(Bradley Shurman is a demographic strategist and cultural commentator. He’s the co-founder and co-host of #NewRules Media, the founder and CEO of Human Change, and the author of The Super Age: Decoding Our Demographic Destiny. Used with permission, this article appeared online at https://substack.com/home/post/p-148817570.)
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Dying in America is not just emotionally taxing; it’s financially burdensome, too. Experts emphasize that proactive end-of-life (EOL) planning – through advance directives, medical power of attorney, and clear communication of final wishes – reduces financial strain and alleviates emotional stress on loved ones. Taking steps to prepare helps individuals and their families navigate this difficult time with greater resilience.
AUSTIN – My friend Jocko passed away unexpectedly just over a year ago, right before his 46th birthday, from hypertensive cardiovascular disease. He was a beacon of light who lived every day to the fullest. A fixture on the social scene, he knew just about everyone in the city and devoted his free time and financial resources to charitable organizations supporting the LGBTQ+ community. He was loved.
What Jocko wasn’t was a life planner. Like nearly a quarter of men in his age group, Jocko was single, and, like more than two-thirds of Americans, he had not made any preparations for his eventual end. So, when he passed away, there was a scramble among friends and family to figure out what to do with his estate and how to honor his wishes, including the difficult decision on his final resting place (he’d converted from Catholicism to Episcopalian without his family’s knowledge). There was no will, no plan, and it was incredibly stressful for all involved.
According to Gary Wederspahn from Final Exit Network, what might be holding Americans back from planning for the end is steeped in terror management theory, a psychological concept that explores how humans cope with the existential fear of death. It posits that awareness of our mortality can provoke deep anxiety, which we manage by embracing cultural worldviews, belief systems, and values that give life meaning and a sense of lasting legacy. However, it doesn’t spur people into action for EOL planning.
And, let’s be real: Americans are notoriously bad at long-term planning, especially for later life. They tend not to prepare adequately for retirement—one out of five people haven’t saved properly, according to AARP – and they certainly don’t plan for health-related issues that may incapacitate them, or for their eventual demise, despite the universal reality that it comes for us all; it’s the one thing we have in common.
Expensive Endings
According to The Lancet, dying in America comes with a hefty price tag. On average, healthcare expenditures from all sources – both public and private – amount to $80,000 in the final 12 months of life and rise to $155,000 over the last three years. While insurance programs like Medicare and Medicaid cover most expenses, out-of-pocket costs remain significant, both in time and money. Additionally, certain conditions, such as dementia, often lack sufficient insurance coverage, leaving families to shoulder substantial burdens. Advance directives can help mitigate some costs, but just the ones before death.
A recent study by the National Funeral Directors Association revealed that the median funeral cost is $8,300, typically covering expenses such as the viewing, burial, service fees, transportation, casket, embalming, and other preparations. The median cost of a funeral with cremation is $6,280. However, these prices do not include additional expenses like cemetery plots, monuments, markers, or flowers.
When someone dies without a will, the main costs to their estate include court fees, attorney fees, appraisal fees, potential search fees for missing heirs, and administrative costs need to be covered. These expenses can increase substantially due to the complexity of distributing assets without clear instructions, often leading to higher legal fees (and more headaches) than estates with a will in place.
Failure to plan can risk the financial and mental health of spouses and family members.
Getting Ready to Exit
Wederspahn’s organization publishes “The Good Death Society Blog” and advocates for the right to die on one’s own terms. It also supports “death-with-dignity” (DWD) laws, which allow terminally ill individuals to request and receive prescription medication to end their lives in a humane and dignified manner. These laws are designed to give people control over their dying process when facing incurable and debilitating conditions, typically with a prognosis of six months or less to live. [Ten] states and Washington, D.C. now have DWD legislation, which impacts about 20 percent of the US population.
But, he says, those laws don’t cover the vast majority of people, arguing that more should take control over their EOL decisions earlier, and on their terms, because the likelihood of losing personal autonomy increases over time without a plan. “It’s the old Boy Scout model of being prepared,” he says. And too often, individuals and their caregivers aren’t financially or mentally prepared for what’s coming.
New practitioners, such as EOL doulas, grief counselors, and death coaches, can help individuals with their final exit. Death doulas focus on holistic, non-medical care and offer emotional and physical support for the dying and their families, helping them create peaceful environments, navigate end-of-life wishes, and embrace the moment. Grief counselors, who are typically licensed mental health professionals, prepare individuals for the emotional complexity of loss, providing essential coping skills to handle both anticipatory and post-loss grief. Death coaches help people confront their mortality by reframing the idea of death itself, using reflective practices to reduce fear and promote a purposeful life.
Greg Barnsdale, a seasoned funeral home director, certified financial planner, and author of Do Not Ignore Your Mortality: Practical Advice From a Funeral & Financial Insider, agrees. He stresses that EOL planning helps reduce the stress of aging and leaves survivors more financially and emotionally resilient, more likely to get along, and less likely to contest final wishes, resulting in more meaningful legacies for the departed. Immense pressure is taken off the courts from dealing with so many unorganized estates, and cumulatively, the economy benefits. “It’s a massive win for everyone,” Barnsdale says.
Making the Plan
He and Wederspahn agree that preparing for the end can help promote a better life. “We can live a more fulfilled life if we accept the fact that we won’t live forever,” says Barnsdale.
So, how should you plan for the end?
- Define for yourself what a good death looks like. It is one in in which a person passes with dignity, peace, and minimal suffering, in alignment with their values and wishes. It includes control over care decisions, access to pain management, emotional and spiritual support, and a sense of closure or acceptance. Surrounded by loved ones, a good death honors privacy, allows for meaningful goodbyes, and reflects a life lived with purpose.
- Put your wishes in a document, generally an advance directive (AD), which could include a do-not-resuscitate order. This provides peace of mind by ensuring that one’s healthcare wishes – such as life-sustaining measures or pain management preferences – are respected, even during serious illness or at the end of life. For families and caregivers, an AD reduces the emotional burden of making difficult medical decisions, preventing conflicts and ensuring that loved ones can focus on providing support rather than navigating uncertain choices.
- Make sure your loved ones know your wishes by having those tough conversations about your eventual end. These talks help families avoid uncertainty and potential conflict during an already emotional time, giving clarity on decisions about medical treatments, caregiving, and even personal matters, such as where someone would like to spend their final days. By sharing their wishes openly, individuals provide loved ones with guidance and reassurance, empowering them to make choices that align with their deepest values and create a sense of peace and preparedness for everyone involved.
- Choose a person with medical power of attorney and authority over health and EOL decisions. This individual can advocate for the patient’s wishes regarding medical treatments, end-of-life care, and other critical choices, providing clarity and direction for healthcare providers and family. Empowering a specific person reduces potential conflict among loved ones, ensures that personal values are upheld in care decisions, and provides invaluable peace of mind during challenging moments.
- Prepare a will, ideally with a lawyer. By clearly outlining beneficiaries, appointing guardians for minor children, and detailing how assets should be handled, a will prevents confusion, family disputes, and lengthy legal proceedings. It provides peace of mind for the individual and clarity for loved ones during a difficult time, helping to protect family harmony and ensure that personal legacies are respected.
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Final Exit Network (FEN) is a network of dedicated professionals and caring, trained volunteers who support mentally competent adults as they navigate their end-of-life journey. Established in 2004, FEN seeks to educate qualified individuals in practical, peaceful ways to end their lives, offer a compassionate bedside presence and defend a person’s right to choose. For more information, go to www.finalexitnetwork.org.
Payments and donations are tax deductible to the full extent allowed by law. Final Exit Network is a 501(c)3 nonprofit organization.
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