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DESIGNING A
GOOD DEATH
NAVIT
UX DESIGN
WORK AT HUGE
DEATH NARRATIVE
NANCY CRUZAN 1957-1990
“I was fantasising about my own death, I started thinking what my funeral would be
like and what music would be played, I was at that level of insanity.”
Billy Corgan 
INTRO TO DEATH
THE RESEARCH
CONVERSATIONS
PROTOTYPING
MORTALITY
DEATH WORKERS
EMBALMING
A  Good Death - SXSW Future15 session
SUSTAINABLE DEATH
POST-MORTEM DATA
A  Good Death - SXSW Future15 session
EVALUATION
HEALTH CARE POWER OF ATTORNEY
NOTE: YOU SHOULD USE THIS DOCUMENT TO NAME A PERSON AS YOUR HEALTH CARE
AGENT IF YOU ARE COMFORTABLE GIVING THAT PERSON BROAD AND SWEEPING POWERS
TO MAKE HEALTH CARE DECISIONS FOR YOU. THERE IS NO LEGAL REQUIREMENT THAT
ANYONE EXECUTE A HEALTH CARE POWER OF ATTORNEY.

STATE OF NORTH CAROLINA
HEALTH CARE POWER OF
ATTORNEY

EXPLANATION: You have the right to name someone to make health care decisions for you when you

COUNTY OF __________________
NOTE: YOU SHOULD USE THIS DOCUMENT TO NAME A PERSON AS YOUR HEALTH CARE
AGENT IF YOU ARE COMFORTABLE GIVING THAT PERSON BROAD AND SWEEPING POWERS
TO MAKE HEALTH CARE DECISIONS FOR YOU. THERE IS NO LEGAL REQUIREMENT THAT
STATE OF TEXAS
ANYONE EXECUTE A HEALTH CARE POWER OF ATTORNEY.

COUNTY OF

BODY DISPOSITION
cannot make or communicate those decisions. This form may be used to create a health care power of
AUTHORIZATION attorney, and meets the requirements of North Carolina law. However, you are not required to use this
AFFIDAVIT

form, and North Carolina law allows the use of other forms that meet certain requirements. If you prepare
your own health care power of attorney, you should be very careful to make sure it is consistent with
§
North Carolina law.
KNOW ALL PERSONS BY THESE PRESENTS:

§

EXPLANATION: You have the right to name someone to make health care decisions for you when you
This document gives the person you designate as your health care agent broad powers to make health
cannot make or communicate those decisions. This form may be used to create a health care power of
care decisions for you when you cannot make the decision yourself or cannot communicate your decision
Texas Health and Safety wishes
attorney, and meets the requirements of North Carolina law. However, you are not required to use this I, ___________________________ (print name), based on the authority of the You should discuss your Code, concerning life-prolonging measures, mental health
to other people.
§711.002(g), upon my oath make the following declaration and directiveand other health care decisions with your health care agent. Except to the extent that you
form, and North Carolina law allows the use of other forms that meet certain requirements. If you prepare
treatment, concerning the disposition of my body
your own health care power of attorney, you should be very careful to make sure it is consistent with North
after my death: I declare that it is my wish and I hereby authorize and specific limitations or restrictions in thisbe
express direct that, upon my death, my remains form, your health care agent may make any health care
Carolina law.
(initial one box):

decision you could make yourself.

This document gives the person you designate as your health care agent broad powers to make health care
This form does not impose a duty on your health care agent to exercise granted powers, but when a
decisions for you when you cannot make the decision yourself or cannot communicate your decision to other Cremated
power is exercised, your health care agent will be obligated to use due care to act in your best interests
people. You should discuss your wishes concerning life-prolonging measures, mental health treatment, and Interred at a cemetery or on private property
and in accordance with this document.
other health care decisions with your health care agent. Except to the extent that you express specific
Interred at a mausoleum
limitations or restrictions in this form, your health care agent may make any health care decision you could
Donated to medical science; if this disposition is not possible because no medical or research facilityis intended to be valid in any jurisdiction in which it is presented,
make yourself.
This Health Care Power of Attorney form will
This form does not impose a duty on your health care agent to exercise granted powers, but when a power is
exercised, your health care agent will be obligated to use due care to act in your best interests and in
accordance with this document.
This Health Care Power of Attorney form is intended to be valid in any jurisdiction in which it is presented,
but places outside North Carolina may impose requirements that this form does not meet.

accept my body, I direct that my remains be (initial one box):
but places outside North Carolina may impose requirements that this form does not meet.
Cremated
If you want to use this form, you must complete it, sign it, and have your signature witnessed by two
Interred at a cemetery or on private property
qualified witnesses and proved by a notary public. Follow the instructions about which choices you can
Interred at a mausoleum
initial very carefully. Do not sign this form until two witnesses and a notary public are present to watch
you sign it. You then should give a copy to your health care agent and to any alternates you name. You
Other disposition as specified:
should consider filing it with the Advance Health Care Directive Registry maintained by the North Carolina
_________________________________________________________________________________
Secretary of State: http://www.nclifelinks.org/ahcdr/

If you want to use this form, you must complete it, sign it, and have your signature witnessed by two
_________________________________________________________________________________
qualified witnesses and proved by a notary public. Follow the instructions about which choices you can
initial very carefully. Do not sign this form until two witnesses and a notary public are present to watch
Other disposition as specified:
you sign it. You then should give a copy to your health care agent and to any alternates you name. You
1.
Designation of Health Care Agent.
should consider filing it with the Advance Health Care Directive Registry maintained by the North Carolina ________________________________________________________________________________________
Secretary of State: http://www.nclifelinks.org/ahcdr/
I, _____________________, being of sound mind, hereby appoint the following person(s) to serve as my

________________________________________________________________________________________

health care agent(s) to act for me and in my name (in any way I could act in person) to make health care
decisions for me as authorized in this document. My designated health care agent(s) shall serve alone,
Signature of Declarant: ______________________________________ Date: _____________________________
in the order named.

1. Designation of Health Care Agent.

I, _______________________________, being of sound mind, hereby appoint the following person(s) to serve as
A.
Name:
Printed name of Declarant: ____________________________________
my health care agent(s) to act for me and in my name (in any way I could act in person) to make health care
Home Address:
decisions for me as authorized in this document. My designated health care agent(s) shall serve alone, in the order
BEFORE ME, the undersigned notary public for the State of Texas, personally appeared
named.
A.
Name: _____________________________
Home Address: _____________________________
___________________________________________

B.

Name:

Home Telephone: _________________________ __________________________, the Declarant in this Body Disposition Authorization Affidavit, who upon
Home Address:
Work Telephone: _________________________ his/her oath made the foregoing declaration(s), including placing his/her initials in the boxes he/she choose on this
Cellular Telephone: _________________________

the _______________ day of _________________________, 20_____.
B.
Name: _____________________________ Home Telephone: __________________________
Home Address: _____________________________ Work Telephone: __________________________
___________________________________________ Cellular Telephone: __________________________
C.
Name: _____________________________ Home Telephone: _________________________
Home Address: _____________________________ Work Telephone: _________________________
___________________________________________ Cellular Telephone: _________________________

C.
Name:
Home Address:

____________________________________________________
Notary Public for the State of Texas
My commission expires: ________________________________
Funeral Consumers Alliance of North Texas
2875 E Parker Rd, Plano TX 75074, 972-509-5686, info@fcant.org
MAY BE REPRODUCED FOR PRIVATE USE ONLY. NO COMMERCIAL USE IS APPROVED.

Body Disposition Authorization Affidavit — Page 1 of 2

Home Telephone:
Work Telephone:
Cellular Telephone:
Home Telephone:
Work Telephone:
Cellular Telephone:
Home Telephone:
Work Telephone:
Cellular Telephone:
HEALTH CARE POWER OF ATTORNEY
NOTE: YOU SHOULD USE THIS DOCUMENT TO NAME A PERSON AS YOUR HEALTH CARE
AGENT IF YOU ARE COMFORTABLE GIVING THAT PERSON BROAD AND SWEEPING POWERS
TO MAKE HEALTH CARE DECISIONS FOR YOU. THERE IS NO LEGAL REQUIREMENT THAT
ANYONE EXECUTE A HEALTH CARE POWER OF ATTORNEY.

STATE OF NORTH CAROLINA
HEALTH CARE POWER OF
ATTORNEY

(6) Artificial nutrition and hydration: Artificial nutrition and hydration must be
provided, withheld or withdrawn in accordance with the choice I have made in
paragraph (5) unless I have checked and initialed
one of the boxes below:
EXPLANATION: You have the right to name someone to make health care decisions for you when you

COUNTY OF __________________

NOTE: YOU SHOULD USE THIS DOCUMENT TO NAME A PERSON AS YOUR HEALTH CARE
AGENT IF YOU ARE COMFORTABLE GIVING THAT PERSON BROAD AND SWEEPING POWERS
TO MAKE HEALTH CARE DECISIONS FOR YOU. THERE IS NO LEGAL REQUIREMENT THAT
STATE OF TEXAS
ANYONE EXECUTE A HEALTH CARE POWER OF ATTORNEY.

COUNTY OF

BODY DISPOSITION
cannot make or communicate those decisions. This form may be used to create a health care power of
AUTHORIZATION attorney, and meets the requirements of North Carolina law. However, you are not required to use this
AFFIDAVIT

form, and North Carolina law allows the use of other forms that meet certain requirements. If you prepare
your own health care power of attorney, you should be very careful to make sure it is consistent with
§
North Carolina law.
KNOW ALL PERSONS BY THESE PRESENTS:

§

EXPLANATION: You have the right to name someone to make health care decisions for you when you
This document gives the person you designate as your health care agent broad powers to make health
cannot make or communicate those decisions. This form may be used to create a health care power of
care decisions for you when you cannot make the decision yourself or cannot communicate your decision
Texas Health and Safety wishes
attorney, and meets the requirements of North Carolina law. However, you are not required to use this I, ___________________________ (print name), based on the authority of the You should discuss your Code, concerning life-prolonging measures, mental health
to other people.
§711.002(g), upon my oath make the following declaration and directiveand other health care decisions with your health care agent. Except to the extent that you
form, and North Carolina law allows the use of other forms that meet certain requirements. If you prepare
treatment, concerning the disposition of my body
your own health care power of attorney, you should be very careful to make sure it is consistent with North
after my death: I declare that it is my wish and I hereby authorize and specific limitations or restrictions in thisbe
express direct that, upon my death, my remains form, your health care agent may make any health care
Carolina law.
(initial one box):

Check

Initial

decision you could make yourself.

This document gives the person you designate as your health care agent broad powers to make health care
This form does not impose a duty on your health care agent to exercise granted powers, but when a
decisions for you when you cannot make the decision yourself or cannot communicate your decision to other Cremated
power is exercised, your health care agent will be obligated to use due care to act in your best interests
people. You should discuss your wishes concerning life-prolonging measures, mental health treatment, and Interred at a cemetery or on private property
and in accordance with this document.
other health care decisions with your health care agent. Except to the extent that you express specific
Interred at a mausoleum
limitations or restrictions in this form, your health care agent may make any health care decision you could
Donated to medical science; if this disposition is not possible because no medical or research facilityis intended to be valid in any jurisdiction in which it is presented,
make yourself.
This Health Care Power of Attorney form will

___

accept my body, I direct that my remains be (initial one box):
but places outside North Carolina may impose requirements that this form does not meet.
Cremated
If you want to use this form, you must complete it, sign it, and have your signature witnessed by two
Interred at a cemetery or on private property
qualified witnesses and proved by a notary public. Follow the instructions about which choices you can
Interred at a mausoleum
initial very carefully. Do not sign this form until two witnesses and a notary public are present to watch
you sign it. You then should give a copy to your health care agent and to any alternates you name. You
Other disposition as specified:
should consider filing it with the Advance Health Care Directive Registry maintained by the North Carolina
_________________________________________________________________________________
Secretary of State: http://www.nclifelinks.org/ahcdr/

I want artificial nutrition regardless of my condition.

This form does not impose a duty on your health care agent to exercise granted powers, but when a power is
exercised, your health care agent will be obligated to use due care to act in your best interests and in
accordance with this document.
This Health Care Power of Attorney form is intended to be valid in any jurisdiction in which it is presented,
but places outside North Carolina may impose requirements that this form does not meet.

If you want to use this form, you must complete it, sign it, and have your signature witnessed by two
_________________________________________________________________________________
qualified witnesses and proved by a notary public. Follow the instructions about which choices you can
initial very carefully. Do not sign this form until two witnesses and a notary public are present to watch
Other disposition as specified:
you sign it. You then should give a copy to your health care agent and to any alternates you name. You
1.
Designation of Health Care Agent.
should consider filing it with the Advance Health Care Directive Registry maintained by the North Carolina ________________________________________________________________________________________
Secretary of State: http://www.nclifelinks.org/ahcdr/
I, _____________________, being of sound mind, hereby appoint the following person(s) to serve as my

___

I do NOT want artificial nutrition regardl ess of my condition.
________________________________________________________________________________________

health care agent(s) to act for me and in my name (in any way I could act in person) to make health care
decisions for me as authorized in this document. My designated health care agent(s) shall serve alone,
Signature of Declarant: ______________________________________ Date: _____________________________
in the order named.

1. Designation of Health Care Agent.

___

I, _______________________________, being of sound mind, hereby appoint the following person(s) to serve as
A.
Name:
Printed name of Declarant: ____________________________________
my health care agent(s) to act for me and in my name (in any way I could act in person) to make health care
Home Address:
decisions for me as authorized in this document. My designated health care agent(s) shall serve alone, in the order
BEFORE ME, the undersigned notary public for the State of Texas, personally appeared
named.
A.
Name: _____________________________
Home Address: _____________________________
___________________________________________

I want artificial hydration regar dless of my condition.
B.

Name:

Home Telephone: _________________________ __________________________, the Declarant in this Body Disposition Authorization Affidavit, who upon
Home Address:
Work Telephone: _________________________ his/her oath made the foregoing declaration(s), including placing his/her initials in the boxes he/she choose on this
Cellular Telephone: _________________________

the _______________ day of _________________________, 20_____.
B.
Name: _____________________________ Home Telephone: __________________________
Home Address: _____________________________ Work Telephone: __________________________
___________________________________________ Cellular Telephone: __________________________

___

Home Telephone:
Work Telephone:
Cellular Telephone:

C.
Name:
Home Address:

____________________________________________________
Notary Public for the State of Texas

Home Telephone:
Work Telephone:
Cellular Telephone:
Home Telephone:
Work Telephone:
Cellular Telephone:

I do NOT want artificial hydration regardless of my condition.

C.
Name: _____________________________ Home Telephone: _________________________
Home Address: _____________________________ Work Telephone: _________________________
___________________________________________ Cellular Telephone: _________________________

My commission expires: ________________________________

Funeral Consumers Alliance of North Texas
2875 E Parker Rd, Plano TX 75074, 972-509-5686, info@fcant.org
MAY BE REPRODUCED FOR PRIVATE USE ONLY. NO COMMERCIAL USE IS APPROVED.

Body Disposition Authorization Affidavit — Page 1 of 2
THE PROBLEM
1. THE DENIAL OF DEATH
“...The idea of death, the fear of it, hunts the humans animal like nothing else; it is a
mainspring of human activity. Activity designed largely to avoid the fatality of
death, to overcome it by denying in some way that it is the final destiny for man.”
Ernest Becker
Six Out Of 10 People Say They Feel
Intimidated Talking To Their Families
About End-of-life Decisions.

Source: California Healthcare Foundation survey
2. THE CURRENT FORMS
“Dying is more than a set of problems to be solved. The nature of dying is not
medical, it is experiential.”
Ira Byock
I,
HEREBY APPOINT
AS MY HEALTH CARE AGENT TO MAKE ANY AND ALL HEALTH
CARE DECISIONS FOR ME, EXCEPT TO THE EXTENT THAT I
STATE OTHERWISE. THE PROXY SHALL TAKE EFFECT ONLY
WHEN AND IF I BECOME UNABLE TO MAKE MY OWN HEALTH
CARE DECISIONS.
THE CHALLENGE
WHY DOES IT MATTER?
HIGH COST OF END OF LIFE CARE
Medicare recipients spend during the five
years before their death averaged about:

$39,000
Individuals

Source: Mount Sinai School of Medicine study

$51,000
Couples

$66,000
Long-term illnesses
THE SOLUTIONS
CAN DEATH BE GOOD?
A  Good Death - SXSW Future15 session
1. COMPLEXITY VS.
SIMPLICITY
2. VISUALIZED
INFORMATION
3. CONVERSATIONAL
TONE
1. COMPLEXITY VS. SIMPLICITY
Lack of design thinking
A PDF TOOLKIT

Tool #5
After Death Decisions
to Think About Now
Name & Date_______________________________________
After the death of a loved one, family and friends are often left with some tough decisions. You
can help ease the pain and anxiety by making your wishes—about burial, autopsy, and organ
donations—clear in advance.

ORGAN AND T ISSUE DONATION
D ID YOU KNOW?
More than 68,000 patients are on the national organ transplant waiting list. Each day, 13 of
them will die because the organs they need have not been donated. Every 16 minutes, a new
name will be added to that waiting list.
Organs you can donate: Heart, Kidneys, Pancreas, Lungs, Liver, Intestines.
Tissue you can donate: Cornea, Skin, Bone Marrow, Heart Valves, Connective Tissue.
To be transplanted, organs must receive blood until they are removed from the b ody of the
donor. Therefore, it may be necessary to place the donor on a breathing machine temporarily or
provide other organ-sustaining treatment.
If you are older or seriously ill, you may or may not have organs or tissue suitable for
transplant. Doctors evaluate the options at or near the time of death.
The body of an organ donor can still be shown and buried after death.

1.

Do you want to donate viable ORGANS for transplant? (Circle one)
Yes
Not sure
No

2.

If Yes, check one:
____ I will donate any organs.
____ Just the following: _______________________________

Do you want to donate viable TISSUES for transplant? (Circle one)
Yes
Not sure
No

If Yes, check one:
____ I will donate any organs.
____ Just the following: ____________________________
A GOOD DEATH TOOLKIT
INFO

TITLE
tHIS IS WHERE THE QUESTION GOES
OPTION 1

OPTION2

STATISTICS

245,000

SOURCE
2. VISUALIZED INFORMATION
Lack of visualization to display complex information
USA CREMATION TRENDS 2011
Deaths

Cremations

% of death cremated

2,464,392

1035,074

42.0%

Source: The Nebraska Coalition for Compassionate Care and the Nebraska Hospice and Palliative Care Association, (NHPCA) 2010 end-of-life survey .
NUMBER OF PATIENTS IN THE U.S
WHO RECEIVE TUBE FEEDING

Hospital

245,000

Home HealthCare

30,700

babies

8,100,000

Source: AHRQ Healthcare Costs and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) 2009 data.
ATTITUDE TOWARDS ADVANCE DIRECTIVES
Want

Have

93%

20%

Source: The Nebraska Coalition for Compassionate Care and the Nebraska Hospice and Palliative Care Association, (NHPCA) 2010 end-of-life survey .
3. CONVERSATIONAL TONE
The current content lacks a humanizing aspect.
It feels cold, clinical, and not conversational.
WHAT IF
you are in severe discomfort most of the time
(such as nausea, diarrhea).
Want
Treatment

1

2

3

4

5

Do not
Want Treatment
LIVING WILL
Which of the following do you fear the most
near the end of your life?
Being in pain

OR

Losing the ability
to think

OR

Being a financial burden on
loved ones

OR

To be alone
CREATING CONVERSATIONS
WHERE CONVERSATIONS
ARE TABOO.
NAVIT KEREN
navitush@gmail.com
@navit_keren

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A Good Death - SXSW Future15 session

  • 2. NAVIT UX DESIGN WORK AT HUGE DEATH NARRATIVE
  • 4. “I was fantasising about my own death, I started thinking what my funeral would be like and what music would be played, I was at that level of insanity.” Billy Corgan 
  • 16. HEALTH CARE POWER OF ATTORNEY NOTE: YOU SHOULD USE THIS DOCUMENT TO NAME A PERSON AS YOUR HEALTH CARE AGENT IF YOU ARE COMFORTABLE GIVING THAT PERSON BROAD AND SWEEPING POWERS TO MAKE HEALTH CARE DECISIONS FOR YOU. THERE IS NO LEGAL REQUIREMENT THAT ANYONE EXECUTE A HEALTH CARE POWER OF ATTORNEY. STATE OF NORTH CAROLINA HEALTH CARE POWER OF ATTORNEY EXPLANATION: You have the right to name someone to make health care decisions for you when you COUNTY OF __________________ NOTE: YOU SHOULD USE THIS DOCUMENT TO NAME A PERSON AS YOUR HEALTH CARE AGENT IF YOU ARE COMFORTABLE GIVING THAT PERSON BROAD AND SWEEPING POWERS TO MAKE HEALTH CARE DECISIONS FOR YOU. THERE IS NO LEGAL REQUIREMENT THAT STATE OF TEXAS ANYONE EXECUTE A HEALTH CARE POWER OF ATTORNEY. COUNTY OF BODY DISPOSITION cannot make or communicate those decisions. This form may be used to create a health care power of AUTHORIZATION attorney, and meets the requirements of North Carolina law. However, you are not required to use this AFFIDAVIT form, and North Carolina law allows the use of other forms that meet certain requirements. If you prepare your own health care power of attorney, you should be very careful to make sure it is consistent with § North Carolina law. KNOW ALL PERSONS BY THESE PRESENTS: § EXPLANATION: You have the right to name someone to make health care decisions for you when you This document gives the person you designate as your health care agent broad powers to make health cannot make or communicate those decisions. This form may be used to create a health care power of care decisions for you when you cannot make the decision yourself or cannot communicate your decision Texas Health and Safety wishes attorney, and meets the requirements of North Carolina law. However, you are not required to use this I, ___________________________ (print name), based on the authority of the You should discuss your Code, concerning life-prolonging measures, mental health to other people. §711.002(g), upon my oath make the following declaration and directiveand other health care decisions with your health care agent. Except to the extent that you form, and North Carolina law allows the use of other forms that meet certain requirements. If you prepare treatment, concerning the disposition of my body your own health care power of attorney, you should be very careful to make sure it is consistent with North after my death: I declare that it is my wish and I hereby authorize and specific limitations or restrictions in thisbe express direct that, upon my death, my remains form, your health care agent may make any health care Carolina law. (initial one box): decision you could make yourself. This document gives the person you designate as your health care agent broad powers to make health care This form does not impose a duty on your health care agent to exercise granted powers, but when a decisions for you when you cannot make the decision yourself or cannot communicate your decision to other Cremated power is exercised, your health care agent will be obligated to use due care to act in your best interests people. You should discuss your wishes concerning life-prolonging measures, mental health treatment, and Interred at a cemetery or on private property and in accordance with this document. other health care decisions with your health care agent. Except to the extent that you express specific Interred at a mausoleum limitations or restrictions in this form, your health care agent may make any health care decision you could Donated to medical science; if this disposition is not possible because no medical or research facilityis intended to be valid in any jurisdiction in which it is presented, make yourself. This Health Care Power of Attorney form will This form does not impose a duty on your health care agent to exercise granted powers, but when a power is exercised, your health care agent will be obligated to use due care to act in your best interests and in accordance with this document. This Health Care Power of Attorney form is intended to be valid in any jurisdiction in which it is presented, but places outside North Carolina may impose requirements that this form does not meet. accept my body, I direct that my remains be (initial one box): but places outside North Carolina may impose requirements that this form does not meet. Cremated If you want to use this form, you must complete it, sign it, and have your signature witnessed by two Interred at a cemetery or on private property qualified witnesses and proved by a notary public. Follow the instructions about which choices you can Interred at a mausoleum initial very carefully. Do not sign this form until two witnesses and a notary public are present to watch you sign it. You then should give a copy to your health care agent and to any alternates you name. You Other disposition as specified: should consider filing it with the Advance Health Care Directive Registry maintained by the North Carolina _________________________________________________________________________________ Secretary of State: http://www.nclifelinks.org/ahcdr/ If you want to use this form, you must complete it, sign it, and have your signature witnessed by two _________________________________________________________________________________ qualified witnesses and proved by a notary public. Follow the instructions about which choices you can initial very carefully. Do not sign this form until two witnesses and a notary public are present to watch Other disposition as specified: you sign it. You then should give a copy to your health care agent and to any alternates you name. You 1. Designation of Health Care Agent. should consider filing it with the Advance Health Care Directive Registry maintained by the North Carolina ________________________________________________________________________________________ Secretary of State: http://www.nclifelinks.org/ahcdr/ I, _____________________, being of sound mind, hereby appoint the following person(s) to serve as my ________________________________________________________________________________________ health care agent(s) to act for me and in my name (in any way I could act in person) to make health care decisions for me as authorized in this document. My designated health care agent(s) shall serve alone, Signature of Declarant: ______________________________________ Date: _____________________________ in the order named. 1. Designation of Health Care Agent. I, _______________________________, being of sound mind, hereby appoint the following person(s) to serve as A. Name: Printed name of Declarant: ____________________________________ my health care agent(s) to act for me and in my name (in any way I could act in person) to make health care Home Address: decisions for me as authorized in this document. My designated health care agent(s) shall serve alone, in the order BEFORE ME, the undersigned notary public for the State of Texas, personally appeared named. A. Name: _____________________________ Home Address: _____________________________ ___________________________________________ B. Name: Home Telephone: _________________________ __________________________, the Declarant in this Body Disposition Authorization Affidavit, who upon Home Address: Work Telephone: _________________________ his/her oath made the foregoing declaration(s), including placing his/her initials in the boxes he/she choose on this Cellular Telephone: _________________________ the _______________ day of _________________________, 20_____. B. Name: _____________________________ Home Telephone: __________________________ Home Address: _____________________________ Work Telephone: __________________________ ___________________________________________ Cellular Telephone: __________________________ C. Name: _____________________________ Home Telephone: _________________________ Home Address: _____________________________ Work Telephone: _________________________ ___________________________________________ Cellular Telephone: _________________________ C. Name: Home Address: ____________________________________________________ Notary Public for the State of Texas My commission expires: ________________________________ Funeral Consumers Alliance of North Texas 2875 E Parker Rd, Plano TX 75074, 972-509-5686, info@fcant.org MAY BE REPRODUCED FOR PRIVATE USE ONLY. NO COMMERCIAL USE IS APPROVED. Body Disposition Authorization Affidavit — Page 1 of 2 Home Telephone: Work Telephone: Cellular Telephone: Home Telephone: Work Telephone: Cellular Telephone: Home Telephone: Work Telephone: Cellular Telephone:
  • 17. HEALTH CARE POWER OF ATTORNEY NOTE: YOU SHOULD USE THIS DOCUMENT TO NAME A PERSON AS YOUR HEALTH CARE AGENT IF YOU ARE COMFORTABLE GIVING THAT PERSON BROAD AND SWEEPING POWERS TO MAKE HEALTH CARE DECISIONS FOR YOU. THERE IS NO LEGAL REQUIREMENT THAT ANYONE EXECUTE A HEALTH CARE POWER OF ATTORNEY. STATE OF NORTH CAROLINA HEALTH CARE POWER OF ATTORNEY (6) Artificial nutrition and hydration: Artificial nutrition and hydration must be provided, withheld or withdrawn in accordance with the choice I have made in paragraph (5) unless I have checked and initialed one of the boxes below: EXPLANATION: You have the right to name someone to make health care decisions for you when you COUNTY OF __________________ NOTE: YOU SHOULD USE THIS DOCUMENT TO NAME A PERSON AS YOUR HEALTH CARE AGENT IF YOU ARE COMFORTABLE GIVING THAT PERSON BROAD AND SWEEPING POWERS TO MAKE HEALTH CARE DECISIONS FOR YOU. THERE IS NO LEGAL REQUIREMENT THAT STATE OF TEXAS ANYONE EXECUTE A HEALTH CARE POWER OF ATTORNEY. COUNTY OF BODY DISPOSITION cannot make or communicate those decisions. This form may be used to create a health care power of AUTHORIZATION attorney, and meets the requirements of North Carolina law. However, you are not required to use this AFFIDAVIT form, and North Carolina law allows the use of other forms that meet certain requirements. If you prepare your own health care power of attorney, you should be very careful to make sure it is consistent with § North Carolina law. KNOW ALL PERSONS BY THESE PRESENTS: § EXPLANATION: You have the right to name someone to make health care decisions for you when you This document gives the person you designate as your health care agent broad powers to make health cannot make or communicate those decisions. This form may be used to create a health care power of care decisions for you when you cannot make the decision yourself or cannot communicate your decision Texas Health and Safety wishes attorney, and meets the requirements of North Carolina law. However, you are not required to use this I, ___________________________ (print name), based on the authority of the You should discuss your Code, concerning life-prolonging measures, mental health to other people. §711.002(g), upon my oath make the following declaration and directiveand other health care decisions with your health care agent. Except to the extent that you form, and North Carolina law allows the use of other forms that meet certain requirements. If you prepare treatment, concerning the disposition of my body your own health care power of attorney, you should be very careful to make sure it is consistent with North after my death: I declare that it is my wish and I hereby authorize and specific limitations or restrictions in thisbe express direct that, upon my death, my remains form, your health care agent may make any health care Carolina law. (initial one box): Check Initial decision you could make yourself. This document gives the person you designate as your health care agent broad powers to make health care This form does not impose a duty on your health care agent to exercise granted powers, but when a decisions for you when you cannot make the decision yourself or cannot communicate your decision to other Cremated power is exercised, your health care agent will be obligated to use due care to act in your best interests people. You should discuss your wishes concerning life-prolonging measures, mental health treatment, and Interred at a cemetery or on private property and in accordance with this document. other health care decisions with your health care agent. Except to the extent that you express specific Interred at a mausoleum limitations or restrictions in this form, your health care agent may make any health care decision you could Donated to medical science; if this disposition is not possible because no medical or research facilityis intended to be valid in any jurisdiction in which it is presented, make yourself. This Health Care Power of Attorney form will ___ accept my body, I direct that my remains be (initial one box): but places outside North Carolina may impose requirements that this form does not meet. Cremated If you want to use this form, you must complete it, sign it, and have your signature witnessed by two Interred at a cemetery or on private property qualified witnesses and proved by a notary public. Follow the instructions about which choices you can Interred at a mausoleum initial very carefully. Do not sign this form until two witnesses and a notary public are present to watch you sign it. You then should give a copy to your health care agent and to any alternates you name. You Other disposition as specified: should consider filing it with the Advance Health Care Directive Registry maintained by the North Carolina _________________________________________________________________________________ Secretary of State: http://www.nclifelinks.org/ahcdr/ I want artificial nutrition regardless of my condition. This form does not impose a duty on your health care agent to exercise granted powers, but when a power is exercised, your health care agent will be obligated to use due care to act in your best interests and in accordance with this document. This Health Care Power of Attorney form is intended to be valid in any jurisdiction in which it is presented, but places outside North Carolina may impose requirements that this form does not meet. If you want to use this form, you must complete it, sign it, and have your signature witnessed by two _________________________________________________________________________________ qualified witnesses and proved by a notary public. Follow the instructions about which choices you can initial very carefully. Do not sign this form until two witnesses and a notary public are present to watch Other disposition as specified: you sign it. You then should give a copy to your health care agent and to any alternates you name. You 1. Designation of Health Care Agent. should consider filing it with the Advance Health Care Directive Registry maintained by the North Carolina ________________________________________________________________________________________ Secretary of State: http://www.nclifelinks.org/ahcdr/ I, _____________________, being of sound mind, hereby appoint the following person(s) to serve as my ___ I do NOT want artificial nutrition regardl ess of my condition. ________________________________________________________________________________________ health care agent(s) to act for me and in my name (in any way I could act in person) to make health care decisions for me as authorized in this document. My designated health care agent(s) shall serve alone, Signature of Declarant: ______________________________________ Date: _____________________________ in the order named. 1. Designation of Health Care Agent. ___ I, _______________________________, being of sound mind, hereby appoint the following person(s) to serve as A. Name: Printed name of Declarant: ____________________________________ my health care agent(s) to act for me and in my name (in any way I could act in person) to make health care Home Address: decisions for me as authorized in this document. My designated health care agent(s) shall serve alone, in the order BEFORE ME, the undersigned notary public for the State of Texas, personally appeared named. A. Name: _____________________________ Home Address: _____________________________ ___________________________________________ I want artificial hydration regar dless of my condition. B. Name: Home Telephone: _________________________ __________________________, the Declarant in this Body Disposition Authorization Affidavit, who upon Home Address: Work Telephone: _________________________ his/her oath made the foregoing declaration(s), including placing his/her initials in the boxes he/she choose on this Cellular Telephone: _________________________ the _______________ day of _________________________, 20_____. B. Name: _____________________________ Home Telephone: __________________________ Home Address: _____________________________ Work Telephone: __________________________ ___________________________________________ Cellular Telephone: __________________________ ___ Home Telephone: Work Telephone: Cellular Telephone: C. Name: Home Address: ____________________________________________________ Notary Public for the State of Texas Home Telephone: Work Telephone: Cellular Telephone: Home Telephone: Work Telephone: Cellular Telephone: I do NOT want artificial hydration regardless of my condition. C. Name: _____________________________ Home Telephone: _________________________ Home Address: _____________________________ Work Telephone: _________________________ ___________________________________________ Cellular Telephone: _________________________ My commission expires: ________________________________ Funeral Consumers Alliance of North Texas 2875 E Parker Rd, Plano TX 75074, 972-509-5686, info@fcant.org MAY BE REPRODUCED FOR PRIVATE USE ONLY. NO COMMERCIAL USE IS APPROVED. Body Disposition Authorization Affidavit — Page 1 of 2
  • 19. 1. THE DENIAL OF DEATH “...The idea of death, the fear of it, hunts the humans animal like nothing else; it is a mainspring of human activity. Activity designed largely to avoid the fatality of death, to overcome it by denying in some way that it is the final destiny for man.” Ernest Becker
  • 20. Six Out Of 10 People Say They Feel Intimidated Talking To Their Families About End-of-life Decisions. Source: California Healthcare Foundation survey
  • 21. 2. THE CURRENT FORMS “Dying is more than a set of problems to be solved. The nature of dying is not medical, it is experiential.” Ira Byock
  • 22. I, HEREBY APPOINT AS MY HEALTH CARE AGENT TO MAKE ANY AND ALL HEALTH CARE DECISIONS FOR ME, EXCEPT TO THE EXTENT THAT I STATE OTHERWISE. THE PROXY SHALL TAKE EFFECT ONLY WHEN AND IF I BECOME UNABLE TO MAKE MY OWN HEALTH CARE DECISIONS.
  • 24. WHY DOES IT MATTER?
  • 25. HIGH COST OF END OF LIFE CARE Medicare recipients spend during the five years before their death averaged about: $39,000 Individuals Source: Mount Sinai School of Medicine study $51,000 Couples $66,000 Long-term illnesses
  • 27. CAN DEATH BE GOOD?
  • 29. 1. COMPLEXITY VS. SIMPLICITY 2. VISUALIZED INFORMATION 3. CONVERSATIONAL TONE
  • 30. 1. COMPLEXITY VS. SIMPLICITY Lack of design thinking
  • 31. A PDF TOOLKIT Tool #5 After Death Decisions to Think About Now Name & Date_______________________________________ After the death of a loved one, family and friends are often left with some tough decisions. You can help ease the pain and anxiety by making your wishes—about burial, autopsy, and organ donations—clear in advance. ORGAN AND T ISSUE DONATION D ID YOU KNOW? More than 68,000 patients are on the national organ transplant waiting list. Each day, 13 of them will die because the organs they need have not been donated. Every 16 minutes, a new name will be added to that waiting list. Organs you can donate: Heart, Kidneys, Pancreas, Lungs, Liver, Intestines. Tissue you can donate: Cornea, Skin, Bone Marrow, Heart Valves, Connective Tissue. To be transplanted, organs must receive blood until they are removed from the b ody of the donor. Therefore, it may be necessary to place the donor on a breathing machine temporarily or provide other organ-sustaining treatment. If you are older or seriously ill, you may or may not have organs or tissue suitable for transplant. Doctors evaluate the options at or near the time of death. The body of an organ donor can still be shown and buried after death. 1. Do you want to donate viable ORGANS for transplant? (Circle one) Yes Not sure No 2. If Yes, check one: ____ I will donate any organs. ____ Just the following: _______________________________ Do you want to donate viable TISSUES for transplant? (Circle one) Yes Not sure No If Yes, check one: ____ I will donate any organs. ____ Just the following: ____________________________
  • 32. A GOOD DEATH TOOLKIT INFO TITLE tHIS IS WHERE THE QUESTION GOES OPTION 1 OPTION2 STATISTICS 245,000 SOURCE
  • 33. 2. VISUALIZED INFORMATION Lack of visualization to display complex information
  • 34. USA CREMATION TRENDS 2011 Deaths Cremations % of death cremated 2,464,392 1035,074 42.0% Source: The Nebraska Coalition for Compassionate Care and the Nebraska Hospice and Palliative Care Association, (NHPCA) 2010 end-of-life survey .
  • 35. NUMBER OF PATIENTS IN THE U.S WHO RECEIVE TUBE FEEDING Hospital 245,000 Home HealthCare 30,700 babies 8,100,000 Source: AHRQ Healthcare Costs and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) 2009 data.
  • 36. ATTITUDE TOWARDS ADVANCE DIRECTIVES Want Have 93% 20% Source: The Nebraska Coalition for Compassionate Care and the Nebraska Hospice and Palliative Care Association, (NHPCA) 2010 end-of-life survey .
  • 37. 3. CONVERSATIONAL TONE The current content lacks a humanizing aspect. It feels cold, clinical, and not conversational.
  • 38. WHAT IF you are in severe discomfort most of the time (such as nausea, diarrhea). Want Treatment 1 2 3 4 5 Do not Want Treatment
  • 39. LIVING WILL Which of the following do you fear the most near the end of your life? Being in pain OR Losing the ability to think OR Being a financial burden on loved ones OR To be alone