty one years after a life in being, or one generation from lives presently in being plus twenty-one years. 

When trusts were drafted back in my early days of practice, they would end twenty one years upon the death of the youngest grandchild or Carolyn Kennedy, both then lives in being.

The rule against perpetuities is now being flagrantly flouted.  Thanks to the Wall Street Journal research, I learned that  in Alaska and South Dakota, trusts can last forever; in Delaware, most trusts can last forever but real estate can be held in trust for only 110 years; in Wyoming, trusts can last for 1000 years, and in Florida, trusts can last for 360 years.  These states are particularly egregious because they don't impose income taxes on trusts created by or for nonresidents.  Some fifteen other states have changed the rule against perpetuities and permit dynasty trusts which last forever or for hundreds of years.  You don't have to be a resident of the state to take advantage, so long as a trustee is located there.

The result could easily be predicted. The Wall Street Journal reports that $100 billion in assets has flown into personal trusts in those states.  The bank and trust companies managing the trusts and holding the assets have collected about $1 billion in annual trustee fees.  Families can avoid all federal estate and generation skipping taxes FOREVER under the current federal tax laws.  With  such trusts, people can protect their assets against bankruptcy, divorce, lawsuits and other creditors.  Some estate planners are urging their clients to fund their dynasty trusts now. 

Hats off to the research by Robert Sitkoff and Max Schanzenbach at the Northwestern University School of Law and to Rachel Emma Silverman who reported for the Wall Street Journal.

If Congress doesn't do something, we can look forward to more and more of the nation's wealth and economic power concentrated in the hands of bank and trust companies.  This is not the recipe for a future great society.  I have seen the disastrous effects that great inherited wealth has on too many people who struggle to find a purpose in their lives.

With the nation debating how to protect and fund social security for the future economic health of all Americans, nothing seems more repellent and un-American than the rush by those wealthy and socially unconscious to set  up their own economic dynasties and avoid all taxes in doing so.  Dynasty trusts are the opposite of great legacies.

UPDATE:  While I believe that trusts can be a good vehicle to pass on wealth to people that you know like your children and grandchildren which are the lives in being the Rule of Perpetuities envisioned, trusts that last beyond that time are vehicles to perpetuate the accumulation and protection of wealth for bloodlines forever, a perpetual oligarchy that's antithetical to the American dream.

Posted by Jill Fallon at 7:48 PM | Permalink

Linked Forever by the Ultimate Gift

If you knew that your body after your death could save two people's lives would you sign an organ donor card?  Think of the happiness and gratitude of the families

Maxine Walters did.  Well, she didn't sign an organ donor card, but she told her long term partner while watching the news of the tsunami in South Asia, "You see all them people dying? If anything happens to me, you should help them."

Maxine came from Barbados to New York City eight years ago and died of a sudden stroke at age 44.
Fortunately, her children understood what their mother and gave permission to harvest the organs.

In addition to the small acts of charity that seem easier to recall in sadness, her family said, Ms. Watson subscribed to the broad view that each person had an obligation to his or her neighbor. In her native country, Barbados, that was just the way of things. "Everyone from Barbados is family to one another," said her sister, Pauline Ellington.

Read the whole story, Linked Forever by the Ultimate Gift

Posted by Jill Fallon at 4:22 PM | Permalink

February 14, 2005

On the very edge of life and death

Some people fight to be born and some fight to wake up, both to ponder if you are responsible for making life and death decisions for another person.

This baby survived three abortions, was born alive at 24 weeks  in a case documented in the Journal of Obstetrics and Gynaecology.

She claimed she had been told that an ultrasound scan had confirmed the child was dead - but shortly afterwards she went into labour.

The 24-year-old mum - who has not been named - changed her mind about wanting to keep the baby after she felt him move on her way home.

Her son is now two years old and is the first long-term abortion survivor to have been born so prematurely.

This woman awoke from a 20 year coma.

"Hi mum," she said to her mother.
The words were a shock and a joy for Scantlin's parents.
"There's just no words," mother Betsy Scantlin told a CBS television news show. "I've just laughed ever since because it's just so amazing."

And this woman emerged from a six week coma to be told that she had been stricken with meningitis and cancer ----and that she had given birth to a baby girl!

Posted by Jill Fallon at 7:49 PM | Permalink

February 10, 2005

Wrong sperm

A Connecticut woman who was artificially inseminated with the wrong sperm gave birth to a healthy baby boy in January.  While the woman and her fiance are African American, the sperm belonged to a white man.  DNA tests are underway to confirm the child's paternity.

Her doctor tried to convince her to terminate the pregnancy, but the woman refused. believing this may be her last chance at motherhood.  She said, "The race is unimportant and I want this child to be happy and I want this child to grow and feel complete and whole."

While the lawyer from the infertility clinic was not available for comment, her lawyer said, "While she's thrilled to have this baby, this error has made her life much more complicated." 

I'll say.  Like who's responsible for child support.

Posted by Jill Fallon at 4:11 AM | Permalink

January 16, 2005

On the Bioedge

A clearinghouse of legal and medical bioethical news and opinion, the Australasian Bioethics Information (ABI)  is a rich source for finding out current stories that illustrate complex bioethical questions.  We will all face some of these issues.  Legal and health professionals will see a lot more of them in the coming years.(I'm having trouble creating a working link so here's the url to cut and paste. )

Take a look at the sampling of stories in just one week's newsletter. You must remember you're not  reading crazy stories from the  News of the World or the Onion,  but from a respectable newsletter.  It just shows  you how far we've come into an unimaginable future, how close we are to the bioedge.

  • Healthy patients deserve euthanasia too, say Dutch doctors.  Just being alive is suffering enough apparently.
  • Lobotomised Kennedy sister dies at 86 after 60 years in an institution.
  • Alabama man lives in coma for 23 years because his family refuses to let go
  • Some doctors "offensive" towards Down syndrome infants
  • Grandmothers overturn age-old conceptions. More on the 67 year old Romanian woman who's seven months pregnant with twins.

UPDATE: The 67 year old Romanian woman, Adriana IIiescu gave birth to twin girls today.  One died shortly afterwards, the other is in good health

Posted by Jill Fallon at 12:01 AM | Permalink

January 14, 2005

Celebrating Lives Well Lived - Oh Well

You don't often see ads for mortuaries except for discreet ads in the obituary pages.  That's about to change.  Boomers want funerals to be more about their lives and they are not alone in their interest in personalizing funerals.

That will likely change as the interest in personalizing funerals continues to grow.  Baby boomers are saying they want the funeral industry to be more about their lives.   

Kristi Arellano reported  in the Denver Post (sorry link expired)

Denver's Fairmount Cemetery & Mortuary  has launched a billboard and print campaign featuring black-and-white photographs of smiling people accompanied by epitaphs such as "Walked on all seven continents" and "Put six kids through college." 

The tagline: "Celebrating lives well lived."

The aim of the ads is to bring Fairmount to the forefront of people's minds when they find themselves planning a funeral and secondly, to encourage funeral planning. 

Can't argue with that, but what about lives not so well lived.

Oh Well

via Jim Treacher

Posted by Jill Fallon at 6:01 PM | Permalink

Getting the Last Word

“If you want to be dead-sure to get the last word, pen your own obituary.” writes Gayle Ronan Sims at the Philadelphia Inquirer

Funeral directors, hospice workers, ministers and newspapers say they're seeing an increase in self-written obituaries, which are making their way into the organized person's "important papers" files, along with burial plans and wills.

Many people are finding that writing their own obituaries can be an inspiring experience, bringing families together. And getting their names and stories published - for most people, for the first and only time - is a commitment to posterity.

"People planning their funerals often include self-written obituaries," said Julian Weinstein, corporate secretary of Goldsteins' Rosenberg's Raphael-Sacks, a Philadelphia funeral home. "They want a memorial to themselves, and they want the facts straight."

Another thing to add to my growing list.
Posted by Jill Fallon at 5:25 PM | Permalink

January 11, 2005

It seemed queer putting up my own tombstone

The tombstone of Oliver Wendell Holmes, Jr, at Arlington Cemetery lists his military service first before his tenure as U.S. Supreme Court Justice, probably so his wife could be buried there as well, or so he wrote to his friend Harold Lasky.

I have a lovely spot in  Arlington toward the bottom of the hill where the house is, with  pine trees, oak, and tulip all about, and where one looks to see a  deer trot out (although of course there are no deer). I have ordered  a stone of the form conventional for officers which will bear my  name, Bvt. Col. and Capt. 20th Mass. Vol. Inf. Civil War- Justice  Supreme Court, U.S.-March 1841- His wife Fanny Holmes and the dates.  It seemed queer putting up my own tombstone-but these things are  under military direction and I suppose it was necessary to show a soldiers' name to account for my wife"

In a letter to another friend, Holmes writes about the unknown bones collected from Civil War battlefields.

I shall go out to Arlington  tomorrow, Memorial Day, and visit the gravestone with my name and my  wife's on it, and be stirred by the military music, and, instead of  bothering about the Unknown Soldier shall go to another stone that  tells beneath it are the bones of, I dont remember the number but  two or three thousand and odd, once soldiers gathered from the  Virginia fields after the Civil War. I heard a woman say there once, 
'They gave their all. They gave their very names.' Later perhaps  some people will come in to say goodbye."

A good photograph of his tombstone can be seen at this link from 

Posted by Jill Fallon at 3:50 PM | Permalink

January 5, 2005

Should Survivors Have Legal Access to Email?

An interesting discussion at A Stich in Haste over whether survivors should have legal access to email.  In Michigan, the family of 20 year-old Justin Ellsworth, a soldier killed in Iraq, is trying to persuade Yahoo! to give them access to his email account.  So far, Yahoo! is standing by its policy of protecting the privacy of its subscribers.

I had never heard of "sweepers", friends of dying AIDS patients who were designated "when the time came" to

go through the dead friend's apartment and "sanitize" it (i.e., clean out the porn and other things best unseen by grieving parents). Today I'm sure such practices would often include email passwords with instructions to wipe out potentially embarrassing emails and cyber-accounts.

KipEsquire asks:

How can Justin Ellsworth's parents be so sure that they will want to see those emails? More importantly, how can they be sure Justin wanted it?    My heart goes out to Mr. and Mrs. Ellsworth, as it does for all those who have lost loved ones in Iraq and Afghanistan and everywhere else. But I would give them a somber warning: Be careful what you sue might get it.

This is going to become more and more of an issue in the years to come.  Which is why everyone should leave a letter to their executor saying explicitly just what they want people to have access to, and, if they want, the passwords.  Unless permission is explicitly given, the deceased's privacy should be respected.  You don't read other people's mail. Period.

Posted by Jill Fallon at 8:56 AM | Permalink

December 29, 2004

Called Back to Life by Boss

Bill DiPasquale locked himself into his apartment and drank himself into a coma after losing his job as waiter.  After his family pulled the plug on life support, a friend whispered a message from his boss in his ear,

"Get your ass back to work"

Five minutes later, in a whisper that hit a Massachusetts General Hospital room like a thunderbolt, DiPasquale awoke saying, "I've got to get to work.''    His would-be mourners were stunned. The coma had broken. They were his first words in weeks.
Read the full story in the Boston Herald  Wake-up call stops waiter at death's door.

Posted by Jill Fallon at 4:34 AM | Permalink

December 17, 2004

Unclaimed Money

First cash, then claims come out of the wall. $210,000 find leads to ownership dispute with no end in sight

This is what happens when you don't let your heirs know where everything is. You want to let someone know you've hidden more than $200,000 in the wall. Otherwise it just becomes part of the 400 billion dollars in unclaimed money in the United States.

Posted by Jill Fallon at 11:41 AM | Permalink

December 11, 2004

Seminars that manipulate seniors into buying annuities

Carolyn Said, a reporter for the San Francisco Chronicleexamines the history behind a California class-action suit against those insurance companies who use estate-planning sessions to sell annuities to seniors.

    Charlotte Cook found out something startling after her East Sacramento neighbor of 20 years, Leo Travis, died. She discovered that her friend, a frail, almost-blind man with severe emphysema, had cashed in his life savings in his final months to purchase annuities that wouldn't mature until he was 98.

    Cook was furious. "He would have had to pay major fines to get his money back out should he have needed hospitalization or to go into a skilled nursing facility. He had no liquid capital left," she said.

    That's why Cook, as the executor of Travis' estate, joined with two seniors who were sold similar products and two advocacy organizations for seniors in a class-action lawsuit against insurance companies and living-trust companies that market to elderly people. It is the largest case of its kind in California......

    The lawsuit, filed late last month in San Francisco Superior Court, charges that the companies sponsor free estate-planning seminars for seniors as a way "to learn about the senior's assets and manipulate them into purchasing manifestly inappropriate financial investments for seniors, namely annuities."

    Two companies named as defendants in the suit -- Estate Preservation Inc. of El Segundo (Los Angeles County) and Ameri-Estate Legal Plan Inc. of Irvine (Orange County) -- said they had done nothing illegal or unethical.

    Two other defendants, American Investors Life Insurance Co. in Topeka, Kan., and American Equity Investment Life Insurance Co. in Des Moines, Iowa, said they had no comment. Another defendant, Gentry Group of Dallas, did not return phone calls.

    "There's nothing wrong with a living trust," said Louise Renne, former San Francisco city attorney and now a partner with Renne Sloan Holtzman & Sakai, representing the plaintiffs in the case. "But there certainly is something wrong when a living-trust seminar or mill is used as a way to gather information about a senior's assets and then sell them an annuity."

    Financial planners say annuities are a poor investment choice for people over 65 because they generally have long maturation periods and severe penalties for early withdrawal. Sometimes they even have substantial surrender charges if the owner dies before a certain age.

    But they are lucrative for the insurance agents who sell them. According to, typical annuity commissions are from 5 to 5.5 percent of the money invested, with some agents collecting commissions of up to 14 percent.

Posted by Jill Fallon at 2:50 PM | Permalink

December 1, 2004

Look for more boutique estate planning firms

It seems as if estate planning simply doesn't fit the large-firm business model. Deborah Jacobs explores why in "Scaling Down" in Bloomberg's Wealth Manager, the June 04 issue which unfortunately is not online. As top lawyers leave mammoth firms to open their own estate-planning boutiques, they not only find a better lifestyle and more flexibility, they no longer have to compete for partnership shares with high-flying litigators.

Boutique firms offer several advantages. They are more welcoming of smaller estates, they often have a sharper focus and a lower overhead. Since they are not looking for business other than estate planning, they are more open to strategic alliances with other professionals: teams of professionals each with unique areas of expertise who work together on a particular project for their mutual client.

Posted by Jill Fallon at 4:09 PM | Permalink

October 9, 2004

My Inheritance Has Been Spent

In England, the beneficiary of a 95 year old woman, found that much of her inheritance had been spent by the widow's hairdresser who had been trusted with her financial affairs.

    Julie Thompson-Edwards, a trading standards officer, the executor and main beneficiary of the estate of 95 year old Olive Bird, described how she discovered that thousands of pounds of her bequest had already been spent by the hairdresser who, with power of attorney, spent some 82,000 pounds on horses and a training paddock in My inheritance has been spent.

Who you choose to hold your durable power of attorney is one of the most important decisions you can make because there is no oversight of power of attorneys

    COLUMBUS - The estates of some elderly people, including those losing their mental abilities, could be depleted by caregivers who abuse a powerful legal tool giving them control over the person's checkbook, home and other assets.

    State law requires no oversight when someone is granted power of attorney. The forms are available at libraries and on the Internet. No one keeps track of the agreements, and no one ensures the senior is competent to sign over control.

    "It can be a license to steal," Franklin County Probate Judge Lawrence A. Belskis said. "When you give somebody a power of attorney, you are giving that person the right to do anything you could do yourself."

    The lack of oversight isn't harmful if the person chosen has "a good heart and good intentions," said Diana Kubovcik, director of client services for the Central Ohio Area Agency on Aging.

    "But those same powers can be misused, with potentially horrific results," she said.

    The same thing can happen with a court-approved guardian, who has even more power, such as where the person lives or whether to approve medical treatment. There is more court oversight in such cases, but there are many guardianships to keep track of: 7,000 in Franklin County alone.

    The person might gain the financial power after being hired to provide full-time home health care, said Sally Hurme, a lawyer with AARP's national office in Washington.

    "We frequently hear stories of frail older women who hire attendants who isolate them from loved ones so their very survival depends upon them," Hurme said. "In no time, the attendant controls what the older woman eats, when she goes out and whether she gets the medical care she needs."

    Of the 161 complaints received last year by the Ohio Department of Aging, 100 were determined legitimate, said Beverley Laubert, long-term-care ombudsman. Of those, 73 were resolved or partly resolved, four couldn't be reconciled and 23 were withdrawn.

Posted by Jill Fallon at 4:39 PM | Permalink

September 28, 2004

A Terrible Decision More and More of Us Face

Few people are prepared to deal with some of the terrible decisions they will have to make. The New York Times today called it "The Ultimate Family Quarrel" How do adult children decide whether a parent lives or dies when faced with a crisis like Geraldine Reardon's. A terrible situation that more and more of us will face.

Just when a family should be coming together, supporting each other with full hearts, disagreements about what to do and what Mom or Dad would want because of the lack of a health care proxy can split families totally.

    The crisis posed by Mrs. Reardon's condition and her family's rocky history was daunting but hardly unusual, doctors and other experts say. Medical advances are forcing more patients and families to confront ever more grueling choices about living and dying. Such advances offer the hope of saving desperately ill patients but can also result in patients surviving in such severely compromised conditions that families become painfully confused.

    This inevitably exposes or creates family conflicts, which then make urgent medical decisions even more difficult, a wrenching cycle that can tear families apart. In addition, doctors often disagree about how to treat such patients, and living wills often fail to resolve critical questions.

    "Every hospital in the country has families going through this all the time now," said Dr. Erik Steele, vice president for patient care services at Eastern Maine Medical Center in Bangor, where a recent case involved four siblings so divided over whether to keep their 88-year-old mother alive that they first put her on a respirator and then took her off it.

    "This is going to be an issue more and more for us, and I think it's an issue almost unique to our generation," Dr. Steele said. "For the first time, we have this degree of technical ability to keep people alive without the ability to always restore them to good health. At the same time we have a much higher expectation of what health care can do." ------

    While families often seem to pull together when dealing with treatable illnesses, they often splinter over an end-of-life decision, experts say. Old frictions surface and new ones form, based on family relationships and different ideas of what makes a life worth living. Living wills, advance directives and health care proxies are intended to resolve crucial questions about what a patient would want, but they often fall far short.

Such a life and death decision is fraught with the emotion of the circumstances and conscious and unconscious emotions of the children. While health care proxies are designed to deal with this situation, some try too much to control future medical decisions. I wrote about the recent study by the Hastings Center in Is the Living Will Dead?

A lawyer friend for whom I have a great deal of respect said the most important thing with health care proxies was to give one person the authority to make all medical decisions. The worst thing is not to have a health care proxy and to burden all the children with making such a terrible decision.

Posted by Jill Fallon at 7:08 PM | Permalink

July 20, 2004

15 trust officers in 16 years

As financial services consolidate, trust managers come under fire reports the Wall Street Journal today.

The wave of consolidation in banks has reduced the estimated number of institutions offering trusts from 4000 to about 3000 in the last decade according to the Federal Deposit Insurance Company. At the same time the use of trusts for personal assets has soared, growing to $1.1 trillion in 2003 from $928 million in 2002 according to the VIP Forum, a research group in Washington, D.C. that tracks the wealth management industry.

    "In trusts that's a particularly big issue, because relationships mean a lot," says Robert Wolf, an estate lawyer with Tener, Van Kirk, Wolf & Moore in Pittsburgh. "The word 'trust' kind of says it all. How can you have trust without relationships?" One of his clients, he says, has had 15 trust and investment officers in 16 years because of rapid turnover at the client's bank.

    Big banks face more pressure "to sell the corporate product of the month," says Mike Carroll, president and chief executive of independent trust company Heritage Trust Co. in Oklahoma City. But, he says, it's a tough business for large institutions: "It's too time-consuming, too much touch, too much relationship-driven."

    With trusts more prevalent -- and beneficiaries more financially savvy -- squabbles about trust funds have become common, especially since beneficiaries have little power to control trustees, say estate planners. One big problem: Many older trusts don't have clauses dictating how and when a trustee can be removed, making it tough to switch trustees without expensive litigation. In addition, the turbulence in recent years in the stock market has caused the value of many trust funds to plummet, brewing unease among beneficiaries.

The wave of consolidation in banks has reduced the estimated number of institutions offering trusts from 4000 to about 3000 in the last decade according to the Federal Deposit Insurance Company. At the same time the use of trusts for personal assets has soared, growing to $1.1 trillion in 2003 from $928 million in 2002 according to the VIP Forum, a research group in Washington, D.C. that tracks the wealth management industry.

    "In trusts that's a particularly big issue, because relationships mean a lot," says Robert Wolf, an estate lawyer with Tener, Van Kirk, Wolf & Moore in Pittsburgh. "The word 'trust' kind of says it all. How can you have trust without relationships?" One of his clients, he says, has had 15 trust and investment officers in 16 years because of rapid turnover at the client's bank.

    Posted by Jill Fallon at 9:45 AM | Permalink

July 16, 2004

We were not quiet in our minds

Unless you keep your affairs in order, and that is what EstateVaults™ will allow you to do, your family will have a terrible time finding out what's what and what's where and they will be "out of their wits with trouble" as Samuel Pepys was more than 400 years ago.

But above all, our trouble is to find that his estate appears nothing as we expected, and all the world believes; nor his papers so well sorted as I would have had them, but all in confusion, that break my brains to understand them. We missed also the surrenders of his copyhold land, without which the land would not come to us, but to the heir at law, so that what with this, and the badness of the drink and the ill opinion I have of the meat, and the biting of the gnats by night and my disappointment in getting home this week, and the trouble of sorting all the papers, I am almost out of my wits with trouble, only I appear the more contented, because I would not have my father troubled. The latter end of the week Mr. Philips comes home from London, and so we advised with him and have the best counsel he could give us, but for all that we were not quiet in our minds.

As one of the commentators to this entry wrote Dealing with an estate is a special kind of torture.

On the one hand, you’d like to sit the dearly departed down and let them have it for leaving their affairs in such terrible mess for you clean up when you’ve already got plenty to do in your own life thank you very much!!

On the other hand, you feel horribly guilty for thinking such things about someone who was so sick, and who cared enough about you to leave you part of their estate.

Posted by Jill Fallon at 11:22 AM | Permalink

July 15, 2004

IRS oks Intentionally Defective Irrevocable Trust

Tom Herman's Tax Report as usual as the scoop.

    Suppose you want to give money to your kids. You can transfer assets into an intentionally defective irrevocable trust, or IDIT. Because of the trust's special nature, the income it generates is included on your personal income-tax return while you are alive, but its assets aren't included in your taxable estate, says Martin Nissenbaum of Ernst & Young. "This is a positive thing" if your goal is "to have as much money as possible go to your kids" or other heirs.

    You "effectively wind up paying the kids' income tax on the trust income" without having to worry that the IRS will label that payment as a taxable gift to the kids, says Lawrence P. Katzenstein, a lawyer at Thompson Coburn LLP in St. Louis.

    For more details, see IRS revenue ruling 2004-64, which generally confirms the strategy -- and the point that the payment of the income tax by the grantor doesn't create a taxable gift, Mr. Nissenbaum says.

Posted by Jill Fallon at 11:28 AM | Permalink

Fumbled Handoff

Because of the trust's special nature, the income it generates is included on your personal income-tax return while you are alive, but its assets aren't included in your taxable estate, says Martin Nissenbaum of Ernst & Young.... For more details, see IRS revenue ruling 2004-64, which generally confirms the strategy -- and the point that the payment of the income tax by the grantor doesn't create a taxable gift, Mr. Nissenbaum says.

Posted by Jill Fallon at 11:12 AM | Permalink

June 26, 2004

Leaving Loved Ones Vulnerable

About 58% of adult Americans don't have a basic will. 69% don't have any sort of advance medical directives.

Why don't people make wills?

Myth and superstition

    They think they're not old enough - 15%
    They think they don't have enough assets - 25%
    They don't want to think about death and incapacity - 8%

So what makes people draw up a will?
    The arrival of a new child - 25%
    Marriage - 7%

And I think life experience. When you experience how bad it can be, you don't want anyone else ever to go through that. Almost one in five Americans (18%) have personally experienced problems after the death or incapacitation of a loved one due to a lack of or improperly prepared an estate plan, including conflicts over asset distribution.

What's been your experience? Do you have any horror stories or good stories to encourage others to do the responsible thing?

Posted by Jill Fallon at 5:17 PM | Permalink

June 4, 2004

Medical Privacy bars Mother from medical records of 18 year old son

Last week, I visited with Deborah Pechet Quinan, one of my favorite lawyers. An estate planner, Deborah believes in making it as easy as possible for her clients to understand complex documents by giving them easy to understand flow charts and fiduciary listings. Ive great respect for many lawyers - I should being one myself but Ive never liked the priestly nature of the profession and the I know more than you do attitude of too many lawyers. Of course, lawyers know more about the law, but that doesnt mean that they cant make their documents easier for their clients to understand and access essential information.

After telling me a story about a mother who couldnt see the medical records of her gravely injured 18 year old son because of medical privacy, Deborah now recommends a HIPAA Authorization as one of the standard documents for her clients.

Turns out that the federal privacy rules have put a shield around health-related information that can prevent advisors and family members from getting necessary facts, they used to be able to get quite easily. Overview Privacy

Since violators of medical privacy can be punished with civil and criminal penalities and even jail if the offenses are committed under false pretenses or with the intent to use the information for commercial or personal gain, doctors and covered entities have become quite wary about disclosing health information without clear authorization

Bound and Determined by Deborah Jacobs in the June issue of Bloomberg Wealth Manager lays out areas where the HIPAA shield can pose problems to existing estate planning documents. Without a HIPAA authorization, it may be difficult to establish incapacity. While durable powers of attorney are not affected, springing powers of attorney may be. So may be successor trustees for revocable living trusts.

While the person to whom you have given a health care proxy or health care power of attorney becomes a personal representative under HIPAA and entitled to the same rights to medical information as you, the patient, there are others whom you may want to have some access to your medical records even for a limited purpose such as proving incapacity. Charles Sabatino, a lawyer with the American Bar Association Commission on Law and Aging in Washington, DC. is quoted as recommending that clients sign a HIPAA release that authorizes disclosure of specific health information to identified parties who may include family members, friends, lawyers, accountants and financial advisors.

A sample release form is available at the website of the National Academy of Elder Law Attorneys
So along with your toothbrush, when you go to the hospital remember to bring your signed release and your health care proxy.

Posted by Jill Fallon at 3:01 PM | Permalink

June 3, 2004

Is the Living Will Dead?

At first controversial, then conventional, now promoted policy, living wills are something just about everyone believes in. Patients should be autonomous and no one wants to live like a vegetable. But they havent worked. Why?

The Hastings Center, an independent, nonpartisan bioethics research institute has published
Enough: The Failure of the Living Will in which Angela Fagerlin and Carl Schneider explore why.

1. Most people dont really know what they want, apart from the general statement I dont want to live like a vegetable Even patients making contemporary decisions about contemporary illnesses are regularly daunted by the decisions difficulty. How much harder, then, is it to conjure up preferences for an unspecifiable future confronted with unidentifiable maladies with unpredictable treatments.
2. People cant articulate what they will want, apart from the general statement I dont want to live like a vegetable. Most living wills are terribly drafted. Unlike property wills where lawyers have experimented with testamentary language for centuries in a process that have produced standard formulas with predictable meanings and default rules, living wills have only been around for a couple of decades and the swirl of approaches has been bewildering. Were living wills too general? Make them specific. Were they one size fits all Make them elaborate questionnaires. Were they uncritically signed? Require probing discussions between doctor and patient
3. They often cant be found. Its a long way from execting a living will to getting it onto hospital charts when the time comes. Where are they? Lost? Forgotten? In safety deposit boxes? With the lawyers? 62% of patients do not give their living wills to their physicians. Of those hospitalized with living wills, only 26% of their medical charts accurately recorded that information and only 16% of the charts contained the form.

The authors conclude "Our survey of the evidence suggests that living wills fail not for want of effort, or education or intelligence, or good will, but because of stubborn traits of human psychology and persistent features of social organization.We should repeal the PSDA( the federal Patient Self Determination Act ), which was passed with arrant and arrogant indifference to its effectiveness and its costs and which today imposed accumulating paperworok and administrative expense for paltry rewards

So What Should People Do?

Durable Powers of Attorney for Health Care or Health Care Proxies are the way to go for those who do want to control future medical decisions. They have many advantages over living wills. As these things go, they are simple, straightfoward, and thrifty. They differ little from current practice where family members act informally for incompetent patients and they probably improve decisions for patients since the surrogates know more at the time of decision than patients can know in advance.

Trust the people who love you to make decisions on your behalf. But empower them to do so m effectively. That means an executed health care proxy or durable power of attorney for health care and a HIPAA authorization so your loved ones can see your health care records if necessary, about which more later

Posted by Jill Fallon at 10:18 AM | Permalink

May 22, 2004

Protect Against Will Challenges

I was surprised to learn in a recent WSJ article by Kaja Whitehouse(subscription required) that 20% of parents divide their estates unevenly according to Kathleen McCarry, an economics professor at the University of California, Los Angeles. About 1/4 of that 20% did so because they want to support a child who required greater financial assistance. Another quarter wanted to repay a child who helped support them in some way.

To prevent any will contests by disgruntled siblings, Whitehouse suggests

    Videotaping of the testator spelling out your last wishes (I suggest explaining why too) Consider a "no contest" clause rather than a disinheritance Draft your will many times. (You want to create layers of wills, differing in slight respects, overriding the old will especially if the change from the old will is dramatic. Use a revocable trust for your assets Keep favored heirs out of the estate planning process Discuss your plans with your heirs so they don't feel things have been concealed.
Posted by Jill Fallon at 5:48 PM | Permalink