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Missouri Durable Power Of Attorney by jessicaDerusso

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									                            Life
                            Choices
                            Make important decisions
                            now about your end-of-life
                            needs. Your loved ones
                            will not have to make
                            those decisions for you
                            if you become impaired.
                            Forms are included to
                            communicate your wishes.




Missouri Attorney General

Chris Koster
                     With knowledge
                     comes choices




                      Chris Koster is sworn in as attorney general by
                      state appellate Judge Joseph Dandurand, now
                      deputy attorney general. Niece Claire Koster
                      holds the Bible.



Dear Missourians,                                to an already popular publication
   As Attorney General, I                        that has been provided to tens of
work to protect the interests of                 thousands of Missourians.
Missourians in all aspects of life.                 You may have signed a living will
This includes health care decisions              years ago. Changes in the law make
and matters surrounding the end of               the advance directives form on page
life.                                            15 of this booklet more effective
   My office partnered with the                  than a living will, so I encourage
Missouri End-of-Life Coalition                   you to complete the form.
to empower Missourians with                         Talk with your family, health care
knowledge about end-of-life issues               providers and clergy about how
and to raise awareness about pain                you wish to spend the end of your
and symptom management.                          life. By communicating openly, you
   This revised edition of Life                  will improve the quality of life for
Choices makes improvements                       yourself and for your family.


                                        Sincerely,



                                   Chris Koster
                           Attorney General of Missouri


        The Office of the Missouri Attorney General is an equal opportunity employer.


                                                                                         3
            Inside Life Choices
CHAPTER 1   PAGE 7    Communicating about the end of life
                 9    Life planning work sheet
                13    Advance directives
                13     ● Durable power of attorney for health care choices
                14     ● Health care choices directive
                15     ● Durable power of attorney for health care choices
                          and health care choices directive form
                21    Living wills
                22    Understanding life-sustaining treatments
                22    Managing your pain is possible
                23    Outside the hospital do-not-resuscitate (OHDNR) order
                24    Hospice care


CHAPTER 2   PAGE 25   Financial considerations
                 26   Wills
                 26    ● Self-proving clause
                 27   Personal representative
                 27   Who receives your estate
                 27   Living trusts
                 27   Non-probate transfers
                 28   Real estate transfers
                 28   Power of attorney
                 29   Durable power of attorney
                 29   Personal custodian
                 29   Guardianship and conservatorship


CHAPTER 3   PAGE 30   When your loved one dies
                 31   Paying for the funeral
                 33   Funeral arrangements
                 33    ● Right of sepulcher
                 35   Financial matters
                 36   Organ and body donation


CHAPTER 4   PAGE 39   Resources
                 40   Find more information about advance care planning
                 41   Terms




                          REVISED MARCH 2009                                  5
      Communicating
    about the end of life




                     CHAPTER 1

PAGE 9   Life planning work sheet
   13    Advance directives
   13     ● Durable power of attorney for health care choices
   14     ● Health care choices directive
   15     ● Durable power of attorney for health care choices
             and health care choices directive form
   21    Living wills
   22    Managing your pain is possible
   22    Understanding life-sustaining treatments
   22     ● CPR
   23     ● Respirator/ventilator
   23     ● Artificial nutrition and hydration
   23    Outside the hospital do-not-resuscitate (OHDNR) order
   24    Hospice care
   24     ● Choosing hospice care




                                COMMUNICATING ABOUT THE END OF LIFE   7
                                         Communicating
                                       about the end of life

                It’s often difficult to think about   be completed without using an
             dying, let alone talk about it. But      attorney, you may wish to consult a
             the only way to ensure your wishes       private attorney.
             are fulfilled is to communicate with        Keep in mind that even though
             clergy, family and physicians.           your wishes are in writing, it may
                Putting your wishes in writing        be difficult for others to understand
             can relieve a tremendous burden for      them. That’s why it is so critical to
             your loved ones. Imagine the stress      talk with your family. Having this
             and sadness your family members          conversation will lessen the pain,
             may experience when you become           doubt and anxiety for your loved
             injured or ill. Now imagine the          ones as you near death.
             added burden on them if you have            While there is no right way or
             not communicated your wishes.            right time to start a conversation
                Having these important                about the end of life with your
             conversations now will save              family, these tips may help you get
             heartache down the road.                 started:
                The way in which you want to          ● Describe someone else’s
             die is a very personal decision.            experience.
             Begin by thinking about your             ● Say your attorney urged you to
             personal feelings about your death.         have the conversation.
             A work sheet to help you starts          ● Use the work sheets in this
             on page 9. Research your options.           booklet.
             Talk with your health care provider,     ● Write a letter or make a tape or
             minister and family.                        video describing your wishes.
                Once you have a clear picture            Have your family review it
             of your wishes, share them with             before you talk.
             your family, friends and doctor.            Your family may resist having
             An excellent way to communicate          the conversation; it’s often difficult
             your wishes is to complete an            to contemplate the loss of a loved
             advance directives form on page          one. Stand your ground about the
             15. It includes a durable power of       importance of talking about dying
             attorney for health care choices and     and bring up the consequences
             health care choices directive.           of putting off the conversation. It
                This document should not be           also may help to have someone be
             construed as legal advice or as an       your spokesperson and lead the
             endorsement of any particular form.      conversation. In the end, you all
             While the form in this booklet can       will have greater peace of mind.




8   LIFE CHOICES                                                                               ago.mo.gov
                                                                                   WORK
  LIFE PLANNING                                                                    SHEET

Name_____________________________________________               Date__________________

Completing this work sheet will give you a framework for thinking about what you want at
the end of life. Your agent may refer to this work sheet if you become unable to speak for
yourself. Use more paper if you need more space. Please note, this is not a legal document
and does not have to be filled out to complete your advanced directives.

My values, beliefs and priorities

Which family members and friends are you closest to?

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________


What do you need most for your physical or mental well-being? Being outdoors? Listening
to music? Being aware of your surroundings and who is with you? How important are
seeing, tasting and touching to you?

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________


Are you spiritual or religious? Would you like a member of the clergy to be with you when
you are dying?

__________________________________________________________________________

__________________________________________________________________________




                                                 COMMUNICATING ABOUT THE END OF LIFE         9
        LIFE PLANNING WORK SHEET CONTINUED

      How would you like to be remembered? What kind of person have you tried to be? Which
      accomplishments are you most proud of?

      __________________________________________________________________________

      __________________________________________________________________________

      __________________________________________________________________________

      __________________________________________________________________________


      Are there cultural or ethnic beliefs and practices that are important to you?

      __________________________________________________________________________

      __________________________________________________________________________


      What fears do you have about dying?

      __________________________________________________________________________

      __________________________________________________________________________

      __________________________________________________________________________

      __________________________________________________________________________


      What would you like to tell your loved ones before you die?

      __________________________________________________________________________

      __________________________________________________________________________

      __________________________________________________________________________

      __________________________________________________________________________




10   LIFE CHOICES                                                                     ago.mo.gov
  LIFE PLANNING WORK SHEET CONTINUED


Sedation may be necessary to control pain that may accompany the end of life. Would you
want to be sedated even if it makes you drowsy or puts you to sleep much of the time?

__________________________________________________________________________

Would you be interested in hospice care?

__________________________________________________________________________


What would you like the last week of your life to be like? Who will be there? Where will you
be? What will you eat if you can eat? What would you like your last words or acts to be?

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________


How do you envision your memorial service or funeral? What songs would you like? Which
readings? Who would you like to participate?

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

Would you like to write a letter or make a taped message for your loved ones to open at a
future time? Who should receive the letter or tape?

__________________________________________________________________________

__________________________________________________________________________



                                                  COMMUNICATING ABOUT THE END OF LIFE          11
         LIFE PLANNING WORK SHEET NOTES


       ________________________________________________________________________

       ________________________________________________________________________

       ________________________________________________________________________

       ________________________________________________________________________

       ________________________________________________________________________

       ________________________________________________________________________

       ________________________________________________________________________

       ________________________________________________________________________

       ________________________________________________________________________

       ________________________________________________________________________

       ________________________________________________________________________

       ________________________________________________________________________

       ________________________________________________________________________

       ________________________________________________________________________

       ________________________________________________________________________

       ________________________________________________________________________

       ________________________________________________________________________

       ________________________________________________________________________

       ________________________________________________________________________

       ________________________________________________________________________

       ________________________________________________________________________



12   LIFE CHOICES                                                        ago.mo.gov
Advance directives                       Is a lawyer needed?
   You may become physically or          The six-page form included in this
                                         chapter is designed to be used
mentally unable to communicate
                                         directly by individuals and meets the
your desires for medical care if         requirements of Missouri laws.
you have an accident or become ill.      However, if you decide to use
Your family and doctors will better      a lawyer, you can contact the
understand your preferences if you       Missouri Bar Lawyer Referral
have expressed them in writing.          Service (there is a fee):
   One way to accomplish this is         Jefferson City: 573-636-3635
through an advance directives form       St. Louis: 314-621-6681
                                         Kansas City: 816-221-9472
(starting on page 15) that names a
                                         Greene County: 417-831-2783
durable power of attorney for health
care choices and includes a health       Get forms online
care choices directive.                  The work sheet and form also can
   It is important to remember that      be found on the Attorney General’s
                                         Web site at ago.mo.gov under the
you have a constitutional right          “Forms” link at the bottom of the
to refuse any medical treatment,         page.
including those that prolong your
life. You also have the right to name
another person, called an agent, to
make health care decisions for you        The six-page advance directives
if you lose the ability to make your    form will help you express your
own decisions.                          wishes regarding the end of life.
   Advance directives allow you to
state exactly what treatments you do    Durable power of attorney for
or do not want if you are unable to     health care choices
communicate your wishes.                   The durable power of attorney
   Many people have living              for health care choices, included
wills and mistakenly believe this       in the first part of the form, allows
document will communicate their         you to appoint another person to
treatment wishes in any situation       make health care decisions that you
in which they are incapacitated.        have not specified in the health care
Even if you already have a living       choices directive. The person you
will, you should consider creating a    appoint, called your agent, also can
health care choices directive.          decide what should be done with
   Many living wills apply only         your body after your death.
when you are near death and do             You already may have a power
not include the withdrawal or           of attorney for business and
withholding of artificial nutrition     financial matters. Many people
and hydration. Health care choices      choose separate agents for business
directives address these issues and     and health care and make this
give specific instructions.             known in separate documents.


                                          COMMUNICATING ABOUT THE END OF LIFE    13
                 Your health care agent should
              be someone who understands your           Give out copies of directive
              goals and values and you trust to            Give copies of the six-page
              carry out your wishes.                    advance directives form to your
                 You may choose a family                doctor, the agent (or agents)
                                                        named in the durable power
              member, spouse, adult child or            of attorney section, and your
              close friend who is at least 18 years     family, friends and clergy. Have
              old. Your agent cannot be a doctor,       conversations with these people
              an employee of a doctor, or an            about your health care decisions
              owner, operator or employee of a          and ask your doctor to put it in
              health care facility in which you         your permanent medical record.
              live, unless you are related. Make        Many people travel with copies of
                                                        their advance directives form.
              sure to ask the person whether he or         You also can write the name
              she is willing to act as your agent,      of your agent on the back of your
              and talk candidly about your wishes       driver’s license with a permanent
              so there are no misunderstandings.        marker. But you still will need to fill
                 Your agent may make decisions          out a form for the advance directive
              for you only if you are physically or     to be recognized.
              mentally unable to do so yourself.
                 Missouri law requires two
              doctors to declare a person                 If you have named an agent, only
              incapacitated, unless you specify       this person has the legal authority to
              otherwise. The durable power of         make health care decisions for you.
              attorney section on the form allows     Tell your family whom you have
              you to choose whether you want          chosen as your agent. Your agent
              one or two doctors to determine         may wish to talk with your family
              whether an agent should make            before making decisions.
              decisions on your behalf.                   Health care providers and your
                                                      agent must follow the directions
              Health care choices directive           given in your advance directive.
                A health care choices directive,      The only exception is if your
              included in the second part of the      request would require a health
              form, allows you to provide clear       care provider to break the law.
              and convincing proof of whether         A provider who does not want to
              you want your life lengthened by        follow your directive must help you
              medical treatment.                      transfer to a facility where your
                When you become unable to             advance directive will be honored.
              make decisions or communicate               An advance directive stays in
              your wishes, your doctor and agent      effect until you die unless you cancel
              will make decisions based on what       it. If you want to later make changes
              you have expressed in the health        to your directive, simply initial and
              care choices directive section of       date the changes in the margin of
              your form.                              your advance directives form.


14   LIFE CHOICES                                                                                 ago.mo.gov
  DURABLE POWER OF ATTORNEY FOR HEALTH CARE CHOICES                                  6-PAGE
  & HEALTH CARE CHOICES DIRECTIVE                                                    FORM


Part I. Durable power of attorney for health care choices


I, _____________________________________________, _________________________,
  Name                                                      Social Security number



appoint

___________________________________________, _____________________________,
Name                                                   Phone


__________________________________________________________________________
Address


as my agent for health care choices when I am unable to make decisions or communicate my
wishes. In the case the person above cannot serve as my agent, or if I am divorced from or
legally separated from the agent above, I appoint the person below:

___________________________________________, _____________________________,
Name                                                   Phone


__________________________________________________________________________
Address


This alternate agent may make health care decisions for me when I am unable to do so or to
communicate my wishes.

This durable power of attorney becomes effective when two physicians certify that I am
incapacitated and unable to make and communicate health care choices.

You may choose to have one physician, instead of two, determine whether
you are incapacitated. If you want to exercise this option — allowing one
physician to determine whether you are incapacitated — initial here.




                                                   COMMUNICATING ABOUT THE END OF LIFE        15
                                                                                             PAGE
        DURABLE POWER OF ATTORNEY FOR HEALTH CARE & HEALTH CARE DIRECTIVE                    2 of 6


      By completing this durable power of attorney, I authorize my agent to make all decisions for
      me regarding my health care. This includes the power to withdraw any type of health care,
      treatment or procedure, even if I may die in the process. I expect my agent to follow my
      health care choices directive. My agent has the power to:
         ● Consent, refuse or withdraw consent to artificially supplied nutrition and hydration.
         ● Make all necessary arrangements for health care on my behalf. This includes admitting
           me to any hospital, psychiatric treatment facility, hospice, nursing home or other health
           care facility.
         ● Hire or fire health care personnel on my behalf.
         ● Request, receive and review my medical and hospital records.
         ● Take legal action if necessary to do what I have directed.
         ● Carry out my wishes regarding autopsy and organ donation, and decide what should be
           done with my body.

      My agent under this durable power of attorney will not incur any personal financial liability.
      The agent also should not be compensated for services performed for me. However, the
      agent shall be reimbursed for reasonable expenses that are part of my care.

      THIS IS A DURABLE POWER OF ATTORNEY AND THE AUTHORITY OF MY
      ATTORNEY IN FACT, WHEN EFFECTIVE, SHALL NOT TERMINATE OR BE VOID
      OR VOIDABLE IF I AM OR BECOME DISABLED OR INCAPACITATED OR IN THE
      EVENT OF LATER UNCERTAINTY AS TO WHETHER I AM DEAD OR ALIVE.




16   LIFE CHOICES                                                                           ago.mo.gov
                                                                                             PAGE
  DURABLE POWER OF ATTORNEY FOR HEALTH CARE & HEALTH CARE DIRECTIVE                          3 of 6


Part II. Health care choices directive

I want those involved in my health care to understand my wishes if I cannot communicate or
make decisions on my own. I make this directive to provide clear and convincing proof of
my wishes and instructions about my health care and treatment.
If my doctor believes medical treatment will lead to my recovery, I want to have the
treatment. I also want to have care and treatment for pain or discomfort even if this
treatment might shorten my life, affect my appetite, slow my breathing or be habit-forming.

  If I have a terminal illness or condition and there is no reasonable hope I will
  recover, or if I am persistently unconscious, I direct all of the life-prolonging
  procedures I have initialed below to be withheld or withdrawn.


I direct the following treatments to be withheld or withdrawn:
       Surgery or other invasive procedures
       Cardiopulmonary resuscitation (CPR) to restart my heart or breathing
       Antibiotics
       Dialysis
       Mechanical ventilator (respirator)
       Artificially supplied nutrition and hydration (including tube feeding)
       Chemotherapy
       Radiation therapy
       All other “life-prolonging” medical treatments or surgeries that are merely intended to
       keep me alive without reasonable hope of making me better or curing my illness or injury.
       I consent to the donation of my organs or tissues. I realize my body may need to be
       maintained artificially after my death until my organs can be removed.
       I refuse to make anatomical gifts of part or all of my body. I prohibit my agent from
       consenting to such gifts before or after my death.




                                                           COMMUNICATING ABOUT THE END OF LIFE        17
                                                                                           PAGE
        DURABLE POWER OF ATTORNEY FOR HEALTH CARE & HEALTH CARE DIRECTIVE                  4 of 6


      I also give the following directions regarding my health care:

      __________________________________________________________________________

      __________________________________________________________________________

      __________________________________________________________________________

      __________________________________________________________________________

      __________________________________________________________________________

      __________________________________________________________________________


      Optional: Describe what you consider an acceptable quality of life. For example, being able
      to recognize my loved ones, make decisions, communicate or feed yourself.

      __________________________________________________________________________

      __________________________________________________________________________

      __________________________________________________________________________

      __________________________________________________________________________

      __________________________________________________________________________

      __________________________________________________________________________


      Attach extra pages if necessary. Sign and date the attached pages.

       Make sure to talk about this directive and your wishes with your agent, your doctors,
       family, friends and clergy. Give each of them a copy of the directive. Bring a copy with
       you when you go to a hospital or other health care facility. Keep the original with your
       important papers.




18   LIFE CHOICES                                                                         ago.mo.gov
                                                                                          PAGE
  DURABLE POWER OF ATTORNEY FOR HEALTH CARE & HEALTH CARE DIRECTIVE                       5 of 6


Part III. Relationship between health care choices directive
and durable power of attorney for health care choices

  As I have executed the health care choices directive and durable power of attorney for
health care choices, I trust and encourage my agent to:
● First, follow my wishes as expressed in the directive or otherwise from knowledge about
  me or having had discussions with me about making choices regarding life-prolonging
  medical treatment.
● Second, if my agent does not know my wishes for a specific decision, but my agent has
  evidence of what I might want, my agent can try to figure out how I would decide. This
  is called substituted judgment and requires my agent imagining himself or herself in my
  position. My agent should consider my values, religious beliefs, past choices and past
  statements I have made. The aim is to choose as I probably would choose, even if it is not
  what my agent would choose for himself or herself.
● Third, if my agent has very little or no knowledge of what I would want, then my agent
  and the doctors will have to make a decision based on what a reasonable person in the
  same situation would decide. This is called making decisions in my best interest. I have
  confidence in my agent’s ability to make decisions in my best interest if my agent does
  not have enough information to follow my preferences or use substituted judgment, and if
  this is the case, I authorize my agent to make decisions that might even be contrary to my
  directive in his or her best judgment.
● Finally, if the durable power of attorney for health care choices is determined to be
  ineffective, or if my agent is unable to serve, the health care choices directive is intended
  to be used on its own as firm instructions to my health care providers regarding life-
  prolonging procedures.




                                                    COMMUNICATING ABOUT THE END OF LIFE            19
                                                                                                                       PAGE
        DURABLE POWER OF ATTORNEY FOR HEALTH CARE & HEALTH CARE DIRECTIVE                                              6 of 6


      Sign this form before two witnesses who are not related to you or financially connected to your estate.

      IN WITNESS THEREOF, I have executed this document on ________________ ____, ________.
                                                                              MONTH                     DAY     YEAR

      Signature _____________________________________________________________________________


      Print name _____________________________________________ SS No.________________________


      Address ______________________________________________________________________________


      The person who signed this document is of sound mind and voluntarily signed this document
      in our presence. Each of the undersigned witnesses is at least 18 years of age.

      Signature ________________________________ Signature ___________________________________


      Print name _______________________________                 Print name _________________________________


      Address _________________________________                  Address _______________________________


      ___________________________________ _____________________________________

       Notarization required
      STATE OF MISSOURI               )
                                      ) SS
      COUNTY OF _____________________ )

      On this ____ day of ____________________, in the year of ________, personally appeared
      before me the person signing, known by me to be the person who completed this document
      and acknowledged it as his/her free act and deed.
      IN WITNESS WHEREOF, I have set my hand and affixed my official seal in the County of
      ________________________, State of Missouri, the day and year first above written.



      _______________________________________
      Notary public’s signature




20   LIFE CHOICES                                                                                                      ago.mo.gov
Living wills
   By creating a living will, you instruct health care providers to withhold
or withdraw medical treatment under certain circumstances. Missouri law
authorizes the creation of living wills that use a statement or declaration in
this form:


        “I have the primary right to make my own decisions
        concerning treatment that might unduly prolong the dying
        process. By this declaration I express to my physician,
        family and friends my intent. If I should have a terminal
        condition it is my desire that my dying not be prolonged
        by administration of death-prolonging procedures. If my
        condition is terminal and I am unable to participate in
        decisions regarding my medical treatment, I direct my
        attending physician to withhold or withdraw medical
        procedures that merely prolong the dying process and
        are not necessary to my comfort or to alleviate pain. It is
        not my intent to authorize affirmative or deliberate acts
        or omissions to shorten my life, rather only to permit the
        natural process of dying.”



   To create a living will, you          To give instructions beyond what
must be 18 or older and have two         a living will allows, complete the
witnesses who also are at least          advance directives form that starts
18 years old. You and your two           on page 15.
witnesses must sign the living will.        Once you complete a living will,
The witnesses cannot be family           make sure to give copies to your
members, beneficiaries to your           doctors, family members and the
estate or financially responsible for    person you have chosen as your
your medical care.                       power of attorney for health care.
   Living wills do have limitations.        If you decide you want to cancel
They apply only to near death            your living will, you can do so
situations in which the patient          either verbally or in writing. Health
will die shortly without medical         care providers are required to note
intervention. Missouri law prohibits     a revocation of a living will in your
a living will from being used to         medical record.
withhold or withdraw artificially
supplied nutrition and hydration.




                                            COMMUNICATING ABOUT THE END OF LIFE   21
              Understanding life-sustaining treatments
                 Your doctor can answer               more fully explain them to you.
              your questions about the types
              of treatments and medical               Cardiopulmonary resuscitation
              interventions that may lengthen            CPR is performed when the heart
              your life and delay death.              or lungs suddenly stop working. It
                 Understanding these treatments       usually includes chest compressions,
              and interventions will help you         administration of drugs and/
              create your advance directives. Life-   or electric shock to restore the
              sustaining treatments are described     heartbeat, and a tube placed in the
              below. However, your doctor may         windpipe for breathing.



                Managing your pain is possible
                   You should not have to live in     shows many people do not
                pain, which is the No. 1 reason       receive the pain relief they need,
                people seek medical care. Insist      especially residents in nursing
                on getting the relief you need by     homes. One study found 26
                talking with family and health        percent of nursing home residents
                care providers.                       who have daily pain receive no
                   You are not alone if you are       pain medication.
                searching for ways to control            Some patients refuse narcotic
                your pain. Pain management is         pain relievers because they
                a major concern for people with       fear they will become addicted.
                serious illnesses or injuries. In a   However, doctors say addiction
                1999 Gallup survey, nine out of       is rare when pain medication is
                10 Americans said they suffered       prescribed and used properly.
                pain at least once a month, and       Fear of addiction should not keep
                42 percent reported feeling pain      you from using pain relievers.
                every single day.                        You may choose to make your
                   Unrelieved pain can be             wishes known regarding pain
                crippling: if you are in pain         management in a written advance
                you may become depressed,             directive. See page 17.
                have trouble sleeping, fall, have        You also can call upon hospice
                trouble thinking clearly, lose your   care teams specially trained in
                appetite and lose the ability to      managing pain to work on your
                move around.                          behalf. You may have to speak up
                   Doctors now have the tools         for yourself more than you would
                to relieve pain for more than 90      like; just remember, pain relief is
                percent of patients. Yet, research    your goal and it is possible.



22   LIFE CHOICES                                                                            ago.mo.gov
   A doctor sometimes will write        person unable to breathe naturally
a do-not-resuscitate (DNR) order        by moving air into the lungs.
instructing health care providers not   Patients recovering from surgery or
to attempt CPR in the case of cardiac   illness sometimes are placed on a
or respiratory arrest. In contrast to   ventilator to help them breathe until
advance directives, the patient or      they can breathe on their own.
health care agent cannot prepare the
DNR order.                              Artificial nutrition and hydration
   Every health care facility has its      A patient who is unable to eat
own policy on when to use DNR           or drink may receive nutrition and
orders. Emergency medical services      fluids directly or indirectly into his
have separate forms. Check with         or her stomach by a feeding tube or
your local ambulance service and        through an intravenous line. This
hospital for information.               artificial method of nutrition and
                                        hydration ordinarily is used when a
Respirator (also called a ventilator)   person temporarily loses the ability
  This machine breathes for a           to eat or digest food or water.


Outside the hospital do-not-resuscitate order
   Some people decide to leave          Because she fully expects her heart
the hospital and die at home,           to stop beating or her lungs to shut
whether it’s their own home, a          down, she does not want to be
nursing home, hospice or other          resuscitated. So she and her doctor
facility. Missouri law now allows       sign an outside the hospital do-not-
these individuals to create a do-       resuscitate (OHDNR) order.
not-resuscitate order. The order           She keeps a copy of this form
must be signed by the patient (or       at home and in her medical file.
guardian) and a doctor, and it tells    This form needs to be accessible
emergency responders the patient        so that if someone does call 911,
does not want treatment to restart      emergency responders know not to
the heartbeat or breathing.             resuscitate. The patient can always
   These orders have long been          change her mind on the spot, letting
allowed in hospitals, authorized        emergency responders know she
by doctors. Until 2007, however, a      does want to be revived.
hospital was the only place where          At the time of this printing, a
this was allowed.                       standard form has not been created.
   A scenario under the new law:        Check with your doctor, lawyer or
an elderly hospitalized woman           the Missouri Department of Health
confers with her doctors and learns     and Senior Services for guidance on
she does not have much longer to        completing an outside the hospital
live. She decides to return home to     do-not-resuscitate order.
spend her final days with family.


                                          COMMUNICATING ABOUT THE END OF LIFE    23
      Hospice care                                          How to find a hospice
                                                            To find a nearby hospice, contact the Missouri
         In a recent survey, 70 percent of Americans        Hospice and Palliative Care Association.
      said they would prefer to be cared for and die
                                                            ● Call: 816-524-9505
      at home, but in Missouri less than 30 percent
                                                            ● Click: www.mohospice.org
      of people spend their final days in their homes.
      In some cases, a hospital or nursing home is
      the most appropriate place for a person to die,     psychological and spiritual needs. The
      such as when advanced medical technology            patient’s family also receives care in many
      is necessary. But most people who die in            ways including respite care that gives family
      hospitals and nursing homes could die at home       members and other caregivers a break.
      if support were available.                          Counselors and social workers also spend
         In recent years, more Missourians have           time with the family. This support continues
      had the opportunity to die at home or in a          for up to a year after the patient dies.
      homelike setting because of hospice care.              Medicare, private health insurance and
      Hospice care focuses on relieving the               Medicaid usually cover the cost of hospice
      symptoms of persons who are dying rather            care for eligible patients. To qualify, a patient
      than trying to cure them. Hospice accepts           must have a life expectancy of six months
      death as a natural part of life.                    or less and agree to forgo curative medical
         A team of care providers creates a plan for      treatments. Many hospices receive donations
      the patient to control pain and allow them to       from the community and offer services based
      live life to the fullest until they die. The team   on need, rather than a patient’s ability to pay.
      usually includes a doctor, nurse, counselors,          Studies show patients benefit most
      clergy, volunteers and aides. Hospice care can      from hospice care if they receive care for
      be provided wherever the patient calls home         at least 60 days, thus getting the pain and
      — the patient’s own home, a nursing home, a         symptom management they need as well as
      hospital, assisted living or a hospice facility.    psychological and spiritual support. However,
         The hospice team addresses not only              most patients receive hospice care for about
      physical symptoms, but also emotional,              36 days and many for one week or less.


        CHOOSING HOSPICE CARE
        To choose a hospice, begin by talking to people you trust who are familiar with area
        hospice programs. This may include your health care provider, minister and friends. Call
        representatives of several hospices, if possible. Here are some questions to ask:
        ● What services do you provide?
        ● What kind of support do you give to the family or caregiver?
        ● What role does the attending doctor and hospice play?
        ● What do your volunteers do?
        ● How do you work to keep the patient comfortable?
        ● How are services provided after hours?
        ● How and where do you provide short-term inpatient care?
        ● Do you provide care in a nursing home or long-term care facility?



24   LIFE CHOICES                                                                                   ago.mo.gov
      Financial
    considerations


              CHAPTER 2

PAGE 26   Wills
     26    ● Self-proving clause
     27   Personal representative
     27   Who receives your estate
     27   Living trusts
     27   Non-probate transfers
     28   Real estate transfers
     28   Power of attorney
     29   Durable power of attorney
     29   Personal custodian
     29   Guardianship and conservatorship




                                             25
                                              Financial
                                            considerations

              Wills
                 Creating a will allows you to plan         Seeking legal help
              for your family’s care and decide             Information contained in this
              who will receive your estate after            chapter is not intended to replace
              you die.                                      advice from a private lawyer.
                 Your estate includes all property          Legal advice is recommended
                                                            for preparation of the documents
              and cash assets owned at the                  described.
              time of death. This includes bank             If you need to find a lawyer in
              accounts, land, furniture, buildings,         your area, you can contact the
              cars, stocks and bonds, proceeds of           Missouri Bar Lawyer Referral
              life insurance payable to the estate,         Service (there is a fee):
              and pension plan benefits payable             Jefferson City: 573-636-3635
              to one’s estate.                              St. Louis: 314-621-6681
                 By creating a will, you can lessen         Kansas City: 816-221-9472
              the taxes that may be included in             Greene County: 417-831-2783
              the transfer of your estate. A will
              also gives guidance to the probate
              court on the distribution of property      distant relatives.
              and payment of debts.                         In the rare case that no relatives
                 In a will, you can name a               can be found, your estate becomes
              guardian for your minor children,          state property.
              thus providing a means for caring             Anyone who is 18 years old and
              for the children without court             of sound mind may make a will in
              involvement. You also can set up           Missouri. To be valid in Missouri, a
              a trust for your family. If you die        will must be in writing and signed
              without a will, the property you           by the maker and two witnesses.
              owned as an individual will go to          The witnesses cannot receive
              your close relatives and sometimes         property under the will.




                SELF-PROVING CLAUSE
                One option that can speed up the probate process is to add what is called
                a self-proving clause. You will need to have two witnesses sign your will in
                front of a notary. Sometimes witnesses to a will have died or are hard to
                locate, which delays probate. By adding this section, your will becomes self-
                proving, which means witnesses do not need to appear in probate court.
                Your personal representative




26   LIFE CHOICES                                                                                ago.mo.gov
   Your will must include the              Establishing a revocable living
name of a person you choose to          trust allows a person to transfer
be your personal representative         property upon death and bypass the
to administer your estate. (This        probate process, which involves
formerly was called the executor.)      time, publicity and expense. The
   You may choose one or more           creator of the living trust usually
persons who are 18 or older or an       serves as the trustee and beneficiary
institution such as a bank or trust     until death or incapacity, when
company. It is a good idea to name      successor trustees and beneficiaries
an alternate personal representative    take over.
in case your first choice dies before      When personal property is
you do or cannot manage your            included in a living trust, the
estate for other reasons.               ownership documents of the
                                        property must be changed. For
Who receives your estate                example, if you want to include
   Under Missouri law you may           your home in the trust, you must
decide to a great extent who            change the deed of the property to
receives your property. However         show the trust, rather than you, as
a surviving spouse may petition         the actual owner.
the court to receive more than you         A revocable living trust does not
specified in your will using what       need to be signed by witnesses, but
is called “right of election.” With     it must be notarized.
this right, your spouse may ask the
probate division for one-third of the   Non-probate transfers
estate if you have children or one-        After your death, your property
half of the estate if you do not.       may be legally transferred to
   The property you jointly own         beneficiaries you have named
with your spouse is not included        without going through probate
in your will. This property             court, if you designate the property
automatically passes to the             in a certain way.
surviving spouse without going             Pay on death (POD) designations
through probate court.                  are used for property such as bank
   Thus, joint ownership makes          accounts; transfer on death (TOD)
distribution of one’s estate simpler    designations are used for items such
after death. Be cautious when using     as brokerage accounts and titled
joint ownership since control of        motor vehicles; and beneficiary
the property is shared between the      deeds are used for real estate.
owners.                                    These designations may be
                                        revoked by the owner, and the
Living trusts                           consent of the beneficiary is not




                                                           FINANCIAL CONSIDERATIONS   27
              required for the owner to mortgage         owner’s name must be on the
              or sell the property. Because these        deed. If one of the names on
              designations do not describe               the title is of someone who has
              in detail the order in which the           died, the name will have to
              property will be passed among the          be removed before a sale can
              intended beneficiaries, they are not       proceed. An attorney can help
              intended to be substitutes for a will.     with this.

              Real estate transfers                    Power of attorney
                 Transferring property is common          If it becomes difficult for you to
              among seniors for several reasons.       take care of your personal business
              Before selling property, transferring    because of an illness or injury,
              a title or adding a name to a title,     you may want to consider giving
              seniors should consider some             someone your power of attorney.
              common situations:                          This means you give someone
              ● A person who has deeded his or         written authority to act in your
                 her house to another person can       name with regard to your financial
                 be forced to move out against his     and business affairs. This is usually
                 or her will. The person to whom       a friend or a relative, not a lawyer.
                 the house is deeded may sell the      The person is called your “attorney
                 house whether the person living       in fact.”
                 there agrees to it or not.               A power of attorney needs to be
              ● Some seniors want to add a             in writing and should state your
                 person to their deed with equal       name and the name of the person
                 property share and a right of         who will be your attorney in fact. It
                 survivorship. To make this            should list the specific powers you
                 happen the deed must say              are giving to the attorney in fact.
                 “as joint tenants with right of          Typically, attorneys in fact
                 survivorship.”                        handle financial affairs such as
              ● If joint tenants are on the deed,
                                                       cashing and depositing checks,
                 one tenant cannot sell the            paying bills and buying groceries.
                 property without the other’s          Be careful about who you choose,
                 consent. When one tenant dies,        because this person will have an
                 the other automatically retains       important role in your life.
                 the property.
                                                       Durable power of attorney
              ● To sell property, the current




28   LIFE CHOICES                                                                              ago.mo.gov
   A power of attorney, like the one       In some cases, the court names a
described above, becomes invalid if     personal guardian and conservator
you become incompetent to make          to take care of a person who cannot
decisions or when you die. If you       properly manage his or her finances,
wish for your attorney in fact to       health and safety. A conservator
continue managing your affairs          manages financial resources, while
after you become incapacitated you      a guardian takes care of personal
should consider a durable power of      needs such as medical treatment.
attorney.                                  The guardian and conservator
   The document should be titled        do not have personal financial
“durable power of attorney” and         responsibility for the person for
should state that the power you         whom they are caring. If you
are giving your attorney in fact is     believe your loved one needs a
“durable” and will continue if you      conservator or guardian, you may
become disabled or incapacitated.       need to pay court costs, hire a
Sign and date the document and          lawyer and post a bond.
have it notarized.                         A court proceeding will
   If you want to include real estate   determine whether the person needs
matters, you will need to file the      a guardian or conservator.
document with your local recorder
of deeds.

Personal custodian
   Another way to allow someone
to take care of your personal
business is to name a personal
custodian. The Missouri personal
custodian law gives you the means
to transfer care of your personal
property and real estate to another
person. You still own the property,
but the custodian manages it.
   The personal custodianship
remains in effect if you become
incapacitated.
   You will need to consult an
attorney to set up a personal
custodianship.

Guardianship and conservatorship




                                                          FINANCIAL CONSIDERATIONS   29
                          When your
                        loved one dies




                                   CHAPTER 3

                    PAGE 31   Paying for the funeral
                         31    ● Pre-paid funerals
                         32    ● Know your pre-need funeral plan
                         32    ● Know who is selling the plan
                         32    ● Know where your money goes
                         33   Funeral arrangements
                         33    ● Right of sepulcher
                         33    ● Embalming
                         33    ● Cremation
                         33    ● Funeral notices
                         33    ● Benefits payable upon death
                         34    ● Obtaining a death certificate
                         34    ● Military honors
                         34    ● Safety concerns
                         35   Financial matters
                         35    ● Stocks and bonds
                         35    ● Safe deposit boxes
                         35    ● Life insurance
                         35    ● Property inventory
                         35    ● Transfer of property
                         35    ● Taxes
                         36   Organ and body donation
                         38    ● Organ and tissue donor registry




30   LIFE CHOICES                                                  ago.mo.gov
                                When your
                              loved one dies

Missouri laws regarding funerals strive to protect citizens at the
time of a loved one’s death. If your loved one dies and you must
make funeral and cemetery arrangements, begin by finding out if
the deceased left instructions for the funeral or cemetery services.
If funeral arrangements exist they must be followed.


Paying for the funeral
  Your loved one may have pre-           Pre-paid funerals
paid for the funeral and burial. If         Today, many older Missourians
not, you may be asked to sign a          are considering pre-need funeral
contract when ordering services.         plans. A pre-need funeral plan is
  The contract usually binds the         an agreement in which a seller
person who signs it to pay the           agrees to provide funeral services
charges, but some of this money          and merchandise at the time of the
may be reimbursed from the estate        buyer’s death. The costs may be
or other sources. If the estate does     paid in installments or in one lump
not have funds to pay the funeral        sum.
costs, the person who signed the            Although there are many honest
contract may have to pay. You also       and reputable funeral directors who
should check to see if your loved        sell pre-need funeral plans, there
one had any death benefits to help       also are unscrupulous con artists
cover the funeral costs.                 who will take your money with no
  Funeral directors must follow          intention of fulfilling their end of
pricing rules set forth by the           the agreement.
Federal Trade Commission                    So, how can you be sure a pre-
including:                               need funeral plan is a good one?
● Offering accurate price
  information over the phone.
● Providing a written, itemized
  price list if you inquire in person.
● Giving purchasers a written
  statement with the total cost and
  a breakdown of each item or
  service.
● Not requiring you to buy certain
  goods or services to receive
  others.


                                                             WHEN YOUR LOVED ONE DIES   31
              Know your pre-need funeral plan           With the right to cancel, if you
                 If you have any questions, get      default on payments, you are
              answers from the seller before you     entitled to recover any amount
              buy.                                   you paid into the plan, minus the
                 Beware of any plan that does        amount the seller is allowed to
              not specify exactly what you will      keep — the first 20 percent of the
              receive. The law requires that pre-    purchase price — usually without
              need funeral contracts specify in      interest depending on the contract.
              detail the merchandise and services       Also remember, all pre-need
              that are to be provided.               funeral plans are subject to a 30-
                 By law funeral directors also       day right to cancel under Missouri
              must provide written price lists for   law.
              all merchandise and services they         To be sure a prearranged funeral
              offer. Shop around. Some plans         plan is best for you, you may want
              guarantee a fixed price; others        to consider other options such
              don’t.                                 as buying additional insurance
                                                     or arranging with a mortuary for
              Know who is selling the plan   and     a certain type of funeral service
              who is honoring it
                                                     without prepayment.
                 Pre-need funeral plans may be
              sold directly by funeral homes         Know where your money goes
              or by other companies that have           By state law, all payments made
              arranged to have a funeral home in     on a pre-need funeral plan, minus
              your area service the plan.            the amount the seller is entitled
                 Sellers are required by law to      to keep, must go into a pre-need
              have a written contract with the       trust. Those funds generally must
              funeral home to ensure there are       be maintained in that trust until you
              arrangements. Ask to see a copy        die.
              of this contract or check with the        Make sure your funeral plan
              funeral home.                          identifies the pre-need trust into
                 Be certain the funeral home         which your payments will be
              designated in the plan is acceptable   deposited, including the name and
              to you, and your family knows of       address of the trustee.
              its obligation to honor the plan.         You have a right to receive from
                 Missouri law gives you the right    the seller, on written request, a
              to cancel a pre-need funeral plan at   written statement of all deposits
              any time unless at the time of sale    made into the trust on your
              you choose to give up that right.      behalf. Making such a request is a
              You should consider giving up that     good way to determine that your
              right only if you are seeking public   payments are going into the trust
              assistance. You may wish to consult    and not into the seller’s pocket. You
              with a representative of the public    also may want to contact the trustee
              assistance agency.                     directly.


32   LIFE CHOICES                                                                            ago.mo.gov
Funeral arrangements                     Get info or file a complaint
Right of sepulcher                       ● Write: State Board of Embalmers
Your agent (named in your durable                 and Funeral Directors
                                                  3605 Missouri Blvd.
power of attorney) will determine                 P.O. Box 423
the final disposition of your body,               Jefferson City, MO 65102
such as cremation or burial. The
                                         ● Call: 573-751-0813
authority to make this decision is
known as the right of sepulcher. As
with other decisions, you should
                                        Funeral notices
talk with your agent about these
                                           Many newspapers include
options and your wishes.
                                        information on deaths. Some
Embalming                               papers automatically include the
   Missouri law does not require        names of people who have died
embalming in most instances.            with information from death
However, after 24 hours an              certificates. Most newspapers also
unembalmed body must be                 print obituaries using information
refrigerated or placed in an airtight   submitted by the family. These
sealed metal or metal-lined casket      articles include information on
or box. For an open casket funeral,     the person’s family, business life,
you may wish to have the remains        affiliations, funeral service and
embalmed to temporarily preserve        suggestions for remembrances.
the body by replacing bodily fluids
                                        Benefits payable upon death
with preservative chemicals. State
                                          You may be eligible for benefits
law does require embalming if the
                                        when your loved one dies.
person died of a communicable
                                        Consider these sources:
disease and the body is not buried
                                        ● Social Security makes payments
or cremated within 24 hours.
                                          to an eligible surviving widow,
   Federal law requires a funeral
                                          widower or entitled child.
home to obtain authorization before
                                        ● Many employers provide a death
embalming a body.
                                          benefit for employees.
Cremation                               ● Qualifying veterans may receive
   Missouri law allows cremation of       death benefits from the Veteran’s
a body. A casket is not required for      Administration.
cremation, which may lower your         ● Your loved one may have
funeral cost. Funeral directors must      purchased funeral insurance.
provide an unfinished wood box or       ● Some civic or employment
alternative container for cremation.      organizations provide death-
                                          related benefits.
                                        ● The deceased may have joined a
                                          memorial society that provides


                                                          WHEN YOUR LOVED ONE DIES   33
                low-cost funeral options through        the record. A fee of $13 per copy
                a specific funeral home.                must accompany the request. Make
              ● Benefits may be available               your check or money order payable
                through the Missouri Department         to the Missouri Department of Health
                of Labor and Industrial Relations       and Senior Services. Do not send
                if the person died on the job.          cash. Allow about two weeks for
                Click on www.dolir.mo.gov.              processing.
              ● The Crime Victims’                         For faster service, contact
                Compensation Fund may provide           VitalChek by calling toll-free
                benefits if the death resulted          877-817-7363 or visiting www.
                from a criminal act. This fund is       vitalchek.com.
                administered by the Department
                of Labor and Industrial Relations       Military honors
                at www.dolir.mo.gov.                       Missouri veterans are eligible for
                                                        the Missouri military funeral honors
              Obtaining a death certificate             program at no cost. The honors
                 You probably will need a copy of       ceremony consists of the firing
              the deceased’s death certificate to       of three rifle volleys, sounding
              settle the estate. A funeral director     of “Taps” and flag folding and
              usually will help you with this.          presentation. Notify your funeral
                 Death certificates also are            director when making funeral
              available at most local health            arrangements if you would like
              departments. Or you can get the           military honors.
              death certificate by writing:
                 Missouri Department of Health          Safety concerns
                 and Senior Services                      When someone who lived alone
                 Bureau of Vital Records                dies, it is important to safeguard
                 P.O. Box 570                           their property while the estate is
                 Jefferson City, MO 65102               being settled. Make sure to stop
                                                        newspapers and the mail and make it
                 You can download an application        appear that the house is occupied.
              for a death certificate at www.dhss.        A warning: Ask the police or
              mo.gov/BirthAndDeathRecords/ or           sheriff’s department to watch the
              include in a letter the deceased’s full   house during the funeral. Burglars
              name at death, date of death, place       sometimes strike.
              of death, your relationship to the
              person and the reason for requesting




34   LIFE CHOICES                                                                               ago.mo.gov
Financial matters
   The bills of the person who died still       Life insurance
will need to be paid. If it will be difficult     Proceeds from a life insurance policy
to make payments, contact the creditors.        are usually paid to the beneficiaries
Most businesses will work with you.             within a few weeks after forms are filed.
● Pay utility bills to ensure continued         The death certificate, insurance policy
   service.                                     and a form requesting the funds must
● Before paying medical bills, find out         be mailed to the company. Contact the
   whether Medicare, Medicaid or private        insurance company for more information.
   insurance will cover the bills.
● Continue paying on debts such as              Property inventory
   mortgages, cars or credit cards.                As soon as possible, make a detailed list
   If the deceased had a bank account           of all property of the deceased and the fair
without a co-signer, money may not be           market value of each item. The list should
accessible. Family and friends might need       reflect any items that are joint property, if
to cover the bills. The estate usually will     the deceased was married. A professional
reimburse these costs. If the deceased had a    appraiser may be helpful. Include real
joint bank account, the co-signer normally      estate, stocks and bonds, cash in financial
will have access to the funds.                  institutions, insurance benefits, vehicles,
                                                boats, furniture and furnishings, jewelry,
Stocks and bonds                                business interests and employment or
   U.S. savings bonds may be redeemed           retirement benefits.
immediately after a person dies. Any
person whose name appears with the              Transfer of property
deceased’s name on the bonds may redeem           Property may be transferred through
the bonds.                                      probate court. The court works to protect
   Selling the stocks of the deceased           the people who have an interest in the
requires certain documentation. A               deceased’s property. Probate proceedings
stockbroker or legal or financial adviser       are not always necessary. Depending
can help you with this.                         on an array of factors, probate may be
                                                necessary. Call an attorney for help.
Safe deposit boxes
   When a person who has a safe deposit         Taxes
box dies, the financial institution where         When a person dies, federal income
the box is located is required to open the      taxes still must be paid by the April 15
box at the request of interested parties.       deadline. The Internal Revenue Service
   Missouri law requires the bank or            has a free booklet to help prepare
other institution to deliver a will found       the deceased’s tax return called “Tax
in the safe deposit box to probate court.       Information for Survivors and Executors
Life insurance policies must be given to        and Administrators,” Publication 559,
the beneficiaries and funeral instructions      which is posted at www.irs.gov. Property
delivered to the appropriate person.            taxes also must be paid on time.



                                                                       WHEN YOUR LOVED ONE DIES   35
              Organ and body donation
              Organ donation                         Body donation
                 You may wish to help others by        Medical schools in Missouri
              donating your organs upon your         accept donations of bodies for
              death. When you die, your advance      science, research or education.
              directive (page 17) will instruct      Each program differs slightly, and
              health care staff on whether your      most programs charge the estate
              organs should be donated.              for transportation. It is best to
                 In addition to using your advance   prearrange any body donation by
              directive, you may make your           contacting the medical school.
              intention to donate your organs
              known by enrolling in the Missouri
              Organ Donor Registry, maintained
              by the Missouri Department of
              Health and Senior Services.
                 This registry is a list of people
              who have signed up to donate
              organs, tissues and eyes. Health
              care providers can check the list to
              see if you wanted to be a donor.

              Ways to enroll in the registry:
              ● Complete the form on page 38.
                Enrollment information is printed
                on the next page.
              ● Sign the back of your driver’s
                license and have a witness sign
                it.
              ● Go to www.missouriorgandonor.
                com.
              ● Call the Department of Health
                and Senior Services at 888-497-
                4564.
                Under Missouri law, your family,
              spouse or guardian may choose to
              donate your organs, even if you had
              not expressed a decision either in
              support or opposition of donation.
              However, if you state before your
              death you do or do not want to
              donate your organs, your family
              must comply with this wish.


36   LIFE CHOICES                                                                         ago.mo.gov
                   Missouri Department of Health and Senior Services
                   P.O. Box 570, Jefferson City, MO 65102-0570 Phone: 573-751-6400  FAX: 573-751-6010
                   RELAY MISSOURI for Hearing and Speech Impaired 1-800-735-2966 VOICE 1-800-735-2466
                   Margaret T. Donnelly                                                                                    Jeremiah W. (Jay) Nixon
                   Director                                                                                                        Governor




Missouri Organ and Tissue Donor Registry Enrollment Information Sheet
Missouri’s Organ and Tissue Donor Registry is a confidential list of organ, tissue and eye donors maintained by the Missouri Department of
Health and Senior Services. You are not required to be on the registry to be a donor and can remove your name at any time. You may also
amend or revoke your decision at any time. Placing your name on the registry means you consent to have your organs and tissues given to
others upon your death. Family consent is no longer required and your decision will be honored. First-person consent makes your decision
final unless revoked in a manner provided by law. If you would like to be on Missouri’s Organ and Tissue Donor Registry, please complete
the following form and send it to the address provided on the form.
                   Questions: Answers to general donation questions can be found at: www.missouriorgandonor.com
. If you have questions about procedures related to transplants or donation, please contact one of the following agencies:
         Midwest Transplant Network (http://www.mwtn.org/)
         Mid-America Transplant Services (http://www.mts-stl.org/
         Heartland Lions Eye Banks (http://www.mlerf.org/
Revocation: You may withdraw or revoke your consent to be listed on the registry. This action does not mean a refusal to make an
anatomical gift. Other authorized persons may make such a gift for you despite your revocation unless you take steps to prevent them from
doing so. If you want to revoke or amend your decision, you may do so by completing a new enrollment form either on-line at
www.missouriorgandonor.com or completing another paper copy and submitting it to the address provided on the form. Your record will
be updated to reflect the changes your have made.
Refusal: If you want to refuse to make an anatomical gift and bar others from doing so on your behalf, you will need to execute a refusal
by completing one of the steps below. Be sure to provide copies of your documentation to family, friends, or others who may be making
end-of-life decisions for you. This information will not be included in the registry or be maintained by the Department of Health and Senior
Services.
•    A record or writing signed by you.
•    A will.
•    A record or writing signed by another person at your direction, if you are physically unable to sign, and witnessed by at least two
     adults, one being a disinterested witness, who sign at your request and attest to such act.
•    A communication made by you in any form during your terminal illness or injury, addressed to at least two adults, one of whom is a
     disinterested witness.
Informed Consent: By completing the enrollment form, I understand that:
1. My information will be kept confidential and will only be used for official registry use and to coordinate my gift.
2. My donation is a gift. There is no cost to me, my family or my estate for my gift. My family or estate will receive no money for my gift.
     It is unlawful for anyone to sell organs or tissues for any reason. All costs and expenses incurred after my death and relating to my
     donation through the recovery of the organs, eyes and tissues will be the donor agencies responsibility. Medical costs not related
     directly to donation and funeral costs are the responsibility of my estate, family or other responsible party.
3. My gift is only valid after I am declared dead by a licensed doctor who is not part of the recovery or transplant process.
4. The hospital and the donor agency will assess my gift potential at the time of my death to make sure it is safe to use my gift for others.
     I consent to the release of my complete medical record and testing necessary to aid the donation process. I understand and release
     the donor agency to notify my family at the time of death of my decision and to ask them to participate in the process by providing
     information about my social and medical history. I understand it is important for me to communicate my decision to my family so they
     can help honor and respect my choice.
5. If blood test results are positive for any reportable condition/disease that may affect others, the results will be sent to the Department
     of Health and Senior Services as required by Missouri law.
6. Every donor is treated with great care and dignity during the donation process including careful reconstruction of one’s body.
     Donation as a rule does not delay funeral plans.
7. Recovered tissues may be used in different forms in order to help more people. For example, skin may be used to create a skin graft
     for burn patients.
8. Donated organs, eyes and tissues are given to people who need them the most. Typically at the local level first, then the region, and
     finally all over the country. Under certain circumstances, organs, eyes and tissues may be sent out of the country to help patients in
     need.
9. My donation can be limited to certain portions of my body and/or for certain purposes (transplantation, therapy, or
     research/education).
10. In compliance with my choice described in this registration, I hereby release all parties, including, but not limited to the hospital, donor
     agencies listed above and their respective directors, officers, employees, agents and designees, and the Department of Health and
     Senior Services from any and all liability or responsibility of any nature in connection with any procedure performed in conjunction
     with my donation.
                                                            www.missouriorgandonor.com
                                                             Healthy Missourians for life.
              The Missouri Department of Health and Senior Services will be the leader in promoting, protecting and partnering for health.

                 AN EQUAL OPPORTUNITY / AFFIRMATIVE ACTION EMPLOYER: Services provided on a nondiscriminatory basis.                                 37
                 MISSOURI DEPARTMENT OF HEALTH AND SENIOR SERVICES
                 DIVISION OF COMMUNITY AND PUBLIC HEALTH
                 ORGAN AND TISSUE DONOR REGISTRY ENROLLMENT APPLICATION
  This will serve as your document of gift. Much of the information on this form is required, so please be sure the form is
  complete. You will receive a confirmation email or letter confirming your enrollment, or in the event information needs to be
  clarified and/or verified. Email may also be used to send out new information about organ and tissue donation and the
  registry. Call toll-free if you have questions: 888-497-4564
  Complete the following information to be added to the registry or to amend a gift.
  PARTICIPANT’S NAME (LAST)                                                 (FIRST)                                      (MIDDLE)                                 (SUFFIX)


  ADDRESS (STREET)                                                          (CITY)                                      (STATE)                                   (ZIP CODE)


  COUNTY OF RESIDENCE                                                                                                       GENDER
                                                                                                                                             Male                     Female
  EMAIL ADDRESS                                                                                  PHONE


  DATE OF BIRTH (Month/Day/Year)                                                          SOCIAL SECURITY NO. or DRIVER LICENSE NO.

  ____________ / _________ / ___________
  My donations are for the following purposes: (Check one)                                GIFT SPECIFICATIONS (Check one)
    Transplant/Therapy Only                                                               I would like to donate
    Research/Education Only                                                                   Any needed organs and tissues, as allowed by law.
    Both Transplant and Research                                                              Any needed organs and tissues as allowed by law, with the following
                                                                                              restrictions:
                                                                                          Restrictions: ___________________________________________

  RACE (optional)                                                                                                                              ETHNICITY (optional)
       White     Black or African American    Asian    Native Hawaiian or Other Pacific Islander                                                   Not Hispanic or Latino
       American Indian or Alaska Native    Other ______________________                                                                            Hispanic or Latino
                                                                                                                                                   Other _______________
  INITIAL THE APPROPRIATE CATEGORY
  __ I affirm that I am under the age of 18, an emancipated minor and able to give full legal consent to organ/tissue donation.
  __ I affirm that I am under the age of 18 but at least 16, I am not emancipated, and therefore providing contact information for my
     parents/guardians below.
  __ I affirm that I am age 18 or over and am able to give full legal consent to organ/tissue donation.
  __ I am the parent/guardian of the child being enrolled in the registry. My relationship to the child is: _________________.
  I affirm that I am the person named above and the information provided is true and correct. I understand my registration serves as my
  document of gift, my gift does not require the consent of another person, I may remove my name at any time, and I may revoke a part or
  all of my decision to gift.
  SIGNATURE (Required of applicant or parent if enrolling a child.)                                                         ENROLLMENT DATE



  WITNESS SIGNATURE                                                                              DISINTERESTED WITNESS SIGNATURE
  (Required if adult is physically unable to sign including due to terminal illness or injury)   (Required if adult is physically unable to sign including due to terminal illness or injury)


  NAME AND CONTACT INFORMATION FOR PARENTS/GUARDIANS


  Fax or mail completed form to:                                                                                                     Phone (toll-free) 888-497-4564
          Missouri Organ Donor Program                                                                                                           Fax: 573-522-2898
          Missouri Department of Health and Senior Services
          PO Box 570
          Jefferson City, MO 65102-0570
  A confirmation will be sent to you within 30 days of receipt in the Missouri Organ and Tissue Donor Program.
MO 580-2545 (9-08)
          Resources



                CHAPTER 4

PAGE 40   Where to find more information about
          advance care planning
    41    Terms
    43    Where to get copies of Life Choices




                                                 39
                                           Resources


              Special recognition;
              Where to find more information
                Thank you to the Missouri End-of-Life Coalition for assistance with
              the creation of this brochure. More information is available in several
              publications and Web sites including:
              ● Senior Citizens Handbook, Laws and Programs Affecting Senior Citizens
                in Missouri: Legal Services of Eastern Missouri, St. Louis.
                314-534-4200. www.lsem.org.
              ● Durable Power of Attorney for Health Care Choices and Health Care
                Choices Directive: Community Alliance for Compassionate Care,
                Springfield, Mo. 417-865-4501. www.missouriendoflife.com.
              ● Planning for Health Care Decision Making: Turnbull Law Office,
                Jefferson City, Mo. 573-634-2910.
              ● AARP: www.aarp.org
              ● Aging with Dignity: www.agingwithdignity.org
              ● Center for Practical Bioethics: www.practicalbioethics.org
              ● Children’s Hospice International: www.chionline.org
              ● Missouri End-of-Life Coalition: www.mo-endoflife.org
              ● Missouri Bar Association: www.mobar.org
              ● Missouri Department of Health and Senior Services: www.dhss.mo.gov
              ● Missouri Hospice and Palliative Care Association: www.mohospice.org
              ● Missouri Revised Statutes: www.moga.mo.gov
              ● National Center on Elder Abuse: www.ncea.aoa.gov
              ● National Hospice and Palliative Care Organization: www.caringinfo.org
              ● WidowNet: www.WidowNet.org




40   LIFE CHOICES                                                                       ago.mo.gov
Terms
Advance directive: A written                 unable to communicate.
document that states a person’s              Durable power of attorney for health
wishes regarding his or her                  care choices: A document in
medical care when the person                 which a person appoints another
is incapacitated or cannot                   individual to make health care
communicate.                                 decisions for him or her when
Artificial nutrition, hydration: Nutrition   the person granting this authority
and fluids delivered through a               becomes incapacitated or unable to
feeding tube or intravenous line.            communicate.
Attorney in fact: A person appointed         Guardian: A person appointed by a
by another individual to act or make         court to take care of the personal
decisions on his or her behalf. This         needs of a person who is unable to
term, when used on the Missouri              do so himself or herself.
driver’s license, is synonymous              Health care agent: A person
with durable power of attorney for           appointed by another individual
health care choices.                         to make health care decisions for
Beneficiary deed: A document stating         him or her when the individual
to whom a person’s principal                 is incapacitated or unable to
residence will pass upon death.              communicate.
Conservator: A person appointed              Heath care choices directive: A
by a court to manage the financial           document designed to communicate
resources of an individual who is            a person’s wishes regarding life-
unable to do so himself or herself.          sustaining medical treatment when
Cardiopulmonary resuscitation (CPR):
                                             the person is incapacitated or
A medical procedure performed                unable to communicate.
when a person’s heart or lungs               Hospice care: A philosophy of
stop that usually includes chest             care that focuses on relieving the
compressions, the administration             symptoms of a person who is dying
of drugs or electric shock to restore        rather than trying to cure them,
the heartbeat, and a tube placed in          with care provided by a team of
the windpipe for breathing.                  medical care providers, counselors
Durable power of attorney: A
                                             and volunteers.
document that states an individual           Living trust: A document naming a
gives another person authority               trustee and beneficiary of property
to manage his or her business                that is used during a person’s
or financial affairs, even if the            lifetime and upon death.
individual granting the authority            Living will: A document that instructs
becomes disabled, incapacitated or           health care providers to withhold


                                                                                    RESOURCES   41
              or withdraw medical treatment             person in regard to financial or
              under certain circumstances when a        business affairs.
              person is near death.                     Probate court: A court that has
              Organ donation: The giving of             jurisdiction over wills and
              one’s organs, tissue or eyes to an        distribution of property and assets
              organization that in turn provides        of people who are deceased.
              the organs to individuals who need        Respirator/ventilator: A machine
              a transplant.                             that moves air in and out of the
              Outside the hospital do-not-resuscitate   lungs for a person who is unable to
              (OHDNR) order: Document that              breathe naturally.
              allows an individual and his or
                                                        Right of sepulcher: The right to
              her doctor to instruct emergency
                                                        determine what is done with a
              responders not to attempt life-
                                                        person’s body after death.
              saving treatment if the individual’s
              heart stops or the individual stops       Self-proving will: A will signed by
              breathing.                                two witnesses and notarized that
                                                        includes specific wording defined
              Personal custodian: A person
                                                        by state law.
              designated by another individual
              to care for his or her personal           Will: A document stating how a
              property and real estate even if          person wants his or her property
              the individual who granted this           and cash assets distributed and who
              authority becomes incapacitated.          should be the guardian of his or her
              Personal representative for will:         minor children upon the person’s
              A person named in a will to               death.
              administer the estate of the maker
              of the will.
              Power of attorney: A document
              stating an individual has the
              authority to act on behalf of another




42   LIFE CHOICES                                                                              ago.mo.gov
Where to get copies of Life Choices
Contact the Attorney General’s Office to get a free
copy of Life Choices:
● Order online: ago.mo.gov/publications/
● Call the Consumer Protection Hotline: 800-392-8222
● E-mail us: ag@ago.mo.gov
Life Choices also can be found on the Attorney General’s
Web site at ago.mo.gov/publications/


Use of forms and information
The forms and information in Life Choices may be copied and
duplicated for use by consumers.
OFFICE OF ATTORNEY GENERAL
       CHRIS KOSTER
        PO Box 899
 Jefferson City, MO 65102
       573-751-3321
        ago.mo.gov


     REVISED MARCH 2009

								
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