#advanced directives

[feminist-space]

These Are The States That Will Ignore Your Final Wishes Just Because You’re Pregnant

You can’t plan for a life-threatening medical emergency. But depending on where you live and if you’re pregnant, the tiny bit of control you

"if you live in any of the nine states that automatically toss out a pregnant person’s advance directive:

Alabama

Indiana

Kansas

Michigan

Missouri

South Carolina

Texas

Utah

Wisconsin

But that’s not the complete story. A 2019 study published in JAMA examined the way all states navigated pregnancy and advance directives and found that 39 states “identified pregnancy as a condition that influences either an incapacitated [patient’s] advance directive or surrogate decision making.”

They also noted some of the nuances that vary between states: which states test for pregnancy before they allow someone to be taken off life support (Alaska, Georgia and Oklahoma); the five states (Kentucky, New Hampshire, North Dakota, Pennsylvania, and South Dakota) that “specified that life-sustaining therapies may be discontinued if they cause the woman undue pain that cannot be alleviated by medication” and the lone state (Pennsylvania) that offers to take on the financial burden of keeping a pregnant person on life support in these situations.

Yet, among these states, the actual laws are hardly public knowledge — only eight of the states’ advance directive documents seek someone’s “pregnancy-specific care preferences.” Of the 31 states that had restrictions on taking pregnant people off life support, 29 of these states have restrictions in their state statutes. However, 69% of the advance directive forms from these states made no mention of them."

...

Ultimately, it comes back to a prevailing narrative that reproductive health care experts and advocates have been urging more Americans to consider: These sort of restrictive laws, pieced together by people with little knowledge of medicine or pregnant bodies cannot fairly legislate around the unique medical needs of pregnant people and the health care providers who care for them."

[arctic-hands]

So like I'm not an official member of the Order Of The Good Death, but I am death positive (PLEASE read up on that instead of being alarmed) but I'm completely overwhelmed by the info packet on making an advanced directive the hospital keeps pushing on me since the pandemic started (at least, that's what I'm hoping the reason is and not them anticipating some eugenicist crap befalling us soon). It's not even anxiety over my mortality–tho against my will there is that, I will not lie–I just don't know where to start. I start reading the packet they gave me and my eyes just glaze over.

My parents are in no way mentally equipped for conversations for everyone's eventual death, not theirs and least of all mine, so I can't ask them for help.

[goodiecornbread]

Wait, your corpse can be used to solve crimes?

Yes!

Body farms are used for forensic studies of body decomposition. They put the [donated] bodies in all sorts of situations-- buried in a plastic bag under 3 feet of dirt, left in a swamp, etc. Then they get studied as they decompose. That way, when a body is found out in the world, experts can look at it and know, "Oh, this person was left here for six days."

So my corpse wouldn't necessarily be directly solving a crime (unfortunately), but it would help forensic investigators in their... forensic investigating.

The University of Tennesee has the most famous farm, but there are many

[anomalousrobot]

Protecting Trans Bodies in Death

Your life. Your death. Your rights. Check out Cake for end of life resources: https://www.joincake.com/gooddeath/The Order of the Good Death resource page, "...

[tmitransitioning]

I'm 30 but I'd like to prepare for the future. Do elderly people still take T? What if they are unable to care for themselves? I am very aware that things change so not all experiences current elderly people may not be the type of heathcare and support I will get. But I'm just so worried.

we’ve addressed this before, you can search menopause for more posts about this, but this one sums it up. the TLDR is: you are usually given the option to decrease your dose or stop all together as your body makes less E. As far as the other question: how do people manage transgender healthcare in old age when they can’t handle it themselves:  The same way they manage diabetes or other health care needs (if they have a medical need, it’s still ordered)- However there’s a very real trend of people who are “not out” having issues with transphobic care homes, or other similar situations.  I’ve been to entire conferences that center on LGBT aging issues- it’s much more than i can write in a few paragraphs.  

The best thing I can say is:  be sure to put your medical wishes out in writing, and be sure to put trans-specific language in your advanced planning documents.  there are blanks in your healthcare advanced directives where you can specifically outline specific wishes “even in the event of mental deterioration (ex: dementia, mental illness), i wish to be known as (name) and to have (pronouns) be used to refer to me.  It is important to maintain my hormone therapy of (T/E/adjunct therapies) as long as it is medically safe to do so.  The decision to discontinue must be made with my POA as well as two doctors, one of which must be a specialist in transgender healthcare.”  (you can customize whatever language here you like, I'm NOT a lawyer I'm just making this shit up based on my own medical knowledge, but it’s what i’d put in mine).  

this type of language will hopefully up the odds that you’ll only be stopped on your HRT if it’s truly medically necessary (versus just what the place you’re living feels like doing, which does happen, tbh), and that you’ll be respected even in death.   Some of these documents need to be notarized (if you have a bank account, usually they offer free notaries), others just need to be witnessed by two people (neither can be the POA themselves) and that depends on state by state.   The second link i have up there also has a lot of good resources for long term planning.  Lastly:  it is LITERALLY never too soon to start planning for later.  i’ve seen a lot of sad endings, and more so in the queer community.  the more you plan for this, the closer to ideal your final transition is.  

mod mayhem

[wayfaringmd]

If you sign a DNR can your next of kin override that? Like if you signed an advance directive but then your heart stops and your family tells the doctors to resuscitate you anyway would the doctors listen to them instead of the paperwork you signed?

Unfortunately, yes, your next of kin can override your DNR. This is a big problem common in the ICU. We doctors are often afraid of lawsuits if we go against a family’s wishes, and it leads to a lot of futile care. I’ve seen families demand full code on people with tubes coming from every orifice who are on 12 different IV drugs with widely metastatic cancer and multiple organ failure who made the decision ahead of time to not be coded. It’s inappropriate. Doctors can choose to honor the DNR, particularly if they feel that continued lifesaving efforts would be futile.

There are times when it’s reasonable to override a DNR (the biggest example I can think of is if a patient is determined to have diminished decision making capacity when they chose the DNR), but they’re uncommon. Remember: a DNR doesn’t mean doctors stop treating you. It only means that if you stop breathing or your heart stops, we will allow for a natural death rather than starting CPR.

[tmitransitioning]

Hi, the prepaying for your funeral thing, well funerals are a business and businesses go defunct. If OP is 30 now, they might not need a funeral until 50 years later. Also, do advanced healthcare directives even work? I mean even same sex couples have issues taking care of each other heathcare if they aren't married why won't they use something like that for themselves?

if OP is 30 they might not need the services for 30 years- OR they might die tomorrow  (not wishing that on OP or anyone!) and it would be really unfortunate to assume “i’m going to die at 80″) and not be prepared.  Businesses do go out of business, you’re right- one helpful thing is to look at a record.  not a great idea to put your money in one that’s been open 10 years, but one that’s been around 50, 100 years, 300 years- might be a better investment.  most parts of the USA have mortuary services that have been around these lengths of times- in other countries-even longer. As a nurse, AND as someone who has had to try to take care of things without an AD for a lesbian partner (before DOMA was repealed), i can tell you that advanced directives DO work.  They’re not 100% fullproof- people can still take your loved ones to court, or challenge them, but here you have your own wishes, in your own words in a legal document and someone willing to stand up and defend you, versus some A$$ family saying “no, disregard what they said they want, i know better.”  99.99% of the time, the document wins out.   what’s more: almost all of the time, WITHOUT the document, the next of kin (family- parents, siblings, children) are the ones who win regardless of how long you’ve been partnered with your unmarried partner.   Within the LGB+ community, especially before marriage equality was a thing, there was a big push to help people get these documents in place- but at that time you have to realize that they weren’t universally accessible like they are now (hospitals didn’t offer them for free; they weren’t generally readily accessible on the internet.) You had to pay money and get a lawyer to write them for you more often than not- which, for most people meant they were cost-prohibitive.  In the early 2000s, the queer community was just beginning to learn how to live again after the AIDS epidemic- just coming to terms with HIV/AIDS as a chronic illness instead of a fatal disease.  It was a totally different world.

NOW you can access advanced directives from your own home, and have a party with your friends, each witnessing the others to ensure that all of you aren’t subjected to maltreatment at the hands of unsupportive family members/next of kin.  

You do not want to know what it feels like to have your loved one's wishes violated because they didn’t put them down on paper.  words cannot express how wrong it feels.  

mod mayhem

[elementop123]

People always told me as a teen and young adult when I wanted to donate my body to science that I should instead donate my organs, but (1) I don't want to die in a hospital if I can help it, which pretty much rules that out (2) my geneticist has told me one of my conditions could be passed on in organ donation (all tissue) possibly, and we just don't know enough about it yet, so I cannot ethically donate my organs. I'm still not sure if my family could handle me donating my body to science, though. But I have a number of rare diseases, and id have to research because I don't want to support eugenics, but id love to support diagnosing and treating some of the conditions I have, and maybe there's a study I could will my body to if my family can handle it...