Estate planning checklist: How to start ‘getting your affairs in order’

Many patients come to MD Anderson for a second opinion after being told elsewhere: “Get your affairs in order.”  

But what does that phrase mean?  

Should you start making plans for a funeral service or picking out a burial plot? Or, designating a legal guardian for your minor children? 

It can be hard to think clearly when you’re anxious about a new cancer diagnosis. So, I’ll share five considerations here that we typically address with patients who are trying to plan for their cancer care. I’ll also make some other suggestions.

Medical power of attorney

We recommend that you start by completing a medical power of attorney form. This document allows you to designate a trusted person to make medical decisions on your behalf, in case you become incapacitated or can’t make them for yourself.  

If you’re happily married, the process is usually pretty straightforward.  In Texas, spouses are automatically considered each other’s legal next of kin. But if you’re not married — or even unhappily married, legally separated, or just not quite divorced yet — having a medical power of attorney in place ensures that only someone you trust will be making those decisions. 

If you’re an MD Anderson patient, you can ask a social work counselor to help you complete a medical power of attorney form at any time.

Living Will

This form allows you to specify which types of care you would like if you’re ever on life support and cannot communicate your wishes for yourself. Some people want their doctors to use every means possible to extend their lives. Others simply wish to be kept pain-free until they die naturally.  

Either way, MD Anderson social work counselors can help you complete a Living Will. 

Do Not Resuscitate (DNR) orders

These documents specify which life-saving measures you’d like to be taken both inside and outside of a hospital setting if your heart fails or you stop breathing. 

In-hospital DNR orders are completed by a doctor each time you are admitted, and expire upon your release or when a doctor cancels the order. That means a new DNR order must be completed any time you are hospitalized.

Out-of-hospital DNR orders alert first responders and other medical personnel of your wishes when you are anywhere other than a hospital setting. These must be signed by a doctor and carried with you at all times.  

Disposition of remains

The person who decides how your body is handled after you die is called your legal next-of-kin. Typically, that person is (in descending order): 

• Your spouse 
• Your adult children 
• Your parents 
• Your siblings  

Thinking about this subject can be awkward and uncomfortable. But if you don’t want a particular person making those arrangements for you, completing a disposition of remains form allows you to specify who can, when the time comes. 

MD Anderson social work counselors can help you complete one of these forms as well. They can also provide you with information about donating your body to science if you wish to explore that option.

Durable power of attorney  

A durable power of attorney lets you designate someone who can pay your bills and handle your financial affairs if you become incapacitated and can’t manage them for yourself. 

These forms can be drafted only by a licensed attorney, so MD Anderson social work counselors can’t help you complete one. We can direct you to free or low-cost legal assistance, though, if needed.

Other considerations for ‘getting your affairs in order’

It can be overwhelming to try to make all of these decisions all at once. And each one brings up its own set of feelings, so the process can be very emotional and draining. That’s why we encourage you to start thinking about these topics as early as possible.

You don’t have to figure out all the answers right away. And, we hope you won’t need them for a long, long time. But it’s good to clarify what you want before you need it. You don’t want to wait until it’s too late, and then not be able to make your wishes known.

Here are some other things you might want to consider while “getting your affairs in order.”

Talk to an attorney

An attorney can help you with many important tasks, including:

• Creating a last will and testament: Make sure yours is up to date, or draft one if you haven’t done so already. 
• Designating an executor for your estate: This person is responsible for the distribution of your money, property and possessions after you die. 
• Keeping finances accessible to your spouse: This could be an issue if bank accounts are frozen due to probate court proceedings. 
• Designating a guardian for minor children: If you’re a single parent or the only surviving parent of minor children, reach out to whomever you’d want to care for them in the event of your death and make sure they’re OK with being named guardians. Then, codify that in your will.  

Make funeral arrangements

This could involve purchasing a cemetery plot or making plans for your burial or cremation, as well as a funeral or memorial service and the distribution of your ashes.  

Veterans can check with the U.S. Department of Veterans Affairs to see if their service qualifies them for free burial or columbarium space at a military cemetery.  

Share practical information with your loved ones

Tell your loved ones about any insurance policies you might have, as well as how to file a claim. Make a list of trusted service people for them, too, such as plumbers, electricians, auto mechanics, etc. That way, they won’t have to start from scratch when you’re no longer around. And, finally, walk them through any household tasks you’ve traditionally handled, so they know how to do them after you’re gone.  

Talk to them about your digital legacy, too, and leave written instructions so they know how to shut down or memorialize your personal and business websites and/or social media accounts. 

Getting started

Ideally, you'll be having conversations about these topics long before they’re needed. Because in the end, clearly communicating what you want not only honors you, but your family, too.  

But if you don’t know where to start, and you’re an MD Anderson patient, contact your social work counselor or ask for a referral from your care team. We have a large and very thorough workbook we can give you to help guide these conversations and decisions. 

We’ve also put together a new one-hour workshop to help patients navigate this process. Sessions are available at our Texas Medical Center Campus, select Houston-area locations, and via Zoom for those who can’t attend in person.  

These workshops, called Plan for Your Care, provide a support group-type setting, in which patients can openly discuss their feelings and wishes about treatment, identify the next steps and start talking to their families about these difficult topics. Contact your social work counselor or reach out to Social Work directly at 713-792-6195 or through MyChart for more information.  

Request an appointment at MD Anderson online or call 1-888-466-0416.