ISSUES THAT AFFECT YOU
Scroll or click to view the following topics on this page:
Advance Health Care Directive and a Living Will
Autopsies
Basic Services Fee (The non-declinable fee)
Body donation
Funeral costs
Living Will
Organ and tissue donation
Prepaying for funeral service
Advance Health Care Directive and a Living Will:
A Living Will may not sufficient to meet each person's needs as it cannot truly anticipate what all the circumstances might be when it is needed. A safer approach is naming a health care power of attorney in an advance health care directive, and communicating your values and priorities to that person as well as your family and friends. A statement about an individual's wishes for after-death care (including a desire to have or not to have organ, tissues or body donation) may be added to any advance health care directive document that does not already have a space on the form for that. Select from the following forms:
The Guide to Maryland Law on Health Care Decisions includes forms
Delaware Advance Health Care Directive Form
The DC Advance Directive (Adobe Reader pdf file) from the D.C. Hospital Association is valid in DC, MD and VA
The Advance Health Care Directive (Adobe Reader pdf file) from the Montgomery County Coalition for End-of-Life Care is valid in DC, MD and VA but omits a living will.
Autopsies:
If the family wishes an autopsy but the medical examiner determines there is no reason to suspect foul play, they will have to make arrangements themselves privately. If the patient died in a hospital, an autopsy can be arranged through the hospital and is usually done there. Alternatively, an autopsy may be arranged directly with a private autopsy service. Autopsies usually cost between $2,000 and $4,000. Preliminary results may be available within three days but final results may take longer.
Basic Services Fee (The non-declinable fee):
The Funeral Rule permits morticians to charge a BASIC SERVICES FEE—for basic mortuary staff services and overhead—which is non-declinable. The consumer must pay this fee in addition to the cost of all funeral goods and services selected unless opting for a Direct Cremation or Immediate Burial, in which case this fee is already included. Here are other facts about the basic services fee, which is usually (but not always) the first item on the GPL:
- It accounts for approximately 40% of all service charges and in our area is roughly 25% higher than that of the national average.
- It is capricious and easily manipulated: a funeral director can lower casket prices to compete with a casket retailer, then recoup by hiking the basic services fee.
- It is inequitable: families selecting minimal funerals must nonetheless pay for overhead expenses related to parking lots or reception rooms.
- It is not consumer-friendly: the FCA has petitioned the FTC to abolish it though to date this has not occurred.
NOTE: Because the basic services fee is the only allowable non-declinable fee, a mortuary may not levy a "casket handling fee". A fee charged when a casket is purchased outside the funeral home is illegal.
Body donation:
In Maryland, bodies may be donated to the Maryland State Board of Anatomy, 1-800-879-2728. This board accepts bodies for all medical schools in Maryland as well as schools of dentistry, physical therapy, mortuary sciences, paramedics, etc. There are no restrictions because of infectious or other diseases the deceased may have had. Because there is great interest in this service, the Board requires application and acceptance of a body in advance.
Alternatively, bodies may be donated directly to specific medical schools in DC and Delaware or to one of a number of commercial entities. Contact:
Howard University Medical School (Department of Anatomy - 202-806-9869),
George Washington University Medical School (Department of Anatomy 202-994-3511),
Georgetown University Medical School (Department of Cell Biology 202-687-1219), or
Uniformed Services University of the Health Science (USUHS) 301-295-3334.
It is best to make arrangements beforehand but, when that has not been done, it is important to make arrangements right away before calling a funeral director.
Local funeral homes normally can transport bodies to the State Board of Anatomy or specific medical school with whom arrangements have been made. However, if a signed donor dies out of state, the family must pay for transportation to a local funeral establishment.
Anyone 18 or older (of sound mind) may sign the appropriate form to donate his/her body to the Maryland State Board of Anatomy or specific medical school, or stipulate in his advance directive a desire to do so. The desire to donate one's organs, tissues or body may also be made via an advance health care directive form in a number of states.
In most cases, the cremated ashes of the donated bodies will be returned by the institution within 18 months to the family or other designated person.
Funeral costs:
Did you know that funeral and memorial services, cremation, and burials vary widely in cost for identical services? That’s why it’s important to compare prices among funeral homes. Click here for the results of our latest Mortuary Price Survey, in which we compare prices—among more than 100 mortuaries in Maryland, Delaware, and West Virginia — for Immediate Burial and Direct Cremation, the simplest of funeral arrangements.
Living Will:
A Living Will may not sufficient to meet each person's needs as it cannot truly anticipate what all the circumstances might be when it is needed. A safer approach is naming a health care power of attorney in an advance health care directive, and communicating your values and priorities to that person as well as your family and friends. See Advance Health Care Directive.
Organ and tissue donation:
Donated organs must be taken immediately after a person has died, usually after severe neurological injury or “brain death” has occurred. This is possible only in a hospital setting.
Tissues such as bone, skin, eyes, cartilage, veins and heart valves can be taken for up to 24 hours after the heart has stopped beating.
A more complete explanation regarding organ, tissue and body donation can be found on the website of the The Washington Regional Transplant Community (WRTC).
If a person dies at home, it is not possible to recover organs but some tissue recovery might still be possible if WRTC is contacted (703-641-0100) and the body is promptly transported to a hospital.
In Maryland, corneas are sent to the Medical Eye Bank of Maryland which is part of an international network of tissue and eye banks. Maryland law permits corneas to be donated without family permission although usually this will not occur if the family objects.
In Maryland, a person may state in an advance directive if he/she does or does not wish to become an organ or tissue donor or may stipulate that only certain types of organs or tissue may be donated. The driver's license in Maryland allows an individual to designate himself an organ donor. If he does not, it is presumed willingness to be an organ donor is still an open question, as it is not possible to decline being an organ donor on the driver's license.
Prepaying for funeral services:
Although planning for after-death care is strongly recommended, prepaying for a funeral may not be a good idea. There are a number of disadvantages.
You may move or die in another state, and it could be expensive to have your body transported back to the funeral home with whom you made your contract.
The money paid today may not cover the cost of what you want when the services or merchandise are needed in the future. This would necessitate substitution of cheaper merchandise or require additional money from your survivors or your estate.
The funeral home you contracted with may close or change ownership.
In many states, part of all of the interest earned on the money you prepaid may be withdrawn by the seller as part of their administrative fees.
You might change your mind about the kind of arrangements you want.
If you want to set aside money in advance to cover the cost of funeral merchandise or services, there are safer approaches. Life insurance may be purchased that will cover the cost of your funeral, or a special trust may be created.
When specific arrangements are made in advance, be sure to tell your family about them including where the documents are filed. If your family isn't aware that you've made plans in advance, your wishes may not be carried out and your family may end up paying for arrangements a second time.