Benjamin Franklin Lodge #83, Madison, WI

Laying Down your Working Tools: A Mason’s Thoughts on Death and Dying, by Bro. Joseph M. Howell. Originally presented to Benjamin Franklin Lodge No. 83 in October 2007.

It is a foundational principle of Freemasonry to remember that just as we were all born into this world through the grace of the Great Architect, by His will we each, some day, must die. In growing as human beings, we learn the value of life by our exposure to death. Perhaps death has touched us personally in some way, or maybe not. Suffice it to say, whether we have internalized the concept of our own mortality or not, each of us knows we will die. This article will discuss some general concepts important at the end-of-life. It also will offer suggestions about ways to fulfill your responsibilities towards people who could be placed in the worst of situations when you are dying – that of uncertainty regarding your wishes.

How do we face death? Many cultures greet death with fear, despair, and grief. Almost without regard to our personal beliefs about what happens when and after we die, death is not something we look forward to, for our loved ones or ourselves. Western medicine portrays death as the ultimate failure. In many cases health care providers will do everything within their power to maintain life, unless they have consent from their patient or the patient’s next of kin not to do so. After decades of perfecting life support, providers are only now beginning to learn that – sometimes -- doing nothing is doing what is right.

Unfortunately, deciding what is right is not always clear, and in fact, often, there can, at the time of death, be more than one option that seems as good as another, with no clear direction on what a person would want to choose for themselves. Sometimes family members disagree. We may think we know what our parent or sibling would want. Surprisingly, if we discuss issues of dying with them, we might find out that we don’t know as much as we thought, either regarding the dying process, or what they would want done after they die. Research suggests that the wishes of people who are dying and the choices of their family members are commonly not in agreement. This has the effect of increasing the level of distress that a family is going through. It may prevent people who are dying from having their wishes carried out.

People who are dying of a life-limiting disease have at least one leg up on the rest of us: they have a good idea how they will die, and within the limits of medical prognostics, how long they will live. This raises many issues for this group of people. Seeing their mortality more clearly, perhaps, these folks are more likely than the rest of us to put aside a bit of time to think about how they want things to go. They get their personal affairs in order, prepare wills, and fill out advance directive forms. Some people take these tasks on as a sort of therapy, and really get into it, not only preparing for their death, but also planning their own memorial services and making funeral arrangements. Others seem to shut down, and do not wish to discuss or think about dying. Investigations by end-of-life researchers, however, indicate that most people who understand they dying do, indeed, want to discuss these issues.

It is interesting that we avoid talking about our own death, and that of people we care about. Outside observers of our culture would think we have an obsession with death. We make jokes about it, and have invented a whole genre -- morbid or dark humor -- of amusements. We love to watch movies about death, to talk about the deaths of people we don’t know, read ghost stories, and celebrate Halloween. Yet when it comes to discussing death that might be close to us, silence prevails. It wasn’t always that way, though. 100 years ago, most people died at home. Their family prepared their bodies, and their loved ones buried or cremated them. Wakes lasted for days, with the body kept on ice, maybe in the living room or dining room. Death was a part of life, and the whole family was a part of it.

We’ve lost something, and we even have a name for it: the medicalization of death. Nowadays, it is the norm to have a person’s body removed from sight as quickly as possible, for preparation by a professional mortician. Instead of bringing people home to die, we send them to the hospital or nursing home. We’ve cleaned up the process to the point that unless someone dies in front of us, we have little, if any, contact or familiarity with the dying process. It’s as though we’ve come to think of death as something other than usual and normal.

It seems clear that the time to start thinking about death is when so many other issues do not burden us. Not everyone experiences life-limiting diseases. Fewer still have the opportunity to make choices about their end-of-life. What, then, are the steps we can take to ensure that if we are not one of the lucky few who die in their sleep at the age of 122, after life-long excellent health?

Advance Directives

One of the most important, yet underutilized, legal documents an adult can prepare is advance directives. Advance directives are of two types: the living will, and the durable power of attorney for health care. A living will is a document that outlines your preferences about medical decisions in the event you are not able to communicate with your providers. Living wills are limited because they cannot think for you. Health care providers can only use what you put in writing in your living will to guide their decisions.

A far better choice is a durable power of attorney for health care, or DPOA. This document designates a person, chosen by you, to make medical and end-of-life decisions for you, in the event you are unable to communicate and make such decisions for yourself. For example: a man was in a car accident, and had severe brain injuries. He was in a coma, and not expected to recover. Life support equipment was being used to keep him breathing and his heart beating. He had a living will in place, but it did not specify whether or not to keep him on life support under these conditions. His family was divided on whether he should be kept on life support, or allowed to die. No one agreed on what he would want.

Completing a DPOA form is a three-step process. Many people miss the first step, which is to have thoughtful conversations with the person you choose to be your DPOA. Remember, they have to be willing to undertake the responsibility. Additionally, it is not their role to do what they would want, but what you would want if you were able to make the decisions yourself. Frank discussions about your end-of-life concerns will help your designee to do that if the situation arises. The second step is to complete the forms and sign them, with your DPOA designee and two witnesses. A link to some Wisconsin DPOA forms is given below. Completing DPOA documents does not require the assistance of a lawyer, but if you have a lawyer, it would not hurt to have them look over your document, and they should have a copy for their files. Others who can help you are social workers, clergy members, nurses, and physicians. Health care workers may not witness DPOA or living will documents. The third step is to make your documents part of your medical records. A copy should be given to your local physician and any specialists or clinics you visit. If you need to be admitted to the hospital, a new copy should be given to your health care team, even if you have provided them in the past. Communication is the key to making sure your wishes are followed.

Your DPOA can be any person of legal age whom you designate, whether you are related to them or not. Keep your eye on what you are asking them to do, when you are thinking about whom you might choose. An additional step is helpful in the case of people in same-sex or unmarried relationships if you live in a state – this is most states – that does not recognize such relationships. Make sure that every copy of your DPOA has attached to it paperwork to give your partner hospital visitation rights and access to your medical records. There have been cases where partners have been designated as the DPOA, but unable to fulfill their duties because they were not permitted to see their partner, and health care information was withheld from them. This has, in fact, happened in Wisconsin. A crisis is not the time to test the good will of health care workers. It is strongly advised that same-sex couples, and other couples who may face these circumstances, use the services of an attorney to make sure their paperwork is in order, and to revisit the documentation as often as is recommended.

Neither living wills nor durable powers of attorney should be thought of as something that can be used to make decisions when you are able to communicate your own desires. They can only be used in instances where you are incapacitated, and in a death-like state or actively dying. Your power of attorney designee cannot make decisions for you when you are able to make them yourself. Here is a link to download living will or durable power of attorney forms for the State of Wisconsin: http://www.dhfs.state.wi.us/forms/advdirectives/

If you live in another state, try doing some Internet searches for advance directive forms in your state. Do not pay for them unless you have determined there are none to be found online for free, and your local hospital does not provide them.

Wills

The importance of having a will cannot be overstated. Moreover, if you own anything more valuable than a lawnmower, your will should be drawn up by an attorney. If you own or share ownership of a house, objects of value, stocks or other interest-bearing investments, and/or substantial financial reserves; or if you have dependents, discuss your estate with a knowledgeable and experienced financial advisor. Your will, however, is not the place to put your desires about cremation versus burial, or other funeral arrangements. These decisions are usually made and performed before a will is read. There are tremendous benefits – not all of them financial – that come from expert estate planning. Do these things now, while you are young and healthy. The earlier you do them, the easier they will be to keep up-to-date.

Communication

It was mentioned above that communication is the key to making sure your wishes are followed. Open discussions with your family members can go a long way in minimizing needless stress during a tragic period. Talk to them about your wishes, and theirs. Let them know it is fine to talk about death. Tell them about your living will or power of attorney, and where these important documents are kept. Children should know whom to call if there is an emergency or death, and should be able to find a list. A conversation with your primary health care provider can be conveniently started when you hand them a copy of your advance directives. Chances are if you are incapacitated, they will be in some way involved in your care. Planning ahead is part of living a healthy life.

Family discussions are the time to let others know what you would like to have happen to you in the event of your death. Customs vary considerably even within the United States, and range from full embalming and caskets that play your college fight song, to cremation and sharing of the ashes in tiny memorial urns. You can have your cat made into a diamond, or your dog wrapped in foil and sent into space. Green burials, with no embalming or non-degradable implements, are becoming more popular and available. If you desire, you can set up your whole funeral in advance, and pay for it now, while the price is lower. You can buy cemetery plots, and even have the headstone or other marker put in place.

“Death…in Masonic philosophy,” according to Mackey’s Encyclopaedia of Freemasonry, “…is the symbol of initiation completed, perfected, and consummated.” Properly and responsibly preparing for our deaths, therefore, is an intrinsic part of living full and meaningful Masonic life. The issues raised in this article could be said to be obligatory to the person who wants to take a load off the shoulders of his loved ones. We will revisit discussions of different aspects of death and dying in the future; for now, you have some planning to do.

Bro. Joseph M. Howell is a member of Benjamin Franklin Lodge #83, in Madison, Wisconsin. He is a Registered Nurse practicing in oncology, and is completing a Ph.D. in nursing research. His research interests focus on the end-of-life concerns of people who are facing death from a life-limiting cancer diagnosis. He often lectures on end-of-life issues to professional and lay audiences.